‘Umbrella construct’ – an innovative technique for reconstruction of the proximal humerus after curettage in locally aggressive benign bone tumours

2020 ◽  
pp. 175857321989598
Author(s):  
Ashish Gulia ◽  
Ajay Puri ◽  
Srinath Gupta ◽  
Vineet Kurisunkal
Keyword(s):  
Proximal Humerus ◽  
Bone Tumours ◽  
Reconstruction Technique ◽  
Intralesional Curettage ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Oncological Outcomes ◽  
Joint Congruity ◽  
The Mean ◽  
Benign Bone Tumours

Aim Reconstructing locally aggressive benign bone tumours of the proximal humerus after intralesional curettage is a challenge. We present a novel reconstruction technique ‘ Umbrella construct’ where a femoral head and a strut allograft are combined to reconstruct the cavity. Complications, graft incorporation time, functional (Musculoskeletal Tumor Society score [MSTS]) and oncological outcomes were evaluated. Methods Between January 2006 and June 2017, 11 cases (10 giant cell tumours, 1 chondroblastoma) underwent curettage followed by reconstruction with Umbrella construct. There were six females and five males with a mean age of 23 years (range 14–36 years). The maximum longitudinal extent of disease was 9 cm (range 5–9 cm). Results The median follow-up was 54 months (range 34–122 months). The mean allograft incorporation time was 7 months (5–8 months). One patient had a graft fracture which was managed conservatively. Two cases developed local recurrence and the construct was revised to a prosthesis in both. The mean MSTS score for the nine cases with retained graft was 27 (23–29). Conclusions Umbrella construct is an effective reconstruction modality which helps to maintain joint congruity and limb length. It has acceptable oncological outcomes with good function.

scholarly journals Outcome of Chondroblastoma Treated With Intralesional Curettage and Autogenous Iliac Bone Graft: A Retrospective Study

2020 ◽  
Author(s):  
Lei Yang ◽  
Panyi Yang ◽  
Daoxi Wang ◽  
Xiaodong Yang ◽  
Lang Li ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Case Series ◽  
Primary Treatment ◽  
Iliac Bone ◽  
Retrospective Case ◽  
Intralesional Curettage ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Rare Benign Tumor ◽  
The Mean

Abstract BackgroundChondroblastoma is a rare benign tumor mainly occurred in epiphyses and apophyses of long bones, and usually affects the young people. The primary treatment for chondroblastoma is intralesional curettage. The aim of this study was to evaluate the clinical result of patients suffering chondroblastoma treated with intralesional curettage, electrocauterization of the cavity and autogenous iliac bone grafting. MethodsFrom January 2000 to January 2010, 15 patients with chondroblastoma were treated with intralesional curettage and electrocauterization of the cavity, and 14 of them received autogenous iliac bone grafting. After operation, patients were immobilized with splint for 4 weeks and followed up for at least 10 years. The recurrence was examined by clinical manifestation and X ray. The clinical outcome included complications and the Musculoskeletal Tumor Society Score (MSTS).ResultsTotally, 15 patients with chondroblastoma were enrolled in our study, including 9 males and 6 females, with a mean age of 13 years old (range from 8 to 21 years). The most common chief compliant were pain and limited joint motion, others including local swelling and increased skin temperature. The mean duration of symptom was 5 months (range from 2-14 months). Tumors mostly affected the proximal humerus (7/15), distal femur (4/15), proximal femur (1/15), proximal tibia (2/15) and femoral head (1/15). With a mean follow up of 12years (range from 10-16 years) , two patients had complications of upper limb shortening and one patient suffered re-operation due to tumor recurrence. The mean postoperative MSTS was 28.1 (range, 24 to 30) points, which was significantly higher than the preoperative score of 17.6 (range, 12 to 21) points.ConclusionsThorough curettage with electrocauterization and autogenous iliac bone grafting has good functional outcomes in the treatment of chondroblastoma, but still has a low risk of recurrence and complications.Level of EvidenceLevel IV, retrospective case series.

10 Years Follow up of Chondroblastoma Treated with Intralesional Curettage: A Retrospective Study

2020 ◽  
Author(s):  
Lei Yang ◽  
Panyi Yang ◽  
Daoxi Wang ◽  
Xiaodong Yang ◽  
Lang Li ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Case Series ◽  
Primary Treatment ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Intralesional Curettage ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
The Mean

Abstract Introduction: Chondroblastoma is a rare benign tumor mainly occurred in epiphyses and apophyses of long bones, and usually affects the young people. The primary treatment for chondroblastoma is intralesional curettage. The aim of this study was to evaluate the clinical and radiologic results of patients suffering chondroblastoma treated with intralesional curettage, electrocauterization of the cavity and bone grafting. Patients and Methods: From January 2000 to January 2010, 15 patients with chondroblastoma were treated with intralesional curettage and electrocauterization of the cavity, among which14 patients received bone grafting. After operation, patients were immobilized with splint for 4 weeks and followed up for at least 10 years. The recurrence was examined by clinical manifestation and X ray. The clinical outcome included complications and the Musculoskeletal Tumor Society Score (MSTS).Results: Totally, 15 patients with chondroblastoma were enrolled in our study, including 9 males and 6 females, with a mean age of 13 years old (range from 8 to 21 years). The most common chief compliant were pain and limited joint motion, others including local swelling and increased skin temperature. The mean duration of symptom was 5 months (range from 2-14 months). Tumors mostly affected the proximal humerus (7/15), distal femur (4/15), proximal femur (1/15), proximal tibia (2/15) and femoral head (1/15). Eight patients were undiagnosed or misdiagnosed before operation, only 7 patients with a consideration of chondroblastoma. With a mean follow up of 12years (range from 10-16 years) , two patients had complications of upper limb shortening and1 patient suffered re-operation due to tumor recurrence. The mean postoperative MSTS score was 28.1 (range, 24 to 30) points, which was significantly higher than the preoperative score of 17.6 (range, 12 to 21) points.Conclusion: Thorough curettage with electrocauterization and bone grafting has a good functional outcome in the treatment of chondroblastoma, but still has a low risk of recurrence and complications.Level of Evidence: Level IV, retrospective case series.

scholarly journals Outcome of modular megaprosthesis in management of Campanacci stage III giant cell tumor around the knee: a prospective study

2021 ◽  
Vol 8 (9) ◽  
pp. 2618
Author(s):  
Ritwika Nandi ◽  
Pinaki Das ◽  
Sujit Narayan Nandi
Keyword(s):  
Functional Outcome ◽  
Giant Cell ◽  
Giant Cell Tumors ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Tumor Excision ◽  
Bone Segment ◽  
The Mean ◽  
A Prospective Study ◽  
Large Bone

Background: Juxta articular giant cell tumors around the knee constitute 50-60% of the total cases reported. If the disease is detected at an advanced stage, reconstruction of the joint after tumor excision poses problems and has poor functional outcome. The aim of the study was to determine the functional outcome after resection of juxta-articular giant cell tumors around the knee and its reconstruction with mega prosthetic arthroplasty will be analyzed.Methods: Between January 2017 and March 2021, 14 patients in the age group of 28-48 years (mean=42.85 years) with Campanacci stage three giant cell tumors around the knee were studied (12-distal femur patients, 2-proximal tibia). Patients underwent tumor excision and reconstruction with modular megaprosthesis. They were evaluated post-operatively using the Revised Musculoskeletal Tumor Society Score (MSTS) for lower limb.  Results: All the patients were followed up for 12-44 months (mean=29.5 months), the average knee flexion at 6 months being 116.4 degrees. The mean MSTS at 6, 12, 18 and 24 months are 19.45, 23.23, 26.61 and 28.77 respectively. Complications observed were infection and tumor recurrence.  Conclusions: In advanced cases where tumor excision leaves large bone segment loss, reconstruction with megaprosthesis can give desirable functional outcome.

Long-term outcomes of an extracorporeal irradiated autograft for limb salvage operations in musculoskeletal tumours

2019 ◽  
Vol 101-B (9) ◽  
pp. 1151-1159 ◽  
Author(s):  
N. Oike ◽  
H. Kawashima ◽  
A. Ogose ◽  
H. Hatano ◽  
T. Ariizumi ◽  
...  
Keyword(s):  
Deep Infection ◽  
Long Term Outcomes ◽  
En Bloc ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Initial Surgery ◽  
Common Diagnosis ◽  
The Mean

Aims We analyzed the long-term outcomes of patients observed over ten years after resection en bloc and reconstruction with extracorporeal irradiated autografts Patients and Methods This retrospective study included 27 patients who underwent resection en bloc and reimplantation of an extracorporeal irradiated autograft. The mean patient age and follow-up period were 31.7 years (9 to 59) and 16.6 years (10.3 to 24.3), respectively. The most common diagnosis was osteosarcoma (n = 10), followed by chondrosarcoma (n = 6). The femur (n = 13) was the most frequently involved site, followed by the tibia (n = 7). There were inlay grafts in five patients, intercalary grafts in 15 patients, and osteoarticular grafts in seven patients. Functional outcome was evaluated with the Musculoskeletal Tumor Society (MSTS) scoring system. Results There were no recurrences in the irradiated autograft and the autograft survived in 24 patients (88.9%). Major complications included nonunion (n = 9), subchondral bone collapse (n = 4), and deep infection (n = 4). Although 34 revision procedures were performed, 25 (73.5%) and four (11.8%) of these were performed less than five years and ten years after the initial surgery, respectively. The mean MSTS score at the last follow-up was 84.3% (33% to 100%). Conclusion Considering long-term outcomes, extracorporeal irradiated autograft is an effective method of reconstruction for malignant musculoskeletal tumours Cite this article: Bone Joint J 2019;101-B:1151–1159

Comparison of free vascularized fibular flaps and allograft fibular strut grafts to supplement spinopelvic reconstruction for sacral malignancies

2021 ◽  
Vol 103-B (8) ◽  
pp. 1414-1420
Author(s):  
Elizabeth P. Wellings ◽  
Matthew T. Houdek ◽  
Aaron R. Owen ◽  
Karim Bakri ◽  
Michael J. Yaszemski ◽  
...  
Keyword(s):  
Malignant Tumour ◽  
Malignant Tumours ◽  
En Bloc ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Total N ◽  
Hardware Failure ◽  
Spinopelvic Fixation ◽  
History Of ◽  
The Mean

Aims Orthopaedic and reconstructive surgeons are faced with large defects after the resection of malignant tumours of the sacrum. Spinopelvic reconstruction is advocated for resections above the level of the S1 neural foramina or involving the sacroiliac joint. Fixation may be augmented with either free vascularized fibular flaps (FVFs) or allograft fibular struts (AFSs) in a cathedral style. However, there are no studies comparing these reconstructive techniques. Methods We reviewed 44 patients (23 female, 21 male) with a mean age of 40 years (SD 17), who underwent en bloc sacrectomy for a malignant tumour of the sacrum with a reconstruction using a total (n = 20), subtotal (n = 2), or hemicathedral (n = 25) technique. The reconstructions were supplemented with a FVF in 25 patients (57%) and an AFS in 19 patients (43%). The mean length of the strut graft was 13 cm (SD 4). The mean follow-up was seven years (SD 5). Results There was no difference in the mean age, sex, length of graft, size of the tumour, or the proportion of patients with a history of treatment with radiotherapy in the two groups. Reconstruction using an AFS was associated with nonunion (odds ratio 7.464 (95% confidence interval (CI) 1.77 to 31.36); p = 0.007) and a significantly longer mean time to union (12 months (SD 3) vs eight (SD 3); p = 0.001) compared with a reconstruction using a FVF. Revision for a pseudoarthrosis was more likely to occur in the AFS group compared with the FVF group (hazard ratio 3.84 (95% CI 0.74 to 19.80); p = 0.109); however, this was not significant. Following the procedure, 32 patients (78%) were mobile with a mean Musculoskeletal Tumor Society Score 93 of 52% (SD 24%). There was a significantly higher mean score in patients reconstructed with a FVF compared with an AFS (62% vs 42%; p = 0.003). Conclusion Supplementation of spinopelvic reconstruction with a FVF was associated with a shorter time to union and a trend towards a reduced risk of hardware failure secondary to nonunion compared with reconstruction using an AFS. Spinopelvic fixation supplemented with a FVF is our preferred technique for reconstruction following resection of a sacral tumour. Cite this article: Bone Joint J 2021;103-B(8):1414–1420.

scholarly journals Effectiveness of Clavicula Pro Humero Reconstruction for Elderly Patients: Report of Two Cases

2016 ◽  
Vol 2016 ◽  
pp. 1-6
Author(s):  
Sho Okimatsu ◽  
Hiroto Kamoda ◽  
Tsukasa Yonemoto ◽  
Shintaro Iwata ◽  
Takeshi Ishii
Keyword(s):  
Elderly Patients ◽  
Proximal Humerus ◽  
Young Patients ◽  
Distal Humerus ◽  
Wide Resection ◽  
Functional Score ◽  
Positive Outcomes ◽  
Postoperative Results ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society

Clavicula pro humero (CPH) reconstruction is a method that is used after proximal humeral excision. During CPH reconstruction, the ipsilateral clavicle is rotated downward and connected to the preserved distal humerus by using plates and screws. This method is frequently used for reconstruction surgeries involving young patients and has positive outcomes. In this study, we describe two cases of CPH reconstruction that were performed on elderly individuals after wide resection of the proximal humerus; postoperative results from these surgeries were satisfactory. The average Musculoskeletal Tumor Society (MSTS) functional score after surgery was 68.5%, indicating that CPH reconstruction is suitable for not only younger but also elderly patients, particularly those over the age of 65 years.

The management of infected nonunion of tibia with a segmental defect using simultaneous fixation with a monorail fixator and a locked plate

2018 ◽  
Vol 100-B (8) ◽  
pp. 1094-1099 ◽  
Author(s):  
S. Gupta ◽  
A. Malhotra ◽  
N. Mittal ◽  
S. K. Garg ◽  
R. Jindal ◽  
...  
Keyword(s):  
Functional Results ◽  
Cement Spacer ◽  
Segmental Defect ◽  
Locked Plate ◽  
Infected Nonunion ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Emotional Acceptance ◽  
Patient Reported ◽  
The Mean

Aims The aims of this study were to establish whether composite fixation (rail-plate) decreases fixator time and related problems in the management of patients with infected nonunion of tibia with a segmental defect, without compromising the anatomical and functional outcomes achieved using the classical Ilizarov technique. We also wished to study the acceptability of this technique using patient-based objective criteria. Patients and Methods Between January 2012 and January 2015, 14 consecutive patients were treated for an infected nonunion of the tibia with a gap and were included in the study. During stage one, a radical debridement of bone and soft tissue was undertaken with the introduction of an antibiotic-loaded cement spacer. At the second stage, the tibia was stabilized using a long lateral locked plate and a six-pin monorail fixator on its anteromedial surface. A corticotomy was performed at the appropriate level. During the third stage, i.e. at the end of the distraction phase, the transported fragment was aligned and fixed to the plate with two to four screws. An iliac crest autograft was added to the docking site and the fixator was removed. Functional outcome was assessed using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria. Patient-reported outcomes were assessed using the Musculoskeletal Tumor Society (MSTS) score. Results The mean age of patients was 38.1 years (sd 12.7). There were 13 men and one woman. The mean size of the defect was 6.4 cm (sd 1.3). the mean follow-up was 33.2 months (24 to 50). The mean external fixator index was 21.2 days/cm (sd 1.5). The complication rate was 0.5 (7/14) per patient. According to the classification of Paley, there were five problems and two obstacles but no true complications. The ASAMI bone score was excellent in all patients. The functional ASAMI scores were excellent in eight and good in six patients. The mean MSTS composite score was 83.9% (sd 7.1), with an MSTS emotional acceptance score of 4.9 (sd 0.5; maximum possible 5). Conclusion Composite fixation (rail-plate) decreases fixator time and the associated complications, in the treatment of patients of infected nonunion tibia with a segmental defect. It also provides good anatomical and functional results with high emotional acceptance. Cite this article: Bone Joint J 2018;100-B:1094–9.

scholarly journals Pedicle frozen autograft-prosthesis composite reconstructions for malignant bone tumors of the proximal femur

2020 ◽  
Author(s):  
gang xu ◽  
Shinji Miwa ◽  
Norio Yamamoto ◽  
Katsuhiro Hayashi ◽  
Akihiko Takeuchi ◽  
...  
Keyword(s):  
Proximal Femur ◽  
Functional Outcomes ◽  
Bone Tumors ◽  
Functional Score ◽  
Malignant Bone Tumors ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Biological Reconstruction ◽  
The Mean

Abstract Background Limb salvage surgery is becoming increasingly popular after tumor resection in the lower extremity. Biological reconstruction and use of megaprosthesis are main methods for malignant bone tumors of the proximal femur, which remain controversial due to short- and long-term complication in the proximal femur. Tumor-bearing bone treated by liquid nitrogen is one of biological reconstruction. This study aimed to evaluate the mid- and long-term functional outcomes and complications in patients treated with frozen autograft–prosthesis composite (FAPC) reconstructions in the proximal femur. Methods This retrospective study included 19 patients (10 women, 9 men) with malignant tumors of the proximal femur who underwent tumor-wide resection and FAPC reconstruction (mean age, 46 years; range, 9-77 years). The mean follow-up period of 69 months (range, 9-179 month). Functional outcomes, oncological outcomes and complications were evaluated by Musculoskeletal Tumor Society score, clinical and radiological examinations. Results The overall survival rate was 68.4%, and the mean Musculoskeletal Tumor Society functional score was 26.4 points (88%). FAPC survival rates were 100% and 50% at 5 and 10 years, respectively. Five of the 19 patients (26%) had complications: 2 required prosthesis removal and 2 developed a deep infection around acetabular. Wear of the acetabulum occurred in 2 cases, while disease recurrence was occurred in 1 case. There were no cases of greater trochanter avulsion, obvious absorption around frozen bone, prosthesis loosening or leg length discrepancy. Conclusions Due to without femoral osteotomy, this technique features satisfactory functional outcome and provide biomechanical stability that is comparable to those of other methods of biological reconstruction or megaprosthesis.

Outcome of modular megaprosthesis in management of Campanacci Stage III Giant cell tumor around the knee - A Prospective Study

2021 ◽  
Author(s):  
Ritwika Nandi ◽  
Pinaki Das ◽  
Sujit Narayan Nandi
Keyword(s):  
Functional Outcome ◽  
Giant Cell ◽  
Giant Cell Tumors ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Tumor Excision ◽  
Bone Segment ◽  
The Mean ◽  
A Prospective Study ◽  
Large Bone

Abstract Purpose : Juxta articular giant cell tumors around the knee constitute 50-60% of the total cases reported. If the disease is detected at an advanced stage, where it has already spread to extraosseous compartment or joint with pathological fractures, reconstruction of the joint after tumor excision poses problems and has poor functional outcome. In this article the functional outcome after resection of juxta-articular giant cell tumors around the knee and its reconstruction with mega prosthetic arthroplasty will be analyzed. Materials and methods: Between January 2017 and March 2021, 14 patients in the age group of 28- 48 years ( mean 42.85 years) with Campanacci Stage three giant cell tumors around the knee were studied . Distal femur was involved in 12 patients and proximal tibia in 2 patients. Patients underwent tumor excision and reconstruction with modular megaprosthesis. They were evaluated post-operatively using the Revised Musculoskeletal Tumor Society Score (MSTS) for lower limb. Results: All the patients were followed up for 12-44 months (mean 29.5 months), the average knee flexion at 6 months being 116.4 degrees. The Mean MSTS at 6 , 12 , 18 and 24 months are 19.45, 23.23, 26.61 and 28.77 respectively. Complications observed were infection and tumor recurrence. Conclusion: In advanced cases where tumor excision leaves large bone segment loss, reconstruction with megaprosthesis can give desirable functional outcome.

scholarly journals Pedicle frozen autograft-prosthesis composite reconstructions for malignant bone tumors of the proximal femur

2020 ◽  
Author(s):  
gang xu ◽  
Shinji Miwa ◽  
Norio Yamamoto ◽  
Katsuhiro Hayashi ◽  
Akihiko Takeuchi ◽  
...  
Keyword(s):  
Proximal Femur ◽  
Functional Outcomes ◽  
Bone Tumors ◽  
Functional Score ◽  
Malignant Bone Tumors ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Biological Reconstruction ◽  
The Mean

Abstract Background Limb salvage surgery is becoming increasingly popular after tumor resection in the lower extremity. Biological reconstruction and use of megaprosthesis are main methods for malignant bone tumors of the proximal femur, which remain controversial due to short- and long-term complication in the proximal femur. Tumor-bearing bone treated by liquid nitrogen is one of biological reconstruction. This study aimed to evaluate the mid- and long-term functional outcomes and complications in patients treated with frozen autograft–prosthesis composite (FAPC) reconstructions in the proximal femur. Methods This retrospective study included 19 patients (10 women, 9 men) with malignant tumors of the proximal femur who underwent tumor-wide resection and FAPC reconstruction (mean age, 46 years; range, 9-77 years). The mean follow-up period of 69 months (range, 9-179 month). Functional outcomes, oncological outcomes and complications were evaluated by Musculoskeletal Tumor Society score, clinical and radiological examinations. Results The overall survival rate was 68.4%, and the mean Musculoskeletal Tumor Society functional score was 26.4 points (88%). FAPC survival rates were 100% and 50% at 5 and 10 years, respectively. Five of the 19 patients (26%) had complications: 2 required prosthesis removal and 2 developed a deep infection around acetabular. Wear of the acetabulum occurred in 2 cases, while disease recurrence was occurred in 1 case. There were no cases of greater trochanter avulsion, obvious absorption around frozen bone, prosthesis loosening or leg length discrepancy. Conclusions Due to without femoral osteotomy, this technique features satisfactory functional outcome and provide biomechanical stability that is comparable to those of other methods of biological reconstruction or megaprosthesis.

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