The Ilizarov Method in the Management of Giant-Cell Tumours of the Proximal Tibia

Abstract

We have used the Ilizarov technique for the management of subarticular defects after the excision of giant-cell tumours in the proximal tibia in five patients. The defect was reconstructed with a segment of 5 to 6 cm obtained from the diaphysis of the affected tibia and by autogenous bone graft from the iliac crest. The newly developed defect in the diaphysis was reconstructed by distraction using the Ilizarov apparatus. Bone grafting at the docking site was performed soon after positioning the bone segments.The mean length of the bone defect was 5.7 cm and the mean duration of external fixation was 233 days. The relative blood flow in the leg measured by 99m Tc angiography increased by 1.7 to 2.3 times that of the control level during distraction and consolidation. When seen at a mean of 43 months all patients showed a normal range of motion in the knee and ankle with no collapse of the articular surfaces.

Over 10-year follow-up of functional outcome in patients with bone tumors reconstructed using distraction osteogenesis

“…Distraction osteogenesis is widely known to regenerate living bone to sufficient strength and, being biological, it can be expected to remain permanent once it is formed [31]. For these patients, it is particularly important to have information regarding return to function so that they can make social and financial plans for the prolonged period of rehabilitation.…”

Osteosarcoma around the knee

“…5 Distraction osteogenesis is well known to regenerate living bone to sufficient strength and, being biological, it can be expected to remain permanent once it is formed. 15 In our series, one patient had a deep infection but did not require amputation. Leg-length discrepancy was not a major problem in children and was managed by subsequent lengthening manoeuvres.…”

Limb Salvage Using Distraction Osteogenesis

“…The type-4 procedure is used for reconstruction of subarticular defects. We have previously described this for the treatment of giant-cell tumours in the proximal tibia, 11 and it may also be used at the distal tibia. Articular cartilage with or without some subchondral bone is left in situ after excision of the tumour, and Ilizarov wires cannot be applied through the epiphysis.…”