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Outcomes following Free Fibula Physeal Transfer for Pediatric Proximal Humerus Reconstruction: An International Multi-Institutional Study.

Publication ,  Journal Article
Azoury, SC; Shammas, RL; Othman, S; Sergesketter, A; Brigman, BE; Nguyen, JC; Arkader, A; Weber, KL; Erdmann, D; Levin, LS; Kovach, SJ; Innocenti, M
Published in: Plast Reconstr Surg
April 1, 2023

BACKGROUND: Vascularized fibula epiphyseal flap was first described in 1998 for proximal humeral reconstruction in children/infants. The authors aim to review their international, multi-institutional, long-term outcomes. METHODS: An international, multi-institutional review (2004 to 2020) was conducted of patients younger than 18 years undergoing free vascularized fibula epiphyseal transfer for proximal humeral reconstruction. Donor- and recipient-site complications, pain, and final ambulatory status were reviewed. Growth of the transferred bone was assessed under the guidance of a pediatric musculoskeletal radiologist. RESULTS: Twenty-seven patients were included with a median age of 7 years (range, 2 to 13 years). Average follow-up was 120 ± 87.4 months. There were two flap failures (7.4%). Recipient-site complications included fracture [ n = 11 (40.7%)], avascular necrosis of the fibula head [ n = 1 (3.7%)], fibular head avulsion [ n = 1 (3.7%)], infection [ n = 1 (3.7%)], and hardware failure [ n = 1 (3.7%)]. Operative fixation was necessary in one patient with a fracture. The case of infection necessitated fibula explantation 2 years postoperatively, and ultimately, prosthetic reconstruction. Sixteen patients developed peroneal nerve palsy (59.3%): 13 of these cases resolved within 1 year (81% recovery), and three were permanent (11.1%). One patient (3.7%) complained of upper extremity pain. Longitudinal growth was confirmed in all but three cases [ n = 24 (88.9%)] at an average rate of 0.83 ± 0.25 cm/year. CONCLUSIONS: The vascularized fibula epiphysis for proximal humerus reconstruction in children preserves the potential for future growth and an articular surface for motion. Peroneal nerve palsy is common following harvest, although this is often transient. Future efforts should be geared toward reducing postoperative morbidity. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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Published In

Plast Reconstr Surg

DOI

EISSN

1529-4242

Publication Date

April 1, 2023

Volume

151

Issue

4

Start / End Page

805 / 813

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Retrospective Studies
  • Paralysis
  • Pain
  • Humerus
  • Humans
  • Fractures, Bone
  • Fibula
  • Epiphyses
 

Citation

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Azoury, S. C., Shammas, R. L., Othman, S., Sergesketter, A., Brigman, B. E., Nguyen, J. C., … Innocenti, M. (2023). Outcomes following Free Fibula Physeal Transfer for Pediatric Proximal Humerus Reconstruction: An International Multi-Institutional Study. Plast Reconstr Surg, 151(4), 805–813. https://doi.org/10.1097/PRS.0000000000010001
Azoury, Saïd C., Ronnie L. Shammas, Sammy Othman, Amanda Sergesketter, Brian E. Brigman, Jie C. Nguyen, Alexandre Arkader, et al. “Outcomes following Free Fibula Physeal Transfer for Pediatric Proximal Humerus Reconstruction: An International Multi-Institutional Study.Plast Reconstr Surg 151, no. 4 (April 1, 2023): 805–13. https://doi.org/10.1097/PRS.0000000000010001.
Azoury SC, Shammas RL, Othman S, Sergesketter A, Brigman BE, Nguyen JC, et al. Outcomes following Free Fibula Physeal Transfer for Pediatric Proximal Humerus Reconstruction: An International Multi-Institutional Study. Plast Reconstr Surg. 2023 Apr 1;151(4):805–13.
Azoury, Saïd C., et al. “Outcomes following Free Fibula Physeal Transfer for Pediatric Proximal Humerus Reconstruction: An International Multi-Institutional Study.Plast Reconstr Surg, vol. 151, no. 4, Apr. 2023, pp. 805–13. Pubmed, doi:10.1097/PRS.0000000000010001.
Azoury SC, Shammas RL, Othman S, Sergesketter A, Brigman BE, Nguyen JC, Arkader A, Weber KL, Erdmann D, Levin LS, Kovach SJ, Innocenti M. Outcomes following Free Fibula Physeal Transfer for Pediatric Proximal Humerus Reconstruction: An International Multi-Institutional Study. Plast Reconstr Surg. 2023 Apr 1;151(4):805–813.

Published In

Plast Reconstr Surg

DOI

EISSN

1529-4242

Publication Date

April 1, 2023

Volume

151

Issue

4

Start / End Page

805 / 813

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Retrospective Studies
  • Paralysis
  • Pain
  • Humerus
  • Humans
  • Fractures, Bone
  • Fibula
  • Epiphyses