Ankle fusion with centralisation of the fibula after distal tibia bone tumour resection

Abstract

BackgroundManagement of distal tibial tumours with limb salvage surgery poses a challenge for the orthopaedic surgeon. This study was done to evaluate the results of fibular centralisation as a technique to reconstruct defects that occurred after resection at this site.Materials and methodsNine patients with a mean age of 23.2 years (range 17–34) with diagnosis of osteosarcoma in four patients, Ewing’s sarcoma in two, giant cell tumour in two and chondrosarcoma in one patient underwent surgical treatment for tumour in the distal tibia. All patients had wide resection of the tumour and ankle arthrodesis with centralisation of the fibula. Patients were assessed clinico-radiologically for bone union, infection and complications. The final functional outcome was estimated according to Musculoskeletal Tumor Society (MSTS) scores.ResultsThe mean age at the time of surgery was 23.2 years (17–34). There were five females and four males. The mean follow-up was 37 months (range 28–54 months). One of the patients with osteosarcoma had a recurrence a year after limb salvage surgery, underwent above-knee amputation, and died 18 months later due to metastasis. One patient developed leg length discrepancy. The mean MSTS score was 22.75 (range 17–27).ConclusionFibular centralisation is a durable reconstruction tool for defects of the distal tibial metaphysis with an acceptable functional outcome. It is an inexpensive and simple procedure, with a low rate of late complications, and reproducible results.Level of evidenceIV Retrospective case series.

Surgical options and reconstruction strategies for primary bone tumors of distal tibia: A systematic review of complications and functional outcome

“…Twenty-six studies [2–[6], [11]–[21], [23], [25], [26], [28], [30]–35] of biological reconstruction and 9 studies [[4], [7]–[10], [15], [24], [27], [29]] of prosthetic replacement were included for comparative analysis. The mean followup durations of biological reconstruction were 67.2 (range, 6–288) and 78.4 (range, 12–324) months for prosthetic replacement, there was no significant difference between these two group ( P = .251).…”

“…Ten studies [3–[6], [15], [18], [19], [30], [32], [34]] of allograft reconstruction and 17 studies [[2], [4], [6], [11]–[17], [23], [26], [28], [30], [31], [33], [35]] of autograft reconstruction were included for comparative analysis. Among the 16 studies (165 cases), five [15–[17], [28], [33]] including 82 cases documented the use of recycled tumor-bearing bone.…”

“…Is it necessary to perform ankle arthrodesis? In this systematic review, twenty-one studies [2], [3], [4], [5], [6], [11], [13], [14], [15], [16], [17], [19], [20], [21], [23], [25], [26], [30], [33], [34], [35] including 142 cases of ankle arthrodesis and six studies [3], [4], [15], [18], [28], [31], [32], [34] including 111 cases of ankle joint preservation were included for comparative analysis. Most researchers hold the notion that arthrodesis was the best way to provide excellent ankle stability, and the final functional outcome further confirmed this theory.…”

“…prosthetic replacement [7], [8], [9], [10], and biological methods, i.e. autograft (vascularized or non-vascularized fibula [2], [4], [6], [11], [12], [13], [14], [15], recycled tumor-bearing bone [15], [16], [17]), allograft [3], [6], [15], [18], [19] and distraction osteogenesis [4], [20], [21]. However, the outcomes of each method are not well known as most studies with a small sample size due to its rarity.…”

Limb saving surgery for Ewing’s sarcoma of the distal tibia: a case report

“…However, the fibula is thinner than the distal tibia, increasing the risk of fracture of transplanted bone. In addition, this surgical procedure is complicated and the operation time long [ 4 , 12 , 13 ]. Endoprosthetic replacement results in instant stability and quick recovery of ankle function, allowing load walking to start early.…”