Abstract
We treated 15 patients with primary malignant bone tumours of the distal tibia of which 14 were treated by limb salvage surgery. Reconstructions were done by allografts with or without microvascular fibula transfer, by bone transport, by fibula transfer alone or by endoprosthetic replacement. The most successful methods were bone transport and endoprosthetic replacement. However, serious complications with deep infections leading to secondary amputation occurred in four patients and in all reconstruction groups. After a mean follow up of 7 years, no local recurrence occurred, and all patients were alive and free of disease. After radical resection, bone transport in defects less than 15 cm is a viable option. In larger defects in children, allograft with vascularised fibula is an acceptable alternative, but amputation still has a role in this group. In adults, endoprosthetic replacement with proper soft tissue coverage is a viable option in cases with large bony defects.
Résumé
Nous avons traité 15 malades avec une tumeur maligne primitive du tibia distal avec pour 14 d’entre eux une chirurgie conservatrice du membre. Les reconstructions ont été faites par allogreffe avec ou sans transfert de péroné vascularisé, transport osseux, transfert du péroné seul ou par remplacement prothétique. Les meilleures méthodes étaient le transport osseux et le remplacement prothétique. Des complications sérieuses avec infection profonde menant à une amputation secondaire, se sont cependant produites chez quatre malades et dans tous les groupes de reconstruction. Après un suivi moyen de 7 ans, aucune récidive locale n’est survenue et tous les malades sont vivants et libres de maladie. Après une résection radicale, le transport osseux dans les défauts de moins de 15 centimètres est une option valable. Dans plus grands défauts chez les enfants, l’allogreffe avec péroné vascularisé est une alternative acceptable, mais l’amputation a encore un rôle dans ce groupe. Chez les adultes le remplacement prothétique avec couverture cutanée adéquate est un choix valable dans les grands défauts osseux.
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References
Abudu A, Grimer RJ, Tillman RM, Carter SR (1999) Endoprosthetic replacement of the distal tibia and ankle joint for aggressive bone tumours. Int Orthop 23(5):291–294
Bielack SS, Kempf-Bielack B, Delling G, Exner GV, Flege S, Helmke K, Kotz R, Salzer-Kuntschik M, Werner M, Winkelmann W, Zonbek A, Jürgens H, Winkler K (2002) Prognostic factors in high-grade osteosarcoma of ht extremities or trunk: an analysis of 1702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols. J Clin Oncol 20(3):776–790
Bishop AT, Wood MB, Sheetz KK (1995) Arthrodesis of the ankle with a free vascularized autogenous bone graft; reconstruction of segmental loss of bone secondary to osteomyelitis, tumor or trauma. J Bone Joint Surg Am 77(12):1867–1875
Bobroff GD, Gold S, Zinar D (2003) Ten year experience with use of Ilizarov bone transport for tibial defects. Bull Hosp Joint Dis 61(3–4):101–107
Capanna R, van Horn JR, Biagini R, Ruggieri R, Betelli G, Campanacci M (1986) Reconstruction after resection of the distal fibulae for bone tumors. Acta Orthop Scand 57(4):290–294
Casadei R, Ruggieri P, Giuseppe T, Biagini R, Mercuri M (1994) Ankle resection arthrodesis in patients with bone tumors. Foot Ankle Int 15(5):242–249
Gantous A, Phillips JH, Catton P, Holmberg D (1994) Distraction osteogenesis in the irradiated canine mandible. Plast Reconstr Surg 93(1):164–168
Gosheger G, Hardes J, Leidinger B, Gebert C, Ahrens H, Winkelman W, Goetze C (2005) Total tibia endoprosthesis including ankle joint and knee replacement in a patient with Ewing’s sarcoma. Acta Orthop Scand (in press)
Grimer RJ, Carter SR, Tillman RM, Sneath RS, Walker PS, Unwin PS, Shewell PC (1999) Endoprosthetic replacement of the proximal tibiae. J Bone Joint Surg Br 81(3):488–494
Holmes SB, Lloyd T, Coughlan KM, Newman L (2002) Distraction osteogenesis of the mandible in the previously irradiated patient. J Oral Maxillofac Surg 60(3):305–309
Lee SH, Kim HS, Park YB, Rhie TY, Lee HK (1999) Prosthetic reconstruction for tumour of the distal tibiae and fibulae. J Bone Joint Surg Br 81(5):803–807
Natarajan MV, Annamalai K, Wiiliams S, Selvaraj R, Rajagopal TS (2000) Limb salvage in distal osteosarcoma using a custom mega prosthesis. Int Orthop 24(5):282–284
Paley D, Maar DC (2000) Ilizarov bone transport treatment for tibial defects. J Orthop Trauma 14(2):76–85
Ruggieri P, Capanna R, Biagini R, Casadei R, Campanacci M (1987) Resection of the distal tibia in bone tumors. Ital J Orthop Traumatol 13(3):299–305
Salzer-Kuntschik M, Brand G, Delling G (1983) Determination of the degree of morphological regression following chemotherapy in malignant bone tumors. Pathologe 4(3):135–141
Song HR, Kale A, Park HB, Koo KH, Chae DJ, Oh CW, Chung DW (2003) Comparison of internal bone transport and vascularized fibular grafting for femoral bone defects. J Orthop Trauma 17(3):203–211
Zeytoonjian T, Mankin HJ, Gebhardt MC, Hornicek FJ (2004) Distal lower extremity sarcomas: frequency of occurrence and patient survival rate. Foot Ankle Int 25(5):325–330
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Laitinen, M., Hardes, J., Ahrens, H. et al. Treatment of primary malignant bone tumours of the distal tibia. International Orthopaedics (SICOT) 29, 255–259 (2005). https://doi.org/10.1007/s00264-005-0656-4
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DOI: https://doi.org/10.1007/s00264-005-0656-4