PURPOSE: Reconstruction after proximal humeral tumour resection remains challenging when tumour clearance requires sacrifice of the shoulder abductor mechanism. This study evaluated oncological, radiological, functional, and cosmetic outcomes after shoulder arthrodesis using a vascularized fibular graft. METHODS: We retrospectively reviewed 12 patients who underwent proximal humeral tumour resection and shoulder arthrodesis with a vascularized fibular graft between 2019 and 2025. All resections involved the rotator cuff and resulted in loss of the functional deltoid mechanism. Outcomes included oncological status, union, graft hypertrophy, complications, MSTS score, range of motion, functional tasks, cosmetic outcome, and donor-site morbidity. RESULTS: Mean age was 21 years and mean follow-up among survivors was 54 months. Diagnoses were osteosarcoma in nine patients, chondrosarcoma in two, and giant cell tumour in one. Margins were wide in 11 patients and marginal in one. Local recurrence occurred in one patient and distant metastases in three. Primary union was achieved in seven patients. Five developed distal graft-host pseudarthrosis; two underwent revision, of whom one united. Final bone union was achieved in eight patients. Among living patients, mean graft hypertrophy was 34%, mean MSTS score was 25.5/30, active flexion was 80°, and active scapulothoracic abduction was 75%. Cosmetic dissatisfaction was reported by all living patients. CONCLUSION: Shoulder arthrodesis with a vascularized fibular graft can provide a stable, functionally useful limb after proximal humeral tumour resection involving the abductor mechanism, although pseudarthrosis and cosmetic dissatisfaction remain important limitations.
Brotea-Mosoiu et al. (Thu,) studied this question.