Vascularized Fibula-Based Physis Transfer: A Follow-Up Study of Longitudinal Bone Growth and Complications.

Abstract

Background

The vascularized free fibula epiphyseal transfer provides an option for the preservation of limb lengthening after resection of the proximal humerus in pediatric sarcoma patients. The purpose of this study was to provide a long-term follow-up of longitudinal growth patterns and outcomes after free fibula epiphyseal transfer in upper extremity reconstruction.

Methods

A retrospective review of 4 patients who underwent free fibula epiphyseal transfer after oncologic resection of the proximal humerus for osteosarcoma was performed. Oncologic details that could affect outcomes were included in the review: primary tumor pathology, location of malignancy, and presence of recurrence. Details on the reconstruction included longitudinal growth of the flap from the time of implantation to the most recently available radiograph and postoperative complications. The length of the fibula over time was measured from the humeral head to the olecranon process.

Results

All patients were alive at the start of this study. The average longitudinal growth rate of the free fibula epiphyseal transfer was 0.54 ± 0.18 cm/y, and patients demonstrated satisfactory and consistent longitudinal bone growth and hypertrophy over time. All 4 patients suffered from a complication of postoperative fibula graft fracture, and 1 of 4 patients experienced unremitting peroneal nerve damage. All patients demonstrated normal wrist and hand motion with a normal arc of elbow flexion and extension.

Conclusion

This study demonstrates that the vascularized fibula epiphyseal transfer offers the ability to preserve longitudinal limb growth and hypertrophy throughout adolescence.

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Citation

Published Version (Please cite this version)

10.1097/gox.0000000000001352

Publication Info

Shammas, Ronnie L, Yash J Avashia, Alfredo E Farjat, Anthony A Catanzano, L Scott Levin, William C Eward, Brian E Brigman, Detlev Erdmann, et al. (2017). Vascularized Fibula-Based Physis Transfer: A Follow-Up Study of Longitudinal Bone Growth and Complications. Plastic and reconstructive surgery. Global open, 5(5). p. e1352. 10.1097/gox.0000000000001352 Retrieved from https://hdl.handle.net/10161/25657.

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Scholars@Duke

Catanzano

Anthony Agostino Catanzano

Assistant Professor of Orthopaedic Surgery

Research at Duke Health allows us to improve the treatments we provide to patients and enhance the overall patient and family health care experience. My primary research interests focus on developing shared decision-making models between physicians and patients, as well as studying the impact of mental health conditions on orthopaedic surgery outcomes and how we can improve our recognition and treatment efforts.

Eward

William Curtis Eward

Frank H. Bassett III, M. D. Associate Professor of Orthopaedic Surgery

I am an Orthopaedic Oncologist, with dual clinical degrees (MD and DVM).  I treat complex sarcomas in people and animals.  My laboratory studies comparative oncology - discoveries we can make about cancer by analyses across different species.

Brigman

Brian Eugene Brigman

Professor of Orthopaedic Surgery
Erdmann

Detlev Erdmann

Professor of Surgery

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