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Comparison of Biological Reconstruction After Resection of Proximal Humerus Bone Sarcomas in Pediatric Patients
Zhuoyu Li1,2, Weifeng Liu1,2, Tao Jin1,2
1Peking University Fourth School of Clinical Medicine, Beijing, China.
Insights
Vascularized fibular epiphyseal transfer (VFET) shows promise for pediatric proximal humeral reconstruction, offering better limb length preservation and fewer complications than clavicle pro humero (CPH) reconstruction. VFET is a viable option for patients with longer life expectancy.
Area of Science:
- Orthopedic Surgery
- Pediatric Oncology
- Reconstructive Surgery
Background:
- Proximal humeral reconstruction in skeletally immature patients with primary sarcoma is challenging.
- Vascularized fibular epiphyseal transfer (VFET) and clavicle pro humero (CPH) are surgical options.
- Evaluating clinical outcomes and complications of these techniques is crucial.
Purpose of the Study:
- To compare the clinical outcomes and complications of VFET versus CPH for proximal humeral reconstruction in pediatric sarcoma patients.
- To assess graft survival, functional recovery, and complication rates between the two methods.
Main Methods:
- Retrospective case-control study of 29 skeletally immature patients (age 5-14) with primary bone sarcomas.
- Patients underwent either VFET or CPH reconstruction between 2009 and 2023.
- Comparison of graft survival, MSTS-93 scores, complication incidence, and limb length discrepancy.
Main Results:
- VFET demonstrated higher 2- and 5-year overall survival (94%, 75%) and revision-free survival (77%, 61%) compared to CPH (86%, 55% and 75%, 37%).
- Functional scores (MSTS-93) were comparable (VFET 82% vs. CPH 79%, p > 0.05).
- VFET had significantly lower mechanical complication rates (52% vs. 88%, p = 0.036) and less upper limb length discrepancy (5.0 cm vs. 10.2 cm, p = 0.003).
Conclusions:
- VFET is a promising biological reconstruction option for pediatric proximal humeral osteosarcoma, especially for patients with longer life expectancy.
- CPH reconstruction is a feasible alternative for centers lacking microsurgical expertise.
- VFET offers advantages in limb length preservation and reduced mechanical complications.
Background:
The aim of this study was to investigate the clinical outcomes and complications of vascularized fibular epiphyseal transfer (VFET) and clavicle pro humero (CPH) for proximal humeral reconstruction after primary sarcoma resection in skeletally immature patients.
Patients And Methods:
This retrospective case-control study included 29 skeletally immature patients (18 male patients, 11 female patients) with primary bone sarcomas who were treated between January 2009 and June 2023 at Beijing Jishuitan Hospital. The average age was 9.4 ± 2.8 years (range, 5-14), and the pathological type included osteosarcoma (25) and Ewing sarcoma (4). We compared the graft survival, function, and complication rate between the VFET group and the CPH group.
Results:
The 2-year and 5-year overall survival rates for the VFET group and CPH group were 94%, 75%, 86%, and 55%, respectively. The 2-year and 5-year revision-free survival for the VFET group and CPH group were 77%, 61%, 75%, and 37%, respectively. At the final follow-up, the mean MSTS-93 score in the VFET group was 82% (67%-97%), while the mean MSTS-93 score in the CPH group was 79% (73%-96%, p > 0.05). The incidence of mechanical complications was significantly higher in the CPH group (88%, 7/8) than that in the VFET group (52%, 11/21) (p = 0.036). The mean difference in upper limb length in the VFET group was 5.0 ± 2.9 cm and 10.2 ± 4.2 cm in the CPH group (p = 0.003).
Conclusions:
We suggest that vascularized fibular epiphyseal transfer may be considered as a promising biological reconstruction option for pediatric patients with proximal humeral osteosarcoma who have a longer life expectancy. For institutions lacking the necessary microsurgical techniques, clavicle pro humero reconstruction remains a relatively simple and feasible alternative reconstruction option.
Level Of Evidence:
Level III Case-control study. See Instructions for Authors for a complete description of levels of evidence.
