scholarly journals Limb Salvage for Primary Malignant Bone Tumors of the Distal Leg in Skeletally Immature Patients: Ankle Arthrodesis Using Vascularized Ipsilateral or Contralateral Fibular Flap

2019 ◽  
Vol 04 (01) ◽  
pp. e36-e41
Author(s):  
Ahmed Mohamed El Ghoneimy ◽  
Mohamed Sokar ◽  
Nehal Kamal
Keyword(s):  
Bone Tumors ◽  
Weight Bearing ◽  
Distal Tibia ◽  
Ankle Arthrodesis ◽  
Full Weight Bearing ◽  
Fibular Graft ◽  
Skeletally Immature ◽  
Malignant Bone Tumors ◽  
Fibular Flap ◽  
The Mean

Background Malignant bone tumors of the distal tibia or fibula in children are rare. Quality of functional outcome following limb salvage surgery is still controversial. This is a retrospective review of the functional outcome of ankle arthrodesis using vascularized fibular flap. Methods A total of seven patients were reviewed. The diagnosis was osteosarcoma in five and Ewing's sarcoma in two patients. The primary tumor site was the distal tibia in six patients and the distal fibula in one patient. The average age at presentation was 10.6 years (range, 6.7–14 years). The average follow-up period was 24.5 months (range, 13–69 years). A pedicled fibular graft was harvested from the ipsilateral leg in two patients and a free vascularized osteocutaneous fibular flap from the contralateral leg in five patients. External fixation was used in five and internal fixation in two patients. Patients were allowed full weight bearing following radiographic evidence of complete bone union. Results The mean time to complete bone union and full weight bearing was 7.1 months (range, 4–13 months). One patient developed nonunion at graft-host junction and one patient had stress fracture of the fibular graft. The mean limb length inequality was 0.57 cm (range, 0–3 cm). The average Musculoskeletal Tumor Society (MSTS) score was 84.5% (range, 73–100%). Conclusion Skeletally immature patients treated by ankle arthrodesis using vascularized fibular flap can return to full weight bearing within the first year following surgery. A contralateral fibular flap has the advantage of preserving the contour of the ankle and reserving the ipsilateral fibula for initial stability at the fusion site. This study is of level IV evidence.

scholarly journals Bilateral Fibular Graft: Biological Reconstruction after Resection of Primary Malignant Bone Tumors of the Lower Limb

Sarcoma ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Maya Niethard ◽  
Carmen Tiedke ◽  
Dimosthenis Andreou ◽  
Frank Traub ◽  
Mario Kuhnert ◽  
...  
Keyword(s):  
Lower Limb ◽  
Bone Tumors ◽  
Weight Bearing ◽  
Young Patients ◽  
Full Weight Bearing ◽  
Fibular Graft ◽  
Malignant Bone Tumors ◽  
Fixation Failure ◽  
Biological Reconstruction ◽  
Osseous Defects

This paper deals with bilateral vascularized fibular grafts (BVFG) as a method for reconstruction of metadiaphyseal defects of the femur and tibia in young patients suffering from malignant bone tumors of the lower limb. This reconstructional technique was used in 11 patients undergoing metadiaphyseal resection of lower limb malignant bone tumors. All patients with Ewing’s sarcoma and osteosarcoma had multimodal treatment according to the EURO-E.W.I.N.G 99 or COSS-96 protocol. Median FU was 63 months. None of the patients experienced local recurrence during FU. 2 patients died due to distant disease during FU. Full weight- bearing was permitted after a mean of 8 months. The median MSTS score was 87%. Complications occurred in five patients. None of the complications led to failure of the biological reconstruction or to amputation. Biological reconstruction of osseous defects is always desirable when possible and aims at a permanent solution. Good functional and durable results can be obtained by using BVFG for the reconstruction of metadiaphyseal defects of the femur and tibia. Radiotherapy in the multimodal setting increases the risk for graft or fixation failure.

scholarly journals Intercalary reconstruction of femur after tumour resection: is a vascularized fibular autograft plus allograft a long-lasting solution?

2018 ◽  
Vol 100-B (3) ◽  
pp. 378-386 ◽  
Author(s):  
D. A. Campanacci ◽  
F. Totti ◽  
S. Puccini ◽  
G. Beltrami ◽  
G. Scoccianti ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Young Patients ◽  
Bone Tumour ◽  
Full Weight Bearing ◽  
Tumour Resection ◽  
Fibular Graft ◽  
Musculoskeletal Tumor Society ◽  
Long Term Outcome ◽  
The Mean

Aims After intercalary resection of a bone tumour from the femur, reconstruction with a vascularized fibular graft (VFG) and massive allograft is considered a reliable method of treatment. However, little is known about the long-term outcome of this procedure. The aims of this study were to determine whether the morbidity of this procedure was comparable to that of other reconstructive techniques, if it was possible to achieve a satisfactory functional result, and whether biological reconstruction with a VFG and massive allograft could achieve a durable, long-lasting reconstruction. Patients and Methods A total of 23 patients with a mean age of 16 years (five to 40) who had undergone resection of an intercalary bone tumour of the femur and reconstruction with a VFG and allograft were reviewed clinically and radiologically. The mean follow-up was 141 months (24 to 313). The mean length of the fibular graft was 18 cm (12 to 29). Full weight-bearing without a brace was allowed after a mean of 13 months (seven to 26). Results At final follow-up, the mean Musculoskeletal Tumor Society Score of 22 evaluable patients was 94% (73 to 100). Eight major complications, five fractures (21.7%), and three nonunions (13%) were seen in seven patients (30.4%). Revision-free survival was 72.3% at five, ten, and 15 years, with fracture and nonunion needing surgery as failure endpoints. Overall survival, with removal of allograft or amputation as failure endpoints, was 94.4% at five, ten, and 15 years. Discussion There were no complications needing surgical revision after five years had elapsed from surgery, suggesting that the mechanical strength of the implant improves with time, thereby decreasing the risk of complications. In young patients with an intercalary bone tumour of the femur, combining a VFG and massive allograft may result in a reconstruction that lasts a lifetime. Cite this article: Bone Joint J 2018;100-B:378–86.

scholarly journals Functional results of various reconstruction techniques in primary malignant bone tumors

2020 ◽  
Vol 3 (1) ◽  
pp. 15-19
Author(s):  
Ioan-Mihai Japie ◽  
Dragoş Rădulescu ◽  
Adrian Bădilă ◽  
Alexandru Papuc ◽  
Traian Ciobanu ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Bone Tumors ◽  
Distal Tibia ◽  
Functional Results ◽  
Reconstruction Technique ◽  
Malignant Bone Tumors ◽  
Msts Score ◽  
The Mean ◽  
Oncologic Therapy

AbstractIntroduction: The aim of the study was to report the clinical and functional outcomes in patients undergoing limb salvage with various reconstruction techniques in primary malignant bone tumor.Materials and methods: This study was performed between 2011 and 2018 on 52 patients with primary malignant bone tumors admitted to the Department of Orthopaedics and Traumatology of University Emergency Hospital, Bucharest. All the patients underwent surgical treatment (resection-reconstruction technique) followed by oncologic therapy. The mean follow-up was 3 years and 8 months and the minimum follow-up was 12 months.Results: The best results were obtained in patients in whom resection of the tumor followed by reconstruction was possible, without affecting the adjacent joint through arthrodesis or arthroplasty. These patients had an average MSTS score of 75.2%. The patients who underwent reconstruction procedures by endoprosthesis also had good results with an average MSTS score of 72.3%, while patients with arthrodesis obtained rather modest results – the average MSTS score being 67.3%. When taking into consideration the location of tumors, the best MSTS scores were obtained in patients with tumors of the distal radius – 80%, followed by femoral and humeral diaphysis – 75.6%, distal femur – 75.2%, proximal femur – 73.3%, proximal humerus – 72.3%, tibial diaphysis – 72.2%, distal tibia – 70% and proximal tibia 68.7%.Conclusions: The orthopedist must judiciously chose the surgical technique, taking into consideration the anatomical particularities and the needs of the patient. Given the functional results and the emotional acceptability, reconstruction with tumor prosthesis represents the first option.

scholarly journals Non-locking buttress plate in distal tibial metaphyseal fractures

2018 ◽  
Vol 1 (2) ◽  
pp. 87-91
Author(s):  
Norman Lamichhane ◽  
Bhogendra Bahadur KC ◽  
Chandra Bahadur Mishra ◽  
Sabita Dhakal
Keyword(s):  
Soft Tissue ◽  
Weight Bearing ◽  
Delayed Union ◽  
Full Weight Bearing ◽  
Distal Fibula ◽  
Fibula Fracture ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Metaphyseal Fractures

Background: Treatment of distal tibial metaphyseal fractures is often challenging and no single technique has been unanimously advocated. Open reduction and internal fixation with plates and screws allows better restoration of anatomical alignment but with more soft tissue complication. Simultaneous fixation of the fibula is not universally carried out. This study aims at evaluation of the outcome of plating technique and the effect of fixation of fibula fracture in treatment of distal tibial metaphyseal fractures. Material and methods: Thirty-one cases (14 cases in Group A with concomitant distal fibula fracture and 17 cases in Group B without distal fibula fracture) were analyzed retrospectively for the mean duration of full weight bearing, mean union time and complications, and compared. Results: The mean time for full weight bearing and radiological union in our study was 14.2 weeks (15.9 in Group A and 13.1 in Group B) and 23.8 weeks (26.6 in Group A and 21.5 in Group B) respectively. 16.1% of cases had post-operative complications including one case of deep infection and malalignment of 6 degree varus (following delayed union) was seen in one case of Group A. Range of motion (ROM) at ankle was not problem in any of the cases except the one delayed union which had 5 degrees of dorsiflexion and 15 degrees of plantiflexion. Conclusion: Open reduction and internal fixation with plate and screws in distal tibial metaphyseal fracture is more economic means of treatment modality with comparable incidence of post-union malalignment and union time,though more soft tissue complications compared to other modalities. Fixation of fibula fracture aids in reducing the incidence of malalignment.

scholarly journals Intercalary Reconstruction after Wide Resection of Malignant Bone Tumors of the Lower Extremity Using a Composite Graft with a Devitalized Autograft and a Vascularized Fibula

Sarcoma ◽  
2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Koichi Ogura ◽  
Shimpei Miyamoto ◽  
Minoru Sakuraba ◽  
Tomohiro Fujiwara ◽  
Hirokazu Chuman ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Bone Tumors ◽  
Callus Formation ◽  
Wide Resection ◽  
Rigid Fixation ◽  
Malignant Bone Tumors ◽  
Fibula Graft ◽  
Vascularized Fibula ◽  
The Mean ◽  
Vascularized Fibula Graft

Introduction. Although several intercalary reconstructions after resection of a lower extremity malignant bone tumor are reported, there are no optimal methods which can provide a long-term reconstruction with fewest complications. We present the outcome of reconstruction using a devitalized autograft and a vascularized fibula graft composite.Materials and Methods.We conducted a retrospective review of 11 patients (7 males, 4 females; median age 27 years) undergoing reconstruction using a devitalized autograft (pasteurization (n=6), deep freezing (n=5)) and a vascularized fibula graft composite for lower extremity malignant bone tumors (femur (n=10), tibia (n=1)).Results. The mean period required for callus formation and bone union was 4.4 months and 9.9 months, respectively. Four postoperative complications occurred in 3 patients: 2 infections (1 pasteurized autograft, 1 frozen autograft) and 1 fracture and 1 implant failure (both in pasteurized autografts). Graft removal was required in 2 patients with infections. The mean MSTS score was 81% at last follow-up.Conclusions.Although some complications were noted in early cases involving a pasteurized autograft, our novel method involving a combination of a frozen autograft with a vascularized fibula graft and rigid fixation with a locking plate may offer better outcomes than previously reported allografts or devitalized autografts.

scholarly journals Iliac intramedullary stabilization for Type IIIA fragility fractures of the pelvis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Shingo Okazaki ◽  
Masahiro Shirahama ◽  
Ryuki Hashida ◽  
Mitsuhiro Matsuura ◽  
Shiro Yoshida ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Weight Bearing ◽  
Fragility Fractures ◽  
Full Weight Bearing ◽  
Walking Ability ◽  
Less Invasive ◽  
Type Iiia ◽  
Iliac Screws ◽  
Intramedullary Stabilization ◽  
The Mean

AbstractThere have been few reports on fixation of Rommens classification Type IIIA fragility fractures of the pelvis (FFPs). Here, we present our less invasive surgical technique, called iliac intramedullary stabilization (ILIS), for the internal fixation of Type IIIA FFPs. The technique involves a closed reduction, termed the femur internal rotation reduction method (FIRM), whereby the fracture fragments are repositioned using lateral rotators by internally rotating the femur while the patient is in the prone position. Two iliac screws are inserted on the ilium bilaterally via the supra-acetabular bone canal during FIRM and connected with two transverse rods and two cross connectors. We refer to this internal fixation procedure as ILIS. We retrospectively recruited patients with Type IIIA fractures, treated using this procedure, at our institute between October 2017 and October 2019. We evaluated operative and post-operative outcomes. We enrolled 10 patients (9 women and 1 man; mean age, 85.2 years) who were followed up for over 6 months. All patients suffered FFPs after falling from a standing position. The mean operative time was 145.1 (range, 94–217) minutes, and the mean blood loss was 258.5 (range, 100–684) ml. All patients were allowed full weight bearing from post-operative day 1. All patients achieved bone union and regained their pre-injury walking ability at 6 months after surgery without evident secondary displacement. In conclusion, our ILIS technique allows less invasive internal fixation of Type IIIA FFPs with adequate stability for full weight bearing from post-operative day 1.

scholarly journals Tibiotalar Arthrodesis Using a Hybrid Technique with a New Low-profile Anatomic Plate and Two Compression Screws: First One-year Results of Twenty Patients

2019 ◽  
Vol 13 (1) ◽  
pp. 232-238
Author(s):  
Christoph Eckstein ◽  
Bernd Füchtmeier ◽  
Franz Müller
Keyword(s):  
Plate Fixation ◽  
Weight Bearing ◽  
Case Series ◽  
Clinical Results ◽  
Ankle Arthrodesis ◽  
Implant Failure ◽  
Full Weight Bearing ◽  
Hybrid Technique ◽  
Low Profile ◽  
Tibiotalar Arthrodesis

Background: The aim of this prospective study was to evaluate and analyse the first clinical results of a recently developed low-profile anatomic plate in combination with two headless compression screws for tibiotalar arthrodesis. Methods: The case series involved 20 consecutive patients who underwent ankle arthrodesis using a hybrid technique. Radiographs were obtained at 6 and 12 weeks and 1 year postoperatively. The outcome was evaluated by using AOFAS and SF 12-questionnaire. Any complications related to the arthrodesis were recorded. Results: The follow-up rate was 100%. Patients mean age at the time of surgery was 60.1 years (range, 40-79). Arthrodesis with full weight-bearing occurred in every patient within 12 weeks postoperatively. There were no patients with delayed union, non-union, infection or implant failure. AOFAS Score and SF-12 scores increased considerably compared to preoperatively. Conclusion: The hybrid technique for ankle arthrodesis is a tibiotalar compression with screws in combination with rigid anterior plate fixation. Our clinical results demonstrated no implant failure, no infection and fusion in any of the 20 patients. Further studies are necessary to support our first results.

scholarly journals A study on clinical outcomes of complex subtrochanteric femoral fractures with cephalomedullary nail

2021 ◽  
Vol 7 (6) ◽  
pp. 1194
Author(s):  
S. F. Kammar ◽  
Karthik B. ◽  
V. K. Bhasme ◽  
Suryakanth Kalluraya
Keyword(s):  
Clinical Outcomes ◽  
Road Traffic ◽  
Weight Bearing ◽  
Femoral Fractures ◽  
Lateral View ◽  
Successful Outcome ◽  
Harris Hip Score ◽  
Full Weight Bearing ◽  
Subtrochanteric Fractures ◽  
The Mean

<p class="abstract"><strong>Background:</strong> The aim of the study was to evaluate the clinical outcomes of complex subtrochanteric fractures treated by using cephalomedulary nail.</p><p class="abstract"><strong>Methods:</strong> This is a prospective observational study of 30 cases of complex subtrochanteric femoral fractures admitted to our hospital from January 2018 to June 2019. Cases were taken according to the inclusion and exclusion criteria i.e. type IV, type V Seinsheimer’s classification, above 18 years and those who are willing to participate in the study has been included and pathological fractures, open fractures were excluded. All the patients are followed up on 2 post-operative day, after 4 weeks, 8 weeks, 12 weeks and 6months. X-ray hip with thigh anteroposterior (AP) and lateral view taken during each follow up. Out comes was assessed using modified Harris hip score.<strong></strong></p><p class="abstract"><strong>Results:</strong> In our study of 30 cases there are 22 males and 8 females and the mean age of 43.7 years. 73.3% patients are due to Road traffic accidents predominance of right side. In our study 66% had type 4 Seinsheimers and 34% cases had type 5 Seinsheimers fracture. The mean duration of hospital stay was 17 days. Mean time for full weight bearing is 12 weeks. Good to excellent results are seen in 80% of type 4 subtrochanteric fractures and 75% of cases of type 5 subtrochanteric fractures. 4 cases had surgical site infection, 3 cases had varus, 1 case had developed implant failure, and 1 case had reverse Z effect.</p><p class="abstract"><strong>Conclusions:</strong> From this study, we conclude that proximal femoral nail is an excellent implant in the treatment of complex subtrochanteric femoral fractures the terms of successful outcome include a good understanding of fracture biomechanics, good preoperative planning and accurate instrumentation.</p>

scholarly journals Outcome of proximal femoral nail antirotation in peritrochanteric fractures: A prospective study

2021 ◽  
Vol 12 (8) ◽  
pp. 125-129
Author(s):  
Pratyenta Raj Onta ◽  
Dilip C Agarwal ◽  
Upendra Jung Thapa ◽  
Pabin Thapa ◽  
Krishna Wahegoankar ◽  
...  
Keyword(s):  
Blood Loss ◽  
Weight Bearing ◽  
Invasive Procedure ◽  
Proximal Femoral Nail ◽  
Harris Hip Score ◽  
Full Weight Bearing ◽  
Femoral Nail ◽  
The Mean ◽  
Proximal Femoral Nail Antirotation ◽  
A Prospective Study

Background: The incidence of peritrochanteric fractures are increasing worldwide. Early mobilization in these fractures prevents from other medical complications. There are many methods of treatment but the ideal method should be less invasive procedure, intramedullary device and stable fixation of fracture. Proximal femoral nail antirotation (PFNA) is biomechanically considered one of the most effective methods of treatment with promising results. Aims and Objectives: The aim of our study was to evaluate the clinical and radiological outcomes in patient who were treated with PFNA in peritrochanteric fracture. Materials and Methods: This study was a prospective study which included 37 patients, conducted in Manipal Teaching Hospital from 1st October 2019 to 30th September 2020. All the patients were clinically evaluated and detail history was obtained. After the anaesthesia clearance the patients were operated. Operating time, intraoperative blood loss and complications were noted. Postoperatively the duration of hospital stay, time of partial and full weight bearing, time for radiological union and complications were noted. At the final follow up Harris Hip Score was used for functional outcome. Results: The mean age of the patient in this study was 64 years (45-88 years). The average time to complete the surgery was 62.49 minutes (45-75 minutes) and the average blood loss was 129.32 ml (65-210 ml). Partial weight bearing was started at the mean time of 8.57 weeks (6-12 weeks) whereas full weight bearing was done at the mean of 14.43 weeks (10-20 weeks). Fracture union was seen at the average of 11.41 weeks (8-18 weeks). The mean Harris Hip score at final follow up was 84.73 (65.8-95.0) with the functional status of 35.1% excellent result, 45.9% good, 13.5% fair and 5.4% poor. Conclusion: Proximal femoral nail antirotation in peritrochanteric fracture is a good method of fixation. The procedure is easy with reduced operative time and radiation exposure. Since this is minimally invasive procedure the blood loss is very less compared to DHS or plate fixation. The patient could be mobilized early from the bed that reduced the complication of immobilization. So we strongly recommend using PFNA for fixation of peritrochanteric fracture of hip.

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