Epiphysis preserving resection of malignant proximal tibial tumours

Abstract

Purpose The purpose of the study was to evaluate the treatment of five patients with proximal tibial epiphysis preserving resection for malignant tumours of the tibia. Method Three patients suffered from Ewing sarcoma, two had osteosarcoma. The proximal level of the resection was in the line of the growth plate in four patients, and 2 cm below of the growth plate in one patient. The distal resection level was in the diaphysis, depending on the tumour border. The resected part of the tibia was substituted by both the ipsilateral and contralateral fibulas. The two fibulas were proximally built into the epiphysis, the contralateral, freely transplanted fibula was placed distally into the tibial diaphysis. The leg was fixed in an Ilizarov frame. Results The follow-up period was 4.9 years on average (range, 3.5-8 years). Neither local recurrence nor metastasis was noticed in patients with tibia tumour resection during the observation time. Proper fixation of the transplanted fibula with all of the patients, both proximal to the tibia epiphysis and distal to diaphysis, was experienced. The range of motion of the knee was 122°on the average. Two patients can walk without support and three can walk with an orthosis fully weight bearing. The limb shortening of the affected side was 2.6 cm on average (range,1.5-4.5 cm). In three patients the transplanted opposite side fibula has broken. In one patient, chronic osteomyelitis developed at the distal part of the transplanted fibula. Conclusions The difficulties of intercalary segment supplementation were present to a greater extent because of the small size of proximal epiphysis, but the preserved knee joint can produce better function for the patient in this limb-saving surgery.

Three‐dimensional‐printed intercalary prosthesis for the reconstruction of large bone defect after joint‐preserving tumor resection

“…However, the reconstruction of the segmental bone defects following joint‐preserving intercalary tumor resection has been a great challenge. Several techniques have been applied for the reconstruction of such segmental bone defects, including distraction osteogenesis, vascularized fibular graft, irradiated autograft, allograft, combined fibula allograft, segmental transport, segmental prosthesis and tissue engineering techniques . However, these reconstruction techniques are usually associated with frequent complications.…”

“…However, these reconstruction techniques are usually associated with frequent complications. Segmental prosthesis for reconstruction of an intercalary defect is less popular than other biologic reconstructions . Guder et al used a custom‐made ultra‐short stem prosthesis to treat 4 patients with tumors of the proximal metaphyseal tibia.…”

“…However, the reconstruction of the large bone defect following joint‐preserving intercalary tumor resection has been a great challenge for orthopedic oncologists. At present, various methods, including vascularized fibular graft, tumor‐devitalized autograft, allograft, combined fibular allograft, segmental transport, segmental prosthesis and tissue engineering techniques, have been used to reconstruct these large intercalary bone defects . Although biological reconstructions with autograft and allograft can obtain a low incidence of long‐term complications and reasonable joint function, they are often associated with too many early complications .…”

Surgical Technique and Outcome of Joint Sparing Limb Salvage Surgery by Three-Dimensional-Printed Prothesis for Children with Osteosarcoma in Distal Femur

“…With the advancement of chemotherapy drugs and arti cial manufacturing system, joint-sparing limb salvage surgery (JSLSS) has been the standard treatment for children with osteosarcoma in order to maintain normal joint function and protect the epiphyseal plate [6]. Biological reconstruction with vascularized bular graft [9], treated autologous bone [10][11], allograft combined bula allograft [12] and segmental transport [13] would be acceptable techniques for this kind of patients. But, these reconstruction techniques would be usually associated with frequent complications, such as graft resorption, nonunion, pathological fractures and insu cient demand of weight-bearing [14].…”

Surgical Technique and Outcome of Joint Sparing Limb Salvage Surgery by Three-dimensional-printed Prothesis for Children With Osteosarcoma in Distal Femur

“…With the advancement of chemotherapy drugs and arti cial manufacturing system, joint-sparing limb salvage surgery (JSLSS) has been the standard treatment for children with osteosarcoma in order to maintain normal joint function and protect the epiphyseal plate [6]. Biological reconstruction with vascularized bular graft [9], treated autologous bone [10][11], allograftcombined bula allograft [12]and segmentaltransport [13] would be acceptable techniques for this kind of patients. But, these reconstruction techniques would be usually associated with frequent complications, such as graft resorption,nonunion, pathological fractures and insu cient demand of weight-bearing [14].…”