Custom-made elbow joint reconstruction with free osteoperiosteal fibula and iliac crest flaps after tumor resection: a case report

Reconstruction of the elbow-joint after tumor resection in paediatric age is challenging. Despite endoprosthesis are currently considered the best reconstructive option for limb salvage in periarticular bone tumors, they present a limited durability and high complication risk, especially when performed in young patients. This paper introduces an innovative microsurgical technique for reconstruction of diaphysis and distal humerus after oncological resection. A 5-year-old patient with Ewing’s sarcoma of the humerus was treated with subtotal intra-articular bony excision preserving the proximal metaepiphysis performed by orthopaedic oncologists after preoperative chemotherapy. Reconstruction was accomplished by an arthroplasty of the elbow joint with osteoperiosteal fibula and iliac crest free flaps, to restore the humeral diaphysis and the distal humerus, respectively. An allograft was used to reinforce the diaphysis. The donor sites were closed primarily. Both flaps survived completely, wounds healed by first intention, and there were no donor sites complications. After 6 months, the patient reported a traumatic minimally displaced fracture of the distal iliac crest without hardware loosening, but no surgical revision was needed. At latest follow up (8 months), esthetic and functional results were acceptable. In conclusion, a satisfactory humeral and elbow joint reconstruction can be obtained with this technique in repairing an osteoarticular massive defect following oncological resection in pediatric age. Autologous biologic reconstruction can be an alternative to endoprosthesis, burdened by a high risk of complications and surgical revisions. Long-term outcomes of this articular reconstruction still remain unknown; additional studies will be required to determine the long-term success, especially in very young patients.