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

Reconstruction of bone defects resulting from tumour resections by free vascularized fibular grafts

The pupose of this study was to evaluate the efficacy of free vascularized fibular grafts in reconstructing bone defects following resection of bone tumours. Twenty-five patients were studied in a prospective manner with a minimum follow up of two years. Reconstruction involved the femur and tibia in nineteen cases whereas humeral reconstructions were five and only one radial reconstruction. Union was achieved in 91.6% at an average of eight months. Complications include two stress fractures which healed conservatively and four infections of which two requied amputations. Local recurrence occurred in two cases whereas metastases occurred in five. Of the nineteen remaining patients limb survival was 89% whereas graft survival was 84%. The average functional evaluation score was 71.1% according to the system recommended by the Musculoskeletal Tumour Society. We conclude that free vascularized fibular transfer offers an efficient mode for reconstructing massive bone defects resulting from tumour resection