Biological Prosthesis (Hollow 3D-Printed Titanium Custom-Made Prosthesis and Bone Graft) for Humeral Reconstruction in Pediatric Oncologic Patients: Surgical Indications and Results.

This study presents the mid-term outcomes of a novel "biological prosthesis" for pediatric humerus reconstruction after major bone tumor removal. This approach involves a hollow 3D-printed titanium custom-made prosthesis combined with bone grafting. The primary aim was to preserve and revitalize the unaffected autologous proximal or distal humeral stump. Between 2017 and 2021, we treated five pediatric patients (mean age 11.2 years; range 7-17) with humeral bone sarcomas. A one-stage surgical procedure involved tumor resection and implanting a hollow 3D-printed custom-made prosthesis. In two cases, we preserved the proximal humerus; in two, the distal part; and in one, both. Graft materials included homologous bone chips in three cases and free vascularized fibular grafts in two cases. All patients were clinically and radiographically assessed after a mean follow-up of 32.2 months (range of 14-68). No significant complications were observed, and no implant revisions were needed. Osseointegration was evident in all cases within eight months post-surgery; vascular support for the remaining autologous stump was demonstrated in all cases. Our hollow 3D-printed custom-made prosthesis and bone grafting offer the potential for partial or complete articular surface preservation. This approach encourages revascularization of the epiphysis, leading to satisfactory outcomes in humerus reconstruction within the pediatric population.

Transphyseal distal humeral separation in neonates: A case series.

INTRODUCTION: Birth trauma is a rare condition. Typically, injury in neonates occurs as a result of obstetrical manipulation to allow delivery or from trauma sustained during a difficult passage through the birth canal. Transphyseal separation of the humerus is particularly rare. Diagnosis is not always straightforward and is prone to mistakes. There is a general consensus that the outcome is usually favorable. It is generally agreed that the fracture needs to be realigned, while the suggested methods in contention vary from a simple plaster cast to closed and even open reduction and percutaneous Kirschner wire fixation. The purpose of this study was to review our experience in treating transphyseal distal humeral separation in neonates to better define the diagnostic and therapeutic pathway. METHODS: Ten consecutive cases of transphyseal distal humeral separation in neonates were treated at our institution between September 2008 and June 2021. All cases were reviewed and clinical data collected on birth injury risk factors, diagnostic workup, age at diagnosis and treatment, and type of treatment. Results of treatment and outcome were analyzed for time to fracture union, complications and clinical alignment, range of motion and residual pain at the latest follow-up. RESULTS: Mean age at diagnosis was 4.2 days (range 0 to 9 days) and time between diagnosis and treatment varied from three to 26 h (average 15 h). Risk factors for birth injury were present in six patients. Four patients were initially treated with closed reduction and cast immobilization, all the other cases were treated with closed reduction and percutaneous pinning. Arthrography was performed at the time of treatment in six cases. Average follow-up was 37 months (range 12 to 120 months). At the latest follow-up, all fractures had healed with full range of motion. No clinical or radiographic deformity requiring repeated surgery or physeal damage was observed. CONCLUSIONS: This rare lesion may occur both in the presence and in the absence of risk factors. Due to the rarity of the injury, misdiagnosis and delayed diagnosis are not uncommon. Treatment with closed reduction and percutaneous pin fixation is advisable and safe.

Trabecular titanium cups in acetabular revision arthroplasty: analysis of 10-year survivorship, restoration of center of rotation and osteointegration.

AIMS: In case of severe bone loss, acetabular revision can be challenged using extra porous pure trabecular titanium (TT) revision cups designed to ensure enhanced iliac and ischiatic purchase. Aim of the study is to report on the clinical and radiological results of a TT acetabular component, evaluating functional outcome, restoration of the hip center of rotation and osteointegration. METHODS: 85 patients, who underwent acetabular revision with a TT revision cup system between October 2009 and December 2018, were included in a retrospective study. Clinical outcome were assessed with Harris Hip Score (HHS). The hip rotation center was measured using the Pierchon method on the AP pelvis film. Loosening of the cup was determined according to the Kosashvili modification of Gill's criteria. Kaplan- Meier survivorship curve was performed. Results The mean follow-up was 6.12 years. The average HHS improved from 54.7 points to 89.7 points (p < 0.05). Two acetabular components (2.3%) were re-revised after a mean of 5.6 years, for aseptic loosening and for infection, with a progressive radiolucency and a > 5 mm vertical migration, respectively. The radiographic evaluation of the position of the hip rotation center revealed a statistically significant difference (p < 0.05) between the pre- and post-operative values. The hip rotation center was correctly restored within 5% of the reference Pierchon values in a percentage of 85.4% relative to horizontal parameters and within 8% in a percentage of 66.7% relative to vertical parameters. 5-year and 10-year survivorships were, respectively, 100% and 88%. CONCLUSIONS: In case of severe bone loss, TT revision cup system allows for good restoration of center of rotation and osteointegration showing good 10-year survival rate.

Custom-Made 3D-Printed Implants as Novel Approach to Reconstructive Surgery after Oncologic Resection in Pediatric Patients.

Recently, custom-made 3D-printed prostheses have been introduced for limb salvage surgery in adult patients, but their use has not been described in pediatric patients. A series of 11 pediatric patients (mean age 10.8 years; range 2-13) with skeletal tumors treated with custom-made implants for the reconstruction of bony defects is described. Patients were followed up every 3 months. Functional results were evaluated by the Musculoskeletal Tumor Society Score (MSTS) for upper and lower limbs. The mean follow-up was 25.7 months (range 14-44). Three patients died after a mean of 19.3 months postoperatively-two because of disease progression and the other from a previous malignancy. Three patients experienced complications related to soft tissues. One patient required device removal, debridement, and antibiotic pearls for postoperative infection. Partial osseointegration between grafts and host bone was observed within a mean of 4 months. At the final follow-up, mean MSTS score was 75%. 3D prostheses may yield biological advantages due to possible integration with the host bone and also through the use of vascularized flaps. Further research is warranted.

The challenge of the surgical treatment of paediatric distal radius/ forearm fracture: K wire vs plate fixation - outcomes assessment.

Aim Distal radius/forearm fractures in adolescent patients remain challenging injuries to treat. Distal radius/forearm bony anatomy is not completely restored with intramedullary K wire fixation. The aim of this study was to compare radiographic and functional outcomes obtained using intramedullary K wire fixation and open reduction and internal fixation in the treatment of distal radius/ forearm fracture. Methods A total of 43 patients who presented with distal radius/ forearm fractures were enrolled and divided into two groups: 23 patients treated with K-wire (IMNK) and 20 patients treated with plate and screws (ORIF). The evaluation criteria were: fracture healing time, objective quality of life measured by the Mayo wrist score (MWS) and quick disabilities of the arm, shoulder and hand score (QuickDash), length time of surgery, complications, sport or play return, forearm visual analogic pain (FVAS), bone healing by radius union scoring system (RUSS). Results In both groups the results obtained were comparable in terms of functional, pain and return to play/sport after the third month after surgery. Bone healing was faster in IMNK than ORIF but without significance (p>0.05). There was less complication in ORIF than IMNK (p<0.05). Conclusion The treatment of adolescent distal radius or forearm fractures remains challenging. One challenge facing the physician is the choice of surgical technique and fixation method, which will be influenced by individual experience and preference. The question of distal radius or forearm fractures in adolescents would be best answered with a prospective randomized study.

A hollow, custom-made prosthesis combined with a vascularized flap and bone graft for skeletal reconstruction after bone tumour resection.

PURPOSE: While limb-sparing surgery is now possible for more than 80% of patients with bone tumours, wide resection is often required, necessitating bone reconstruction. This paper aims to present a surgical technique that combines the advantages of a hollow, titanium, custom-made prosthesis and the biological aspects of microsurgical flaps and bone graft. PATIENTS AND METHODS: From June 2016 to September 2017 at our institution, six consecutive patients with skeletal tumours underwent one-stage reconstructive surgery with concomitant implantation of a 3D-printed prosthesis. RESULTS: At an average follow-up of 30 months (range: 18-45), no early complications were observed, and no implant removals were needed. One patient experienced a delayed haematogenous deep infection, which healed after surgical debridement. Three patients died of their underlying disease 18, 22, and 23 months after surgery, respectively. All flaps and custom reconstructions were successful, with primary osseointegration at a mean of four months (range: 2-7). Patients' average Musculoskeletal Tumour Society score was 23.2 (range: 18-28). CONCLUSION: A hollow, custom-made, titanium prosthesis filled with bone graft, used in conjunction with a microsurgical flap, may offer good osseointegration in different anatomic locations among a patient population with a high risk of infection, pseudarthrosis, and long-term mechanical complications. The surgical technique's advantages are preliminarily demonstrated. Further studies with longer follow-up periods and larger sample sizes are required to confirm our findings.