Abstract
Introduction: This study investigated the effects of chemotherapy, defect length, and patient age on the outcome and complications of callus distraction as a limb salvage technique in 17 patients. Materials and methods: The mean patient age was 18.4 years (range 7–47). Of 17 patients, 8 received chemotherapy and the remaining 9 patients did not. The mean defect length after excision of the lesion was 13 cm (range 8–20). The mean follow-up period for the patients whose treatments were completed was 55 months (range 20–90), the mean distraction index was 12.55 days/cm (range 11–15.7), and the mean external fixation index was 34.73 days/cm (range 30–41). Results: In two patients, local recurrence occurred before distraction was completed. Two patients died, and one of them was a patient in whom local recurrence had occurred. Complications included non-union in one patient, osteomyelitis in one patient, and premature callus, osseous bridge, and varus of the femur in one patient. The extremity functional score was 80% (range 26–100). Chemotherapy and defect length had no significant effect on the distraction or external fixation indices. In contrast, the increase in the external fixation index in those over 20 years old was significant (P=0.043). Conclusion: We found that chemotherapy and defect length have no significant effect on the outcome and complications with this technique, which was more successful in patients younger than 20 years.
Similar content being viewed by others
References
Alman BA, Bary AD (1995) Massive allografts in the treatment of osteosarcoma and Ewing sarcoma in children and adolescents. J Bone Joint Surg Am 77-A:54–64
Bacci G, Ferrari S, Mercury M et al (1998) Predictive factors for local recurrence in osteosrcoma. Acta Orthop Scand 69:230–236
Bacci G, Ferrari S, Lari S, et al (2002) Osteosrcoma of the limb. Amputation or limb salvage in patients treated by neodjuvant chemotherapy. J Bone Joint Surg Br 84-B:88–91
Cannon SR (1997) Massive prostheses for malignant bone tumours of the limb. J Bone Joint Surg Br 79-B:497–506
Cara JA, Canadal J (1994) Limb salvage for malignant bone tumors in young children. J Pediatr Orthop 14:112–118
Chen WM, Chen TH, Huang CK, et al (2002) Treatment of malignant bone tumours by extracorporeally irradiated autograft-prosthetic comosite arthroplasty. J Bone Joint Surg Br 84-B:1156–1161
Dick HM, Strauch RJ (1994) Infection of massive bone allografts. Clin Orthop 306:46–53
Dion N, Sim FH (2002) The use of allografts in musculoskeletal oncology. Instr Course Lect 51:499–506
Enneking WF, Dunham W, Gebhardt MC, et al (1993) A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskelatal system. Clin Orthop 286:241–246
Green SA (1994) Skeletal defects: a comparison of bone grafting and bone transport for skeletal defects. Clin Orthop 301:111–117
Grimer RJ, Taminiau AM, Cannon SR (2002) Surgical outcomes in osteosrcoma. J Bone Joint Surg Br 84-B:395–400
Hejna MJ, Gitelis S (1997) Allograft prosthetic composite replacement for bone tumors. Semin Surg Oncol 13:18–24
Hornicek FJ, Gebhardt MC, Tomford WW, et al (2001) Factors affecting nonunion of the allograft–host junction. Clin Orthop 382:87–98
Jarka DE, Nicholas RW, Aronson J (1998) Effect of methotrexate on distraction osteogenesis. Clin Orthop 354:209–215
Kapukaya A, Necmioğlu S, Alioglu Y, et al (1994) Treatment of limb-length discrepancy with Ilizarov method in poliomyelitic patients. Acta Orthop Traumatol Turc 28:151–153
Kapukaya A, Subasi M, Yildirim Y, et al (1998) Treatment of tibial nonunion by external fixation. Hacettepe J Orthop Surg 8:13–18
Kapukaya A, Subasi M, Kandiya E, et al (2000) Limb reconstruction with callus distraction method after bone tumor resection. Arch Orthop Trauma Surg 120:215–218
Kesemenli C, Subasi M, Kapukaya A (2001) Treatment of traumatic bone defects by bone transport. Acta Orhop Belg 67:380–386
Lindsay HN, Eilert RE, Davino N, et al (1994) Osteogenic sarcoma arising from bony regenerate following Ilizarov femoral lengthening through fibrous dysplasia. J Pediatr Orthop 14:123–129
Lord CF, Gebhardt MC, Tomford WW, et al (1988) Infection in bone allografts: incidence, nature, and treatment. J Bone Joint Surg Am 70-A:369–376
Mankin HJ, Gebhardt MC, Jennings LS, et al (1996) Long-term results of allograft replacement in the management of bone tumors. Clin Orthop 324:86–97
Martin MM, Loretta BC (1995) Prosthetic survival and clinical results with use of large segment replacements in the treatment of high-grade bone sarcoma. J Bone Joint Surg Am 77-A:1154–1165
Picci P, Sangiorgi L, Bahamonde L, et al (1997) Risk factors for local recurrences after limb-salvage surgery for high-grade osteosarcoma of the extremities. Ann Oncol 8:899–903
Said GZ, El-Sherif EK (1995) Resection–shortening–distraction for malignant bone tumor. J Bone Joint Surg Br 77-B:185–188
Shin DS, Weber KL, Chao EYS, et al (1999) Reoperation for failed prosthetic replacement used for limb salvage. Clin Orthop 358:53–63
Springfield D (1996) Autograft reconstruction. Orthop Clin North Am 27:483–492
Subasi M, Kapukaya A, Kesemenli C, et al (2001) Effect of chemotherapeutic agents on distraction osteogenesis: an experimental investigation rabbits. Arch Orthop Trauma Surg 121:417–421
Thompson RC, Pickvance EA, Garry D (1993) Fractures in large segment allografts. J Bone Joint Surg Am 75-A:1663–1673
Tsuchiya H, Tomita K, Shinokawa Y, et al (1996) The Ilizarov method in the management of the giant-cell tumours of the proximal tibia. J Bone Joint Surg Br 78-B:264–269
Tsuchiya H, Tomita K, Minematsu K (1997) Limb salvage using distraction osteogenesis (a classification of the technique). J Bone Joint Surg Br 79-B:403–411
Tsuchiya H, Tomita K, Mori Y, et al (1999) Marginal excision for osteosarcoma with caffeine assisted chemotherapy. Clin Orthop 358:27–35
Tsuchiya H, Abdel-Wanis ME, Sakurakichi K, et al (2002) Osteosarcoma around the knee. J Bone Joint Surg Br 84-B:1162–1166
Ward GW, Yang RS, Eckardt JJ (1996) Endoprosthetic bone reconstruction following malignant tumor resection in skeletally immature patients. Orthop Clin North Am 27:493–501
Wirganowicz PZ, Eckardt JJ, Dorey FJ, et al (1999) Aetiology and results of tumor endoprosthetic revision surgery in 64 patients. Clin Orthop 358:64–74
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kapukaya, A., Subasi, M., Arslan, H. et al. Technique and complications of callus distraction in the treatment of bone tumors. Arch Orthop Trauma Surg 126, 157–163 (2006). https://doi.org/10.1007/s00402-006-0123-8
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-006-0123-8