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Background The reconstructive option of using vascularised free fibula grafts in paediatric humeral sarcoma cases has become popular due to their ability to integrate well, remodel with growth and provide biological repair without immune complications (Li et al. 2025). Mobility rehabilitation in the acute post-operative stage is a challenge due to contralateral upper and lower limb involvement in a patient cohort experiencing the deconditioning effect of pre-operative chemotherapy. Therapy intervention for this population is not yet well described in the literature.Methods Children are admitted to Great Ormond Street Hospital (GOSH) for humeral reconstruction with fibula autograft but go on to complete their rehabilitation at Royal National Orthopaedic Hospital (RNOH). Therefore, an audit of therapy provision across both sites was conducted between November 2020 and January 2025. Data variables collected included length of stay, mobility timepoints, use of gaiter/boot and frequency of community referrals.Results Nine children (aged 7-15 years) underwent this procedure over a five-year period. Percentage of fibular head harvest and use of a knee gaiter/aircast boot are shown in figure 1. All children were placed in a shoulder immobiliser for 6 weeks post-operatively limiting their ability to use a mobility aid. Average length of time at GOSH to mobilise is shown in figure 2 (n=6). Three patients failed to achieve weightbearing before transfer to RNOH. The duration of patient-controlled analgesia use ranged from 1-4 days post-operatively. Patients were seen twice daily on weekdays. The average length of stay at each unit is shown in figure 3. All children required post-discharge community therapy referral.Conclusion To our knowledge we present the first review of the acute post-operative therapy provision and mobility milestones following fibular autograft for humerus reconstruction in paediatrics. Our aim is that this review will provide guidance to other therapists involved with this patient cohort nationally.Abstract 87 Figure 1Fibular head harvest & use of knee gaiter/aircast bootAbstract 87 Figure 2Average post-operative mobility timepointsAbstract 87 Figure 3Average length of stay at GOSH/RNOHReference Li J, Tang X, Wang L, Liu T. Vascularized fibular epiphyseal transfer for biological reconstruction of bone defects following resection in children with proximal humeral sarcoma. BMC Surgery 2025;25(1):95.