Comparison of Biological Reconstruction After Resection of Proximal Humerus Bone
Sarcomas in Pediatric Patients
#MMPMID41220602
Li Z
; Liu W
; Jin T
; Sun Y
; Li Y
; Niu X
; Jiang C
; Zhang Q
JB JS Open Access
2025[Oct]; 10
(4
): ? PMID41220602
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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.
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