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Intercalary reconstruction of the distal femur with or without physeal preservation: results and impact on limb growth

Abstract

Purpose

Allograft reconstruction with or without vascularized fibula can be a valuable solution to treat childhood intercalary tumours of the distal femur. We aimed to assess the oncological status, complication rate and survival of distal femur intercalary reconstruction after trans-metaphyseal (TMR) and trans-epiphyseal resection (TER). We also evaluated the impact of distal temporary graft fixation on skeletal growth after TMR.

Methods

We retrospectively reviewed 23 skeletally immature patients affected by distal femur osteosarcoma (18) and Ewing sarcoma (5). Mean patients age was 10.3 years. In 11 cases, TMR was performed with physis preservation and temporary distal graft fixation. In 9 patients, TER was performed with growth plate sacrifice. The last 3 cases were treated with TMR and sliding plate fixation.

Results

Mean follow-up was 8.4 years. No deaths occurred, but 3 patients presented lung metastasis and 2 cases presented local recurrence in soft tissues. 10 implant-related complications occurred, all surgically treated. At skeletal maturity, mean femoral dysmetria was 2.3 cm after TMR and temporary epiphysiodesis, and 3.1 cm after TER. In TMR group, a strong trend towards physeal recovery was observed after epiphyseal screws removal (p = 0.061), but valgus deformity in distal femur was more frequent (p = 0.049). MSTS score was good or excellent in all patients, with no statistically significant difference between TMR and TER.

Conclusions

Intercalary graft reconstruction after TMR and TER allows good local disease control and excellent functional results with long-term follow-up. Temporary distal fixation might reduce the final limb discrepancy after TMR, but valgus deformity could develop.

Level of evidence

Level IV.

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The research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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All authors whose names appear on the submission: (1) made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work; (2) drafted the work or revised it critically for important intellectual content; (3) approved the version to be published; and (4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Michele Fiore.

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The authors have no conflict of interest to declare.

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Written informed consent was obtained from the patients.

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Consent for the study and publication of data from the patients was obtained.

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The data that support the findings of this study are available from the corresponding author upon request.

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This retrospective study was approved by our Institutional Ethics Committee.

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Zucchini, R., Staals, E.L., Fiore, M. et al. Intercalary reconstruction of the distal femur with or without physeal preservation: results and impact on limb growth. Eur J Orthop Surg Traumatol (2021). https://doi.org/10.1007/s00590-021-03149-z

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Keywords

  • Bone sarcoma
  • Childhood sarcoma
  • Distal femur
  • Intercalary allograft
  • Physeal sparing