Reconstruction of distal femoral defects following resection of malignant tumours by modular prosthesis

Modular prosthesis is a method used for reconstruction of distal femoral defects following resection of malignant tumours. Tremendous progress in bioengineering during the last decades has made it more widely used than the other reconstructive modalities. The aim of this study was to calculate the average prosthetic survivorship and functional outcome of distal femoral prosthesis. This study included 37 patients with malignant tumours of the distal femur that were treated in our institution by wide resection and reconstruction by distal femoral modular prosthesis. They were followed up for an average of 34 months [range 12-91 months]. Local recurrence occurred in 6 patients and chest metastases in 12 patients. Using Kaplan-Meier statistical analysis prosthetic survivorship was 85.9% at 2 years, 69.3% at 3 years and 61% at 5 years. Factors like age, sex, length of resection, type of prosthesis had no significant; atistical impact on prosthetic survivorship. There were 9 prosthetic failures due to infection [4], aseptic loosening [3] id prosthetic breakage [2]. The average functional outcome cording to the musculoskeletal tumour society scoring stem was 86% [range 70-100%]. None of the factors [age, x, length of resection, available muscles and type of prosthesis] had a statistically significant impact on the functional outcome when tested using the Mann-Witney procedure. In conclusion this study shows that two thirds of patients with malignant tumours of the distal femur treated by limb salvage survive their illness. The use of modular prosthesis to reconstruct the distal femoral defect offers an acceptable functional activity for daily living. Moreover, 61% of these prostheses can last 5 years and prosthetic failures are manageable without jeopardizing limb survival

Functional and oncological outcome of total scapulectomy in the management of shoulder girdle malignant bone and soft tissue tumors

The aim of this study was to evaluate the functional and oncological outcome of total scapulectomy in the management of primary malignant bone and soft tissue tumors in and around the shoulder girdle. Eight patients [5 males, 3 females] with an age range of 7-48 years [average 25.5 years] had undergone total scapulectomy in our centre between 1999 and 2003. Five patients had stage IIB, two stage IB, and one stage III tumors according to Enneking's staging system. The follow- up period ranged from 6 to 48 months. The oncological outcome was assessed and the functional outcome was evaluated using the Musculoskeletal Tumor Society [MSTS] rating scale. Seven patients are still alive, one patient died of disease. Local recurrence was not detected in any of our patients while chest metastases occurred in two [one of them already had it at the time of presentation]. The mean functional score was 22.4. The shoulder function was significantly impaired in all cases especially abduction and flexion while the elbow and hand function were completely preserved. It was concluded that total scapulectomy remains a good limb-sparing technique that preserves a functionally useful extremity

Reconstruction of distal tibial defects following resection of malignant tumours by ipsilateral pedicled vascularized fibular graft and ankle arthrodesis

The aim of the work was to evaluate the oncologic and functional outcome after wide resection of malignant tumours of the distal tibia and reconstruction of the defect by ipsilateral pedicled vascularized fibular graft and ankle arthrodesis. 13 Patients with primary malignant tumours of the distal tibia were treated by wide resection. The histological diagnosis was osteosarcoma in 11 cases and Ewing's sarcoma in 2 cases. All patients received neoadjuvant chemotherapy. There were 9 males and 4 females. The mean age of the patients at the time of surgery was 15 years. The fibula was mobilized to fill the defect pedicled on the peroneal vessels. The average size of the defects reconstructed was 10cms. Patients were evaluated functionally using the Musculoskeletal tumor society evaluation system. The average time of the operation was 3 hours. Chest metastases developed in 4 patients and local recurrence in one patient. The mean duration of follow up was 27 months. The mean functional score was 80% at the time of last follow-up. The average time of union of the graft both proximally and distally was 6 months. Complications included superficial infection [2 patients], stress fracture [1 patient], non union [2 patients], varus angulation [2 patients] and limb length discrepancy [9 patients]. Reconstruction of distal tibial defects by the ipsilateral pedicled vascularized fibular graft is a technically easy reconstructive option which offers a predictable long st and ing functional outcome that is comparable, if not better, than that achieved with allografts and prosthetic reconstructions

Management of Pathological fractures of primary bone tumors by limb salvage

The aim of this study was to evaluate the oncologic outcome of patients with primary bone tumors complicated by a pathological fracture and treated by limb salvage. Thirty-one patients [17 males and 14 females] were included in this study, their age average was 17 years [range 6-61 years]. They all had primary bone tumors complicated by a pathological fracture. The diagnosis included osteosarcoma in 17 patients, Ewing's sarcoma in 10 patients, malignant fibrous histiocytoma in 3 patients and lymphoma in one patient. All patients received preoperative chemotherapy, during which the pathological fractures consolidated. The distal femur was affected in thirteen patients, the proximal femur in six patients, mid shaft femur in four patients, the proximal humerus in four patients, the proximal tibia in three patients and the fibula in one patient. Limb salvage was performed in all the patients. A wide resection margin was achieved in all patients. A reconstruction was done by a vascularized fibular graft in eight patients, by a modular prosthesis in six patients, by pedicled fibular graft in four patients, by a pedicled scapular crest graft in three patients and by an osteoarticular allograft in two patients. Rotationplasty was done in seven patients and no reconstruction was done for the patient who had fibular resection. The study concluded that pathological fractures of primary bone tumors should not be always considered as a contraindication for limb salvage as their oncological outcome is acceptable

Rotaionplasty: an ideal operation for treatment of malignant bone tumours of the femur in children and in patients with pathological fractures

Twelve patients who had malignant tumours of the femur were treated by a wide resection and rotationplasty and followed up for a minimum period of 12 months. The average age of the patients was 9 years with the youngest being 6 years and the eldest 15 years. Six patients had pathological fracture of the tumour. There were 6 cases of osteosarcoma, 4 Ewing sarcoma, 1 malignant fibrous histiocytoma and 1 metastatic neuroblastoma. The functional evaluation of these patients according to Enneking functional scoring system was 79%. There were no local recurrences, however, 2 patients developed lung metasteses. We concluded that rotationplasty is an ideal functional and cheap treatment modality for young children with malignant bone tumours of the femur. It is also an oncologically safe method for managing patients with pathological fractures of malignant femoral tumours