Skip to main content

Advertisement

SpringerLink
Log in

Reconstruction of defects following bone tumor resections by distraction osteogenesis

  • Original Article
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The authors present the results of nine patients (two females, seven males) who had bone tumors that were treated with en bloc resection and distraction osteogenesis between 1991–2000.

Materials and methods

The average age of the patients was 19.3 years (14–42 years). The histological diagnosis was osteosarcoma in four cases, Ewing’s sarcoma in two, giant cell tumor in one, osteofibrous dysplasia in one and osteoblastoma in one. A uniplanar external fixator was applied to one case and circular external fixator to the other eight cases.

Results

The average follow-up period was 59.1 months (27–129 months). The external fixator was removed at an average of 18.1 months (range, 4–19 months). The average bone defect after resection was 14 cm (8–24 cm) and the average external fixation index, distraction index, and maturation index were 31.5 (18.7–40.0), 11.2 (10.9–11.2) and 17.8 (7.5–32.7), respectively. The function of the affected leg was excellent in four patients, good in three, fair in one and poor in one according to the Enneking scoring system. We did not observe any early consolidation or osseous binding in the defect area in any patient. Frequent complications were pin tract infection and non-union at the docking site.

Conclusion

Our results indicate that the Ilizarov method allows effective restoration of bone defects in the treatment of bone tumors despite various disadvantages.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7 a, b
Fig. 8
Fig. 9

Similar content being viewed by others

References

  1. Atesalp AS, Basbozkurt M, Erler K, et al (1998) Treatment of tibial bone defects with the Ilizarov circular external fixator in high-velocity gunshot wounds. Int Orthop 22:343–347

    Google Scholar 

  2. Atesalp AS, Erler K, Yıldız C, Basbozkurt M, Gur E (2001) Reconstruction with circular external fixator in massive calcaneal destructions due to land mine injury. Foot Ankle Surg 7:1–7

    Article  Google Scholar 

  3. Atesalp AS, Yildiz C, Basbozkurt M, Gur E (2002) Treatment of type IIIa open fractures with Ilizarov fixation and delayed primary closure in high-velocity gunshot wounds. Mil Med 167:56–62

    Google Scholar 

  4. Canadell J, San-Julian M, Cara J, Forriol F (1998) External fixation in tumor pathology. Int Orthop 22:126–130

    Article  Google Scholar 

  5. Donati D, Zavatta M, Gozzi E, et al (2001) Modular prosthetic replacement of the proximal femur after resection of bone tumor. A long-term follow-up. J Bone Joint Surg Br 83:1156–1160

    Article  Google Scholar 

  6. Donati D, Giacomini S, Gozzi E, Mercuri M (2002) Proximal femur reconstruction by an allograft prosthesis composite. Clin Orthop 394:192–200

    Google Scholar 

  7. Eckardt JJ, Kabo JM, Kelley CM, et al (2000) Expandable endoprosthesis reconstruction in skeletally immature patients with tumors. Clin Orthop 373:51–61

    Article  Google Scholar 

  8. Enneking WF (1987) A system for functional evaluation of the surgical management of musculoskeletal tumors. In: Enneking WF (ed) Limb salvage in musculoskeletal oncology. Churchill Livingstone, New York, pp 5–16

  9. Enneking WF, Campanacci DA (2001) Retrieved human allografts: a clinicopathological study. J Bone Joint Surg Am 83:971–986

    Google Scholar 

  10. Green SA (1990) Complications of pin and wire external fixation. Instr Course Lect 39:219–228

    Google Scholar 

  11. Green SA (1991) Osteomyelitis. The Ilizarov perspective. Orthop Clin North Am 22:515–521

    Google Scholar 

  12. Green SA, Jackson JM, Wall DM, Marinow H, Ishkanian J (1992) Management of segmental defects by the Ilizarov intercalary bone transport method. Clin Orthop 280:136–142

    Google Scholar 

  13. Ilizarov GA (1990) Clinical application of the tension-stress effect for limb lengthening. Clin Orthop 250:8–26

    PubMed  Google Scholar 

  14. Kapukaya A, Subasi M, Kandiya E, Ozates M, Yilmaz F (2000) Limb reconstruction with the callus distraction method after bone tumor resection. Arch Orthop Trauma Surg 120:215–218

    Article  Google Scholar 

  15. Koseoglu E, Yildiz C, Atesalp AS, Basbozkurt M, Gur E (2000) Treatment of posttraumatic lower limb deformities with the Ilizarov method. Acta Orthop Traumatol Turc 34:480–487

    Google Scholar 

  16. Lammens J, Fabry G (1992) Reconstruction of bony defects using the Ilizarov “bone transport” technique. A preliminary report. Arch Orthop Trauma Surg 111:70–72

    Article  Google Scholar 

  17. Lenoble E, Lewertowski JM, Goutallier D (1995) Reconstruction of compound tibial and soft tissue loss using a traction histogenesis technique. J Trauma 39:356–360

    Google Scholar 

  18. Millett PJ, Lane JM, Paletta GA Jr (2000) Limb salvage using distraction osteogenesis. Am J Orthop 29:628–632

    Google Scholar 

  19. Naggar L, Chevalley F, Blanc CH, Livio JJ (1993) Treatment of large bone defects with the Ilizarov technique. J Trauma 34:390–393

    Google Scholar 

  20. Ozaki T, Nakatsuka Y, Kawai A, et al (1998) Reconstruction of bone defect using the bone transport technique for a case of osteosarcoma of the femur. Acta Med Okayama 52:67–70

    Google Scholar 

  21. Ozaki T, Nakatsuka Y, Kunisada T, et al (1998) High complication rate of reconstruction using Ilizarov bone transport method in patients with bone sarcomas. Arch Orthop Trauma Surg 118:136–139

    Article  Google Scholar 

  22. Prokop A, Monig SP, Burger C, Rehm KE (1996) Segmental displacement by callus distraction in extended tibial defects. Langenbecks Arch Chir 381:82–87

    Article  Google Scholar 

  23. Rozbruch SR, Herzenberg JE, Tetsworth K, Tuten HR, Paley D (2002) Distraction osteogenesis for nonunion after high tibial osteotomy. Clin Orthop 394:227–235

    Google Scholar 

  24. Shih LY, Chen TS, Lo WH (1993) Limb salvage surgery for locally aggressive and malignant bone tumors. J Surg Oncol 53:154–160

    Google Scholar 

  25. Stoffelen D, Lammens J, Fabry G (1993) Resection of a periosteal osteosarcoma and reconstruction using the Ilizarov technique of segmental transport. J Hand Surg Br 18:144–146

    Google Scholar 

  26. Subasi M, Kapukaya A, Kesemenli C, et al (2001) Effect of chemotherapeutic agents on distraction osteogenesis. An experimental investigation in rabbits. Arch Orthop Trauma Surg 121:417–421

    Article  Google Scholar 

  27. Tsuchiya H, Tomita K, Shinokawa Y, et al (1996) The Ilizarov method in the management of giant-cell tumors of the proximal tibia. J Bone Joint Surg Br 78:264–269

    Google Scholar 

  28. Tsuchiya H, Tomita K, Minematsu K, et al (1997) Limb salvage using distraction osteogenesis. A classification of the technique. J Bone Joint Surg Br 79:403–411

    Article  Google Scholar 

  29. Usui M, Ishii S, Naito T, Yamashita M, Yamamura M (1993) Microsurgical reconstruction in limb-salvage procedures: comparison between primary and secondary reconstruction. J Reconstr Microsurg 9:91–101

    Google Scholar 

  30. Wolf RE, Enneking WF (1996) The staging and surgery of musculoskeletal neoplasms. Orthop Clin North Am 27:473–481

    Google Scholar 

Download references

Acknowledgements

We thank Roger F. Widmann, MD, co-chief of the Limb-Lengthening Service and assistant director of the Pediatric Orthopedic Service at the Hospital for Special Surgery, N.Y., USA, for critically reviewing the manuscript.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery and Traumatology, Gulhane Military Medical Academy, 06018, Ankara, Turkey

    Kaan Erler, Cemil Yildiz, Barbaros Baykal, A. Sabri Atesalp & Mustafa Basbozkurt

  2. Department of Orthopedics, Military Hospital, Corlu, Tekirdag, Turkey

    M. Taner Ozdemir

Authors
  1. Kaan Erler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cemil Yildiz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Barbaros Baykal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Sabri Atesalp
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Taner Ozdemir
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mustafa Basbozkurt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kaan Erler.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Erler, K., Yildiz, C., Baykal, B. et al. Reconstruction of defects following bone tumor resections by distraction osteogenesis. Arch Orthop Trauma Surg 125, 177–183 (2005). https://doi.org/10.1007/s00402-005-0795-5

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-005-0795-5

Keywords

Search

Navigation