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Introduction: Large aggressive tumors need wide resection and reconstructions. The choice of reconstruction of the defects is limited in pediatric population. Vascular fibula offers a promising graft in these cases. Biological interpositional arthroplasty with the use of local muscle (anconeus) is a promising approach to achieve acceptable range of movement of elbow and forearm. Case presentation: A ten-year-old male child with recurrent ABC of the left proximal radius had undergone en bloc tumor resection, and reconstruction by vascularized fibular grafting and proximal radio-ulnar joint reconstructed with anconeus interposition arthroplasty, showed good clinical results and excellent radiographic results according to the Tang system at 6 month follow-up. Discussion and conclusion: Reconstruction of the resected long bone segment by vascularized fibular graft and Anconeus interposition arthroplasty to reconstruct the radial head in a fibular graft is a convenient alternative to prostheses. Level of evidence: V.