The Leg Bone’s Connected to the Arm Bone: Surgeons Use Fibula to Reconstruct Humerus in Unique Pediatric Sarcoma Case

Orthopaedic oncologist discusses the complex case


Nathan Mesko, MD, an orthopaedic oncologist at Cleveland Clinic, says his job often requires creative solutions to restore function.


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This was certainly true in a recent case when a 5-year-old patient presented to Cleveland Clinic with substantial swelling in his right shoulder, his dominant arm. A thorough workup revealed that the patient had humeral osteosarcoma. The pediatric oncology team began chemotherapy immediately, and the tumor responded nicely over several months. Next, was Dr. Mesko’s challenge.

“The challenge of reconstruction was to provide this energetic, fun-loving 5-year-old with an arm that allowed his humerus and elbow to serve as a working platform for his hand while saving all of the important nerves and blood vessels in his arm, giving him a chance at some form of growth in that arm,” he explains.

Utilizing the free fibula transplant technique

Dr. Mesko shares more details about this case, including a collaboration with Graham Schwarz, MD, of Cleveland Clinic’s Department of Plastic Surgery. The teams worked together, utilizing a free fibula transplant technique to reconstruct the patient’s humerus. “At three months, the patient was feeling like himself again, and the real challenge was trying to keep a 5-year-old down.” Learn how this particular challenge was failed, and more about this unique case in the video below:


“One of the most fun parts about being an orthopaedic oncologist is utilizing creativity to create function. Bone and soft tissue tumors oftentimes pick difficult locations when it comes to resection and reconstruction, and in children in particular this can be a challenging puzzle. Children present with these puzzles, forcing the surgical and oncological teams to take into account growth of the extremity, small size of the anatomy and the parental anxiety that can surround the cancer treatment of their precious loved one,” says Dr. Mesko.


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