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Physeal Distraction for Joint Preservation in Malignant Metaphyseal Bone Tumors in Children

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Physeal distraction facilitates metaphyseal bone tumor resection in children and preserves the adjacent joint. The technique was first described by Cañadell. Tumor resection procedures allowing limb-sparing reconstruction have been used increasingly in recent years without compromising oncologic principles.

Questions/purposes

We report our results with Cañadell’s technique by assessing tumor control, functional outcome, and complications.

Methods

Six consecutive children with primary malignant metaphyseal bone tumors underwent physeal distraction as a part of tumor resection. Tumor location was the distal femur in four patients, the proximal humerus in one patient, and the proximal tibia in one patient. The functional outcome was evaluated after a minimum of 18 months (median, 62 months; range, 18–136 months) using the Musculoskeletal Tumor Society (MSTS) score and the Toronto Extremity Salvage Score (TESS).

Results

At latest followup, five patients were alive and disease-free and one had died from metastatic disease. All tumor resections resulted in local control; there were no local recurrencies. The mean MSTS score was 79% (range, 53%–97%) and corresponding mean TESS was 83% (range, 71%–92%). In one case, postoperative infection required amputation of the proximal lower leg. All physeal distractions were successful except for one patient in whom distraction resulted in rupturing into the tumor. This situation was salvaged by transepiphyseal resection.

Conclusions

We consider Cañadell’s technique a useful tool in the armamentarium to treat children with malignant tumors that are in close proximity to an open physis.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Fig. 1A–F
Fig. 2A–D

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Acknowledgments

We thank Mikel San-Julian, MD, PhD, Department of Orthopedic Surgery, University of Navarra, Spain for his kind support regarding Patient 2 and his personal contributions for applying this technique.

Author information

Authors and Affiliations

  1. University of Zurich, Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland

    Michael Betz MD & Bruno Fuchs MD

  2. Orthopädie Zentrum Zürich, Zurich, Switzerland

    Charles E. Dumont MD & G. Ulrich Exner MD

Authors
  1. Michael Betz MD
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  2. Charles E. Dumont MD
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  3. Bruno Fuchs MD
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  4. G. Ulrich Exner MD
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Corresponding author

Correspondence to Michael Betz MD.

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Each author certifies that he or she, or a member of their immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

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Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at University of Zurich, Balgrist, Zurich, Switzerland.

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Betz, M., Dumont, C.E., Fuchs, B. et al. Physeal Distraction for Joint Preservation in Malignant Metaphyseal Bone Tumors in Children. Clin Orthop Relat Res 470, 1749–1754 (2012). https://doi.org/10.1007/s11999-011-2224-0

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  • DOI: https://doi.org/10.1007/s11999-011-2224-0

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