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Takeuchi Y, Sakamoto A, Noguchi T, Toguchida J, Matsuda S. Recycled bone grafts treated with extracorporeal irradiation or liquid nitrogen freezing after malignant tumor resection. J Surg Oncol 2024; 129:1364-1373. [PMID: 38533914 DOI: 10.1002/jso.27629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/13/2024] [Accepted: 03/11/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION Recycled bone autografts prepared using extracorporeal irradiation (ECIR) or liquid nitrogen freezing (LNF) methods have been used for the reconstruction of skeletal elements after wide resection of sarcomas involving bone tissues. Few reports include long-term follow-up data for histological analyses of recycled autografts, particularly in the case of ECIR autografts. MATERIALS A total of 34 malignant bone and soft tissue tumors were resected and reconstructed using 11 ECIR- and 23 LNF-recycled autografts; the mean postoperative follow-ups were 14 and 8 years, respectively. ECIR was used for either osteosarcomas or Ewing sarcomas, whereas in addition to these tumors LNF was used for chondrosarcomas and soft tissue sarcomas involving bone tissues. Recycled bone was implanted as total bone, osteoarticular, or intercalary grafts, with or without prosthesis or vascularized fibular grafts. RESULTS The 10-year graft survival rate was similar between groups, 81.8% using ECIR and 70.2% using LNF. There were no autograft-related tumor recurrences in either group. Graft survival was unrelated to type of graft or additional procedures. Complication rates tended to be higher using ECIR (64%) compared with LNF (52%) and the infection rate was significantly higher with ECIR (27%) versus LNF (0%). At the final assessment, plain radiographs revealed original recycled bone was present in 7 of 11 ECIR cases and in zero cases treated with LNF autografts, indicating that recycled bone treated with LNF autografts was remodeled into new bone. Histological examination of ECIR-treated bones revealed a delayed and incomplete endochondral ossification process, necrosis and empty lacunae. Conversely, LNF autografts showed remodeled bones with normal trabecular structures. CONCLUSIONS ECIR and LNF treatment of autografts provided adequate tumor control with acceptable clinical results as a reconstruction method.
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Affiliation(s)
- Yuta Takeuchi
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | - Akio Sakamoto
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | - Takashi Noguchi
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | - Junya Toguchida
- Center for iPS Cell Research and Application (CiRA), Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
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El-Gammal TA, El-Sayed Ali A, Kotb MM, Saleh WR, Ragheb YF, Refai OA, Morsy MM, El-Gammal YT. Free Vascularized Proximal Fibular Epiphyseal Transfer For Hip Reconstruction Following Septic Necrosis In Children. J Pediatr Orthop 2024; 44:308-315. [PMID: 38462889 DOI: 10.1097/bpo.0000000000002634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
BACKGROUND Septic necrosis of the femoral head and neck in children represents a challenging problem. Several reconstructive techniques have been described but with disappointing long-term results. Vascularized epiphyseal transfer utilizing the proximal fibula have been successfully used for reconstruction of the proximal humerus and distal radius and only scarcely used for hip reconstruction. This cohort represents the largest reported series of epiphyseal transfer for hip reconstruction following septic necrosis in children. METHODS A total of 18 patients with an average age at surgery of 5.4 years were included. The average follow-up was 3.6 years (range 2.3 to 6.8 y). RESULTS Transient postoperative foot drop was observed in 4 patients. Radiographic resorption of the transferred fibula occurred in 2 cases. Longitudinal growth averaged 7.3 mm/year, and the physis width increased by an average of 2.7 mm/year. The rate of longitudinal growth was fastest after the age of 10 years (18.5 mm/y), which coincides with the pubertal growth spurt. All successful transfers had an open growth plate on final follow-up radiographs. Ten patients had limb length discrepancy of an average 2.8 cm (range 1 to 8 cm). Thirteen patients had satisfactory functional according to the criteria of Hunka et al. Three patients had unsatisfactory results; one had painful nonunion at the fibula-femur junction, and the other two had limited flexion range of 45 degrees. The average postoperative neck-shaft angle was 96.4 degrees which decreased by an average of 8 degrees at the final follow-up. Three patients underwent a valgus subtrochanteric osteotomy to correct a severe varus deformity. The final neck-shaft angle correlated significantly with the functional results where it averaged 96 degrees in the satisfactory group and 57 degrees in the unsatisfactory group. CONCLUSION Vascularized epiphyseal transfer presents a promising treatment for children with septic necrosis of the femoral head and neck in whom other methods have failed to provide satisfactory long-term results. We recommend the procedure be done before the age of 5 years for optimum results. LEVEL OF EVIDENCE Level-IV.
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Affiliation(s)
- Tarek Abdalla El-Gammal
- Department of Orthopedics and Traumatology, Hand and Reconstructive Microsurgery Center, Assiut University Hospitals and School of Medicine, Assiut, Egypt
- Department of Orthopedics, University of Louisville, Louisville, KY
| | - Amr El-Sayed Ali
- Department of Orthopedics and Traumatology, Hand and Reconstructive Microsurgery Center, Assiut University Hospitals and School of Medicine, Assiut, Egypt
| | - Mohamed Mostafa Kotb
- Department of Orthopedics and Traumatology, Hand and Reconstructive Microsurgery Center, Assiut University Hospitals and School of Medicine, Assiut, Egypt
| | - Waleed Riad Saleh
- Department of Orthopedics and Traumatology, Hand and Reconstructive Microsurgery Center, Assiut University Hospitals and School of Medicine, Assiut, Egypt
| | - Yasser Farouk Ragheb
- Department of Orthopedics and Traumatology, Hand and Reconstructive Microsurgery Center, Assiut University Hospitals and School of Medicine, Assiut, Egypt
| | - Omar Ahmed Refai
- Department of Orthopedics and Traumatology, Hand and Reconstructive Microsurgery Center, Assiut University Hospitals and School of Medicine, Assiut, Egypt
| | - Mohamed Mohamed Morsy
- Department of Orthopedics and Traumatology, Hand and Reconstructive Microsurgery Center, Assiut University Hospitals and School of Medicine, Assiut, Egypt
- Department of Orthopedics, University of Birmingham at Alabama, AL
| | - Yousif Tarek El-Gammal
- Department of Orthopedics and Traumatology, Hand and Reconstructive Microsurgery Center, Assiut University Hospitals and School of Medicine, Assiut, Egypt
- Kleinert-Kutz Institute of Hand and Microsurgery, Louisville, KY
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Neto MA, Paulino MF, Amaro AM. Effect of Plate Configuration in the Primary Stability of Osteotomies and Biological Reconstructions of Femoral Defects: Finite-Element Study. Bioengineering (Basel) 2024; 11:416. [PMID: 38790284 PMCID: PMC11117963 DOI: 10.3390/bioengineering11050416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND/OBJECTIVE Osteosynthesis is an alternative treatment for stabilizing femur-bone traumas. The initial stability of the fixation systems is one of the biomechanical parameters affecting implant failure and bone union, especially in surgeries of intercalary reconstructions after the removal of bone tumors. This study aimed to investigate the initial biomechanical effect of using one or two osteosynthesis plate configurations for femoral fixation and the effect of fastening the allograft to the osteosynthesis plate in the case of femoral allograft reconstructions. METHODS Three finite-element models of a femur with three different fixation conditions for a transverse osteotomy in the middle of the diaphysis, i.e., using one and two osteosynthesis plates and an intercalary allograft, were constructed. An eight-hole compression plate and a six-hole second plate were used to simulate osteosynthesis plates. The plate screws were tightened previously to the loading, and the tightening sequences simulate the bolt-tightening procedure in a surgical environment. The models were imported into the ADINA System for nonlinear analysis, using compression loads applied over the femur head. RESULTS Models with the dual fixation systems had the most outstanding compression stiffness. The femur head movement in the dual plate system was 24.8% smaller than in the single plate system. A statistical analysis of a region of interest (VOI) placed in the femur diaphysis showed that the biomechanical effect of using the dual plate system is smaller in the osteotomy region than at the femur head, e.g., a displacement average decrease of only 5% between the two systems, while the maximum value decreases by 26.8%. The allograft fixation to the second osteosynthesis plate leads to an improvement in the system stability. CONCLUSIONS The results presented in this work show that including the bolt analysis in the femoral diaphysis osteotomy fixation will allow for capturing the nonlinear behavior of the osteotomy region more realistically. The stability of the intercalary reconstruction of the femoral diaphysis was higher when the allograft was fastened to the second osteosynthesis plate.
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Affiliation(s)
- M. A. Neto
- University of Coimbra, CEMMPRE, ARISE, Department of Mechanical Engineering, 3030-788 Coimbra, Portugal; (M.F.P.); (A.M.A.)
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Lavía KF, Izquierdo Ó, Boccolini HS, Hernández R, Pérez G, Andrés M, Panadero M. Treatment of a case of septic tibial nonunion by the Capanna technique. Trauma Case Rep 2023; 47:100912. [PMID: 37637455 PMCID: PMC10458955 DOI: 10.1016/j.tcr.2023.100912] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2023] [Indexed: 08/29/2023] Open
Abstract
This report presents the case of a 25-year-old male with an infected tibial diaphyseal nonunion caused by a bone transport procedure carried out to treat an open fracture the patient had sustained 10 years before referral to our hospital. After an initial radical debridement, a bone defect was created, which was subsequently obliterated by placement of an antibiotic-impregnated cement spacer and Stimulan beads and covered by an anterolateral thigh flap. As the patient refused to wear an external fixator and his osseous biology was not amenable to a Masquelet procedure, a decision was made to apply the Capanna technique as soon as the infection healed. The second debridement resulted in a 12-cm-long bone defect that was filled with a tibial allograft and a vascularized fibular graft. At six months, the patient had regained full knee function and was able to bear his full weight, without pain or the need of support equipment. At one year, the bone had healed completely, the infection had subsided and the patient was able to resume his everyday activities. Although the Capanna technique was initially developed to reinforce reconstructions at risk of fracture or nonunion as a result of chemotherapy, its use in post-traumatic cases has been shown to be successful in a selected group of patents. Our study demonstrated that increasing the stability of a reconstruction with an allograft can accelerate the time to heal, and that using a vascularized fibular graft can enhance incorporation of the whole construct. It can be concluded that the Capanna technique is a valid treatment option for managing infected segmental bone defects in selected patients.
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Long-Term Follow-Up of Biological Reconstruction with Free Fibular Graft after Resection of Extremity Diaphyseal Bone Tumors. J Clin Med 2022; 11:jcm11237225. [PMID: 36498798 PMCID: PMC9741265 DOI: 10.3390/jcm11237225] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
This study aimed to evaluate the clinical outcomes and complications of reconstruction with a composite free fibula inside other biological grafts. We retrospectively reviewed 26 patients who underwent reconstruction after bone tumor resection of the diaphysis of the long bone. Surgical data, time to bony union, functional outcomes, and complications were evaluated in all cases. The median follow-up was 72.5 months. The limb salvage rate was 100%. Primary osseous union was achieved in 90.4% of the junctions. The union rates at the metaphyseal and diaphyseal junctions were 100% and 85.7%, respectively (p = 0.255). The mean time of bony union in the upper (87.5%) and lower (91.7%) extremity was 4.6 ± 1.6 months and 6.9 ± 2 months, respectively. The mean MSTS score was 27.2 ± 3.2, with a mean MSTS rating of 90.7%. Complications occurred in 15.4% of the cases. The administration of vascularized or non-vascularized grafts did not significantly influence the union time (p = 0.875), functional outcome (p = 0.501), or blood loss (p = 0.189), but showed differences in operation time (p = 0.012) in lower extremity reconstruction. A composite free fibula inside other biological grafts provides a reasonable and durable option for osseous oncologic reconstruction of the long bone diaphysis of the extremities with an acceptable rate of complications. A higher union rate was achieved after secondary bone grafting. In lower-extremity reconstruction, two plates may be considered a better option for internal fixation. Vascularizing the fibula did not significantly affect the union time.
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Crenn V, Quinette Y, Bouthors C, Missenard G, Viard B, Anract P, Boisgard S, Mascard E, Gouin F. Intercalary allograft reconstruction following femoral tumour resection: mid- and long-term results and benefits of adding a vascularised fibula autograft. World J Surg Oncol 2022; 20:195. [PMID: 35698130 PMCID: PMC9195446 DOI: 10.1186/s12957-022-02650-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 05/24/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Bone healing in femoral reconstructions using intercalary allografts can be compromised in a tumour context. There is also a high revision rate for non-union, infection, and fractures in this context. The advantages and disadvantages of an associated vascularised fibula graft (VFG) are still a matter of debate. Methods In a multicentre study, we retrospectively analysed 46 allograft reconstructions, operated on between 1984 and 2017, of which 18 were associated with a VFG (VFG+) and 28 without (VFG−), with a minimum follow-up of 2 years. We determined the cumulative probability of bone union as well as the mid- and long-term revision risks for both categories by Kaplan-Meier survival analysis and a multivariate Cox model. We also compared the MSTS scores. Results Significant differences in favour of VFG+ reconstruction were observed in the survival analyses for the probability of bone union (log-rank, p = 0.017) and in mid- and long-term revisions (log-rank, p = 0.032). No significant difference was observed for the MSTS, with a mean MSTS of 27.6 in our overall cohort (p = 0.060). The multivariate Cox model confirmed that VFG+ was the main positive factor for bone union, and it identified irradiated allografts as a major risk factor for the occurrence of mid- and long-term revisions. Conclusion Bone union was achieved earlier in both survival and Cox model analyses for the VFG+ group. It also reduced the mid- and long-term revision risk, except when an irradiated allograft was used. In case of a tumour, we thus recommend using VFG+ from a fresh-frozen allograft, as it appears to be a more reliable long-term option. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-022-02650-x.
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Affiliation(s)
- Vincent Crenn
- Service de Chirurgie Orthopédique, CHU de Nantes, Place Alexis Ricordeau, 44000, Nantes, France. .,INSERM, UMR 1238, Phy-Os, Université de Nantes, Nantes, France.
| | - Yonis Quinette
- Service de Chirurgie Orthopédique, CHU de Nantes, Place Alexis Ricordeau, 44000, Nantes, France
| | - Charlie Bouthors
- Service de Chirurgie Orthopédique, APHP/CHU Kremlin-Bicêtre, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Gilles Missenard
- Service de Chirurgie Orthopédique, APHP/CHU Kremlin-Bicêtre, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Brice Viard
- Service de Chirurgie Orthopédique, APHP/CHU Kremlin-Bicêtre, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Philippe Anract
- Service de Chirurgie Orthopédique, AP-HP/Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Stéphane Boisgard
- Service de Chirurgie Orthopédique, CHU Gabriel Montpied, 58 rue Montalembert, 63000, Clermont-Ferrand, France
| | - Eric Mascard
- Département de Chirurgie Orthopédique Pédiatrique, APHP/Hôpital Necker, 149 rue de Sèvres, 75015, Paris, France
| | - François Gouin
- Service de Chirurgie Orthopédique, CHU de Nantes, Place Alexis Ricordeau, 44000, Nantes, France.,INSERM, UMR 1238, Phy-Os, Université de Nantes, Nantes, France.,Département de Chirurgie, Centre Léon Bérard, 28 rue Laennec, 69008, Lyon, France
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Jamshidi K, Bahardoust M, Karimi Behnagh A, Bagherifard A, Mirzaei A. How the Choice of Osteosynthesis Affects the Complication Rate of Intercalary Allograft Reconstruction? A Systematic Review and Meta-analysis. Indian J Orthop 2021; 56:547-558. [PMID: 35342531 PMCID: PMC8921354 DOI: 10.1007/s43465-021-00563-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 11/01/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is no clear consensus on the optimal type of fixation in intercalary allograft reconstruction. In this study, we aimed to compare the rate of most common complications following the plate and nail fixation of the intercalary allograft. MATERIALS AND METHODS We searched PubMed, EMBASE, Web of Science, Scopus, and Cochrane Library. Studies in which the complication rate of the single bridging plate and intramedullary nail fixation was extractable were included. Studies that used extra procedures such as cementation and fibular vascular graft augmentation were excluded. The primary outcome was the fixation-specific rate of nonunion. Secondary outcomes were the fixation-specific rate of fracture, infection, and local recurrence. RESULTS In total, 13 studies with 431 reconstructions (352 reconstructions in the plate group and 79 reconstructions in the intramedullary nailing group) were included in this study. In the plate fixation, the rate of nonunion, fracture, infection and local recurrence was 12%, 11%, 11%, and 3%, respectively. In the intramedullary nail fixation, the rate of nonunion, fracture, infection, and local recurrence was 37%, 5%, 4%, and 0%, respectively. The rate of nonunion was significantly higher in the intramedullary nail group (OR = 6.34; 95% CI 2.98-13.49, P < 0.001). The rate of fracture, infection, and local recurrence was not significantly different between the two fixation methods. CONCLUSIONS Intramedullary nail is associated with a significantly higher rate of nonunion. Since the rate of other complications was not significantly different between the two osteosynthesis types, plate fixation could be considered as a better type of fixation. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43465-021-00563-7.
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Affiliation(s)
- Khodamorad Jamshidi
- grid.411746.10000 0004 4911 7066Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mansour Bahardoust
- grid.411746.10000 0004 4911 7066Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran ,grid.411600.2Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arman Karimi Behnagh
- grid.411746.10000 0004 4911 7066Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Bagherifard
- grid.411746.10000 0004 4911 7066Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Mirzaei
- grid.411746.10000 0004 4911 7066Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
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Migliorini F, La Padula G, Torsiello E, Spiezia F, Oliva F, Maffulli N. Strategies for large bone defect reconstruction after trauma, infections or tumour excision: a comprehensive review of the literature. Eur J Med Res 2021; 26:118. [PMID: 34600573 PMCID: PMC8487570 DOI: 10.1186/s40001-021-00593-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/20/2021] [Indexed: 12/16/2022] Open
Abstract
Large bone defects resulting from musculoskeletal tumours, infections, or trauma are often unable to heal spontaneously. The challenge for surgeons is to avoid amputation, and provide the best functional outcomes. Allograft, vascularized fibular or iliac graft, hybrid graft, extracorporeal devitalized autograft, distraction osteogenesis, induced-membrane technique, and segmental prostheses are the most common surgical strategies to manage large bone defects. Given its optimal osteogenesis, osteoinduction, osteoconduction, and histocompatibility properties, along with the lower the risk of immunological rejection, autologous graft represents the most common used strategy for reconstruction of bone defects. However, the choice of the best surgical technique is still debated, and no consensus has been reached. The present study investigated the current reconstructive strategies for large bone defect after trauma, infections, or tumour excision, discussed advantages and disadvantages of each technique, debated available techniques and materials, and evaluated complications and new perspectives.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Gerardo La Padula
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Ernesto Torsiello
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Filippo Spiezia
- Ospedale San Carlo Potenza, Via Potito Petrone, 85100, Potenza, Italy
| | - Francesco Oliva
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy.,School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent, England.,Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London, E1 4DG, England
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Reconstruction Using Free Vascularized Fibular Grafts after Wide Resection of Humerus Chondrosarcoma in a Patient with Cleidocranial Dysplasia. Case Rep Orthop 2021; 2021:2302879. [PMID: 33747589 PMCID: PMC7960051 DOI: 10.1155/2021/2302879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 01/23/2021] [Accepted: 02/27/2021] [Indexed: 11/18/2022] Open
Abstract
Cleidocranial dysplasia is characterized by hypoplasia of the clavicles, unerupted teeth, narrow pelvis, short stature, and craniofacial malformations. A cause of this skeletal dysplasia is heterozygous mutations of the runt-related transcription factor 2 gene (Runx2), a master regulator for bone and cartilage development. Chondrosarcoma is a primary malignant bone tumor that is usually treated by wide resection surgery. This report shows a case of a 25-year-old female patient with cleidocranial dysplasia who was affected with chondrosarcoma of the left humerus. We performed wide resection of the tumor and reconstruction of the large bone defect of the humerus using free vascularized fibular grafts. The patient preserved the hand function and activity of daily life as the same level as preoperative condition more than five years after the surgery.
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Ou Q, Wu P, Zhou Z, Pan D, Tang JY. Complication of osteo reconstruction by utilizing free vascularized fibular bone graft. BMC Surg 2020; 20:216. [PMID: 33008361 PMCID: PMC7531124 DOI: 10.1186/s12893-020-00875-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/21/2020] [Indexed: 12/19/2022] Open
Abstract
The success of free vascularized fibular bone graft (FVFBG) has accelerated the osteo reconstruction which results from trauma, resection of a tumor or an infectious bone segment, or correction of congenital deformity. But the complication behind should not be overlooked. The failure could necessitate a second surgery, which prolong the rehabilitation period and produce further health cost. Worst, the patients may suffer a permanent impaired ankle function, or a sustained morpho-functional loss on reconstructive area which are hard to save. To provide an overview of the complication related to reconstruction by FVFBG, a narrative review is conducted to identify the complications including their types and rates, the contributing factors, the approaches to measure and the techniques to avoid. Methodologically, by quick research on Pubmed and abstract reading of reviews, we characterize five reconstructive areas where FVFBG were most frequently applied: extremities, mandible, spine, osteonecrosis of femoral head, and penile. Following, the complications on different reconstructive areas are retrieved, studied and presented in five (or more specifically, six) separate sections. By the way, meaningful difference between FVFBG and other bone flap was presented in a few words if necessary. Donor-site morbidities were studied and summarized as a whole. In these literatures, the evidences documented on limb and mandibular reconstruction have the fullest detail, followed by the spine and lastly the penile. In conclusion, FVFBG, though a mature technique, needs further deep and comprehensive study and maybe device-based assistance to achieve better reconstructive effect and minimize donor-site damage.
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Affiliation(s)
- Qifeng Ou
- Department of Orthopedics, Hand and Microsurgery, Xiangya Hospital, Central South University, No.87 XiangYa Road, Changsha, 410008, Hunan, China
| | - Panfeng Wu
- Department of Orthopedics, Hand and Microsurgery, Xiangya Hospital, Central South University, No.87 XiangYa Road, Changsha, 410008, Hunan, China
| | - Zhengbing Zhou
- Department of Orthopedics, Hand and Microsurgery, Xiangya Hospital, Central South University, No.87 XiangYa Road, Changsha, 410008, Hunan, China
| | - Ding Pan
- Department of Orthopedics, Hand and Microsurgery, Xiangya Hospital, Central South University, No.87 XiangYa Road, Changsha, 410008, Hunan, China
| | - Ju-Yu Tang
- Department of Orthopedics, Hand and Microsurgery, Xiangya Hospital, Central South University, No.87 XiangYa Road, Changsha, 410008, Hunan, China.
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Yamamura Y, Emori M, Takahashi N, Chiba M, Shimizu J, Murahashi Y, Sugita S, Iba K, Hasegawa T, Yamashita T. Osteofibrous dysplasia-like adamantinoma treated via intercalary segmental resection with partial cortex preservation using pedicled vascularized fibula graft: a case report. World J Surg Oncol 2020; 18:203. [PMID: 32792007 PMCID: PMC7427073 DOI: 10.1186/s12957-020-01983-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/31/2020] [Indexed: 11/10/2022] Open
Abstract
Background Morphologically, osteofibrous dysplasia-like adamantinoma is thought to be intermediate between osteofibrous dysplasia and adamantinoma. Its treatment is not well established owing to its rarity. Case presentation We report about of a 10-year-old girl with osteofibrous dysplasia-like adamantinoma initially diagnosed as osteofibrous dysplasia and treated via intercalary segmental resection with partial cortex preservation using a pedicled vascularized fibula graft for reconstruction. Bone union was observed 9 weeks after surgery. Twenty-two months after the definitive surgery, no recurrence was observed. Conclusion This case illustrates the upgrade from osteofibrous dysplasia to osteofibrous dysplasia-like adamantinoma. The surgical method may aid the treatment of osteofibrous dysplasia-like adamantinoma with incomplete cortex involvement of the tumor.
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Affiliation(s)
- Yuji Yamamura
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, West 16, South 1, Chuo- ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Makoto Emori
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, West 16, South 1, Chuo- ku, Sapporo, Hokkaido, 060-8543, Japan.
| | - Nobuyuki Takahashi
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, West 16, South 1, Chuo- ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Mitsumasa Chiba
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, West 16, South 1, Chuo- ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Junya Shimizu
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, West 16, South 1, Chuo- ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Yasutaka Murahashi
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, West 16, South 1, Chuo- ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Shintaro Sugita
- Department of Diagnostic Pathology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Kousuke Iba
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, West 16, South 1, Chuo- ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Tadashi Hasegawa
- Department of Diagnostic Pathology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Toshihiko Yamashita
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, West 16, South 1, Chuo- ku, Sapporo, Hokkaido, 060-8543, Japan
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Borzunov DY, Kolchin SN, Malkova TA. Role of the Ilizarov non-free bone plasty in the management of long bone defects and nonunion: Problems solved and unsolved. World J Orthop 2020; 11:304-318. [PMID: 32572367 PMCID: PMC7298454 DOI: 10.5312/wjo.v11.i6.304] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/06/2020] [Accepted: 05/17/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ilizarov non-free bone plasty is a method of distraction osteogenesis using the Ilizarov apparatus for external fixation which originated in Russia and was disseminated across the world. It has been used in long bone defect and nonunion management along with free vascularized grafting and induced membrane technique. However, the shortcomings and problems of these methods still remain the issues which restrict their overall use.
AIM To study the recent available literature on the role of Ilizarov non-free bone plasty in long bone defect and nonunion management, its problems and the solutions to these problems in order to achieve better treatment outcomes.
METHODS Three databases (PubMed, Scopus, and Web of Science) were searched for literature sources on distraction osteogenesis, free vascularized grafting and induced membrane technique used in long bone defect and nonunion treatment within a five-year period (2015-2019). Full-text clinical articles in the English language were selected for analysis only if they contained treatment results, complications and described large patient samples (not less than ten cases for congenital, post-tumor resection cases or rare conditions, and more than 20 cases for the rest). Case reports were excluded.
RESULTS Fifty full-text articles and reviews on distraction osteogenesis were chosen. Thirty-five clinical studies containing large series of patients treated with this method and problems with its outcome were analyzed. It was found that distraction osteogenesis techniques provide treatment for segmental bone defects and nonunion of the lower extremity in many clinical situations, especially in complex problems. The Ilizarov techniques treat the triad of problems simultaneously (bone loss, soft-tissue loss and infection). Management of tibial defects mostly utilizes the Ilizarov circular fixator. Monolateral fixators are preferable in the femur. The use of a ring fixator is recommended in patients with an infected tibial bone gap of more than 6 cm. High rates of successful treatment were reported by the authors that ranged from 77% to 100% and depended on the pathology and the type of Ilizarov technique used. Hybrid fixation and autogenous grafting are the most applicable solutions to avoid after-frame regenerate fracture or deformity and docking site nonunion.
CONCLUSION The role of Ilizarov non-free bone plasty has not lost its significance in the treatment of segmental bone defects despite the shortcomings and treatment problems encountered.
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Affiliation(s)
- Dmitry Y Borzunov
- Department of Traumatology and Orthopedics, Ural State Medical University, Ekaterinburg 620109, Russia
| | - Sergei N Kolchin
- Orthopaedic Department 4, Ilizarov National Medical Research Centre for Traumatology and Orthopaedics, Kurgan 640014, Russia
| | - Tatiana A Malkova
- Department for Medical Information and Analysis, Ilizarov National Medical Research Centre for Traumatology and Orthopaedics, Kurgan 640014, Russia
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Rammelt S, Fritzsche H, Hofbauer C, Schaser KD. Malignant tumours of the foot and ankle. Foot Ankle Surg 2020; 26:363-370. [PMID: 31126797 DOI: 10.1016/j.fas.2019.05.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/25/2018] [Accepted: 05/07/2019] [Indexed: 02/04/2023]
Abstract
Tumours of the foot and ankle constitute about 4-5% of all musculoskeletal tumours with the majority of them being benign. Diagnosis of malignant soft tissue or bone tumours is frequently delayed because of the relatively low prevalence and uncommon presentation at the foot and ankle. Suspicious lesions or lumps should be subjected to CT, MRI and biopsy. Subfascial location, lump size more than 5 cm, increase in size, painful and recurrent tumours should raise the suspicion of malignancy and lead to patient referral to a designated tumour centre. Neoadjuvant and adjuvant systemic chemotherapy and/or radiation therapy, isolated limb perfusion (ILP) and hyperthermia for malignant tumours have to be discussed in a multidisciplinary tumour board. With the advances in local and free tissue transfer, limb-sparing techniques have increasingly replaced primary amputations thus preserving lower limb function as much as possible without compromising on the principles of oncologic resection.
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Affiliation(s)
- Stefan Rammelt
- University Centre of Orthopaedics and Traumatology, University Hospital Carl Gustav Carus, Dresden, Germany.
| | - Hagen Fritzsche
- University Centre of Orthopaedics and Traumatology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Christine Hofbauer
- University Centre of Orthopaedics and Traumatology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Klaus-Dieter Schaser
- University Centre of Orthopaedics and Traumatology, University Hospital Carl Gustav Carus, Dresden, Germany
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Xu L, Wen L, Qiao J, Zhu Z, Qiu Y, Xiong J, Mao H, Wang S. Clinical Outcome of Free Vascularized Fibula Graft in the Surgical Treatment of Extremity Osteosarcoma. Orthop Surg 2020; 12:727-733. [PMID: 32412695 PMCID: PMC7307252 DOI: 10.1111/os.12646] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/23/2020] [Accepted: 02/05/2020] [Indexed: 11/30/2022] Open
Abstract
Objective To determine the clinical outcome and complications associated with use of free vascularized fibular graft (FVFG) in the resection and reconstruction of extremity osteosarcoma (OS). Methods This is a retrospective study recruiting a consecutive series of 18 patients who had undergone resection of extremity OS between May 2009 and June 2017 in our clinic center. Reconstruction of the bone defect with FVFG was performed for each patient. Surgery‐related complications and time of bone union were recorded at the follow‐up visit. The functional outcome of the reconstructed limb was assessed with the musculoskeletal tumor society (MSTS) scoring system. Patients were further classified into low extremity group and upper extremity group according to the tumor location. The Student t‐test was used to compare the surgical outcome between the two subgroups. Results There were 11 males and seven females with an average age of 25.9 ± 14.2 years. The mean length of the bone resection was 11.9 ± 4.1 cm. The mean follow‐up duration was 3.1 ± 1.2 years. As for tumor location, six cases were located in the femur, five in the tibia, four in the humerus, two in the ulna, and one in the radius. All the patients had successful graft healing at an average of 4.9 months after surgery. At the 2‐year follow‐up, an excellent functional outcome was observed in 88.9% of the patients (n = 16). The mean score of MSTS was 27.0 ± 4.6. Screw loosening and autograft fracture were observed in one patient with femur tumor, who had a low MSTS score of 11. Besides, there were three cases with delayed incision healing. Patients with lower extremity OS were found to have significantly longer duration of hospital stay and more blood loss than those with upper extremity OS. The incidence of postoperative complication was higher in the lower extremity group but with marginal significance (0% vs 36.3%, P = 0.1). There was no significant difference regarding time to bone union and the functional outcome as indicated by MSTS score. Conclusions FVFG technique can be effectively applied to the reconstruction of bone defects after OS resection with satisfactory functional outcome and low incidence of complications.
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Affiliation(s)
- Leilei Xu
- Department of Orthopedic Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Li Wen
- Department of Orthopedic Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Jun Qiao
- Department of Orthopedic Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Zezhang Zhu
- Department of Orthopedic Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yong Qiu
- Department of Orthopedic Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Jin Xiong
- Department of Orthopedic Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Haijun Mao
- Department of Orthopedic Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Shoufeng Wang
- Department of Orthopedic Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
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15
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Malizos KN, Fyllos A, Varytimidis S, Dailiana Z. Tips to secure healing at the free vascularised fibular graft-to-host bone junction. Injury 2019; 50 Suppl 5:S46-S49. [PMID: 31708088 DOI: 10.1016/j.injury.2019.10.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The most commonly used vascularized bone graft in Orthopedics for difficult reconstructive problems requiring biological augmentation properties is the fibula. It provides immediate structure and with a patent pedicle, increases blood flow at the recipient site, promoting healing and hypertrophy in response to mechanical stress. The vascular supply from the nutrient branch and the periosteal vessels allows a variety of graft harvesting configurations for a broad spectrum of reconstructive challenges. We present the details on how to optimize healing and graft incorporation at the junction sites.
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Affiliation(s)
- Konstantinos N Malizos
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece.
| | - Apostolos Fyllos
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece
| | - Sokratis Varytimidis
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece
| | - Zoe Dailiana
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece
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Reconstruction of Anterior Mandible and Mouth Floor Using the Myofascial Iliac Crest Free Flap After Tumor Resection. Ann Plast Surg 2019; 82:411-414. [DOI: 10.1097/sap.0000000000001649] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Mettl3 Regulates Osteogenic Differentiation and Alternative Splicing of Vegfa in Bone Marrow Mesenchymal Stem Cells. Int J Mol Sci 2019; 20:ijms20030551. [PMID: 30696066 PMCID: PMC6387109 DOI: 10.3390/ijms20030551] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 01/20/2019] [Accepted: 01/25/2019] [Indexed: 12/16/2022] Open
Abstract
Bone mesenchymal stem cells (BMSCs) can be a useful cell resource for developing biological treatment strategies for bone repair and regeneration, and their therapeutic applications hinge on an understanding of their physiological characteristics. N6-methyl-adenosine (m6A) is the most prevalent internal chemical modification of mRNAs and has recently been reported to play important roles in cell lineage differentiation and development. However, little is known about the role of m6A modification in the cell differentiation of BMSCs. To address this issue, we investigated the expression of N6-adenosine methyltransferases (Mettl3 and Mettl14) and demethylases (Fto and Alkbh5) and found that Mettl3 was upregulated in BMSCs undergoing osteogenic induction. Furthermore, we knocked down Mettl3 and demonstrated that Mettl3 knockdown decreased the expression of bone formation-related genes, such as Runx2 and Osterix. The alkaline phosphatase (ALP) activity and the formation of mineralized nodules also decreased after Mettl3 knockdown. RNA sequencing analysis revealed that a vast number of genes affected by Mettl3 knockdown were associated with osteogenic differentiation and bone mineralization. Kyoto encyclopedia of genes and genomes (KEGG) pathway analysis revealed that the phosphatidylinositol 3-kinase/AKT (PI3K-Akt) signaling pathway appeared to be one of the most enriched pathways, and Western blotting results showed that Akt phosphorylation was significantly reduced after Mettl3 knockdown. Mettl3 has been reported to play an important role in regulating alternative splicing of mRNA in previous research. In this study, we found that Mettl3 knockdown not only reduced the expression of Vegfa but also decreased the level of its splice variants, vegfa-164 and vegfa-188, in Mettl3-deficient BMSCs. These findings might contribute to novel progress in understanding the role of epitranscriptomic regulation in the osteogenic differentiation of BMSCs and provide a promising perspective for new therapeutic strategies for bone regeneration.
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Campanacci DA, Totti F, Puccini S, Beltrami G, Scoccianti G, Delcroix L, Innocenti M, Capanna R. Intercalary reconstruction of femur after tumour resection: is a vascularized fibular autograft plus allograft a long-lasting solution? Bone Joint J 2018; 100-B:378-386. [PMID: 29589494 DOI: 10.1302/0301-620x.100b3.bjj-2017-0283.r2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims After intercalary resection of a bone tumour from the femur, reconstruction with a vascularized fibular graft (VFG) and massive allograft is considered a reliable method of treatment. However, little is known about the long-term outcome of this procedure. The aims of this study were to determine whether the morbidity of this procedure was comparable to that of other reconstructive techniques, if it was possible to achieve a satisfactory functional result, and whether biological reconstruction with a VFG and massive allograft could achieve a durable, long-lasting reconstruction. Patients and Methods A total of 23 patients with a mean age of 16 years (five to 40) who had undergone resection of an intercalary bone tumour of the femur and reconstruction with a VFG and allograft were reviewed clinically and radiologically. The mean follow-up was 141 months (24 to 313). The mean length of the fibular graft was 18 cm (12 to 29). Full weight-bearing without a brace was allowed after a mean of 13 months (seven to 26). Results At final follow-up, the mean Musculoskeletal Tumor Society Score of 22 evaluable patients was 94% (73 to 100). Eight major complications, five fractures (21.7%), and three nonunions (13%) were seen in seven patients (30.4%). Revision-free survival was 72.3% at five, ten, and 15 years, with fracture and nonunion needing surgery as failure endpoints. Overall survival, with removal of allograft or amputation as failure endpoints, was 94.4% at five, ten, and 15 years. Discussion There were no complications needing surgical revision after five years had elapsed from surgery, suggesting that the mechanical strength of the implant improves with time, thereby decreasing the risk of complications. In young patients with an intercalary bone tumour of the femur, combining a VFG and massive allograft may result in a reconstruction that lasts a lifetime. Cite this article: Bone Joint J 2018;100-B:378-86.
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Affiliation(s)
- D A Campanacci
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - F Totti
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - S Puccini
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - G Beltrami
- Department of Paediatric Orthopaedic Oncology, Azienda Ospedaliera Universitaria Careggi
| | - G Scoccianti
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - L Delcroix
- Department of Plastic Surgery and Microsurgery, Azienda Ospedaliera Universitaria Careggi
| | - M Innocenti
- Department of Plastic Surgery and Microsurgery, Azienda Ospedaliera Universitaria Careggi
| | - R Capanna
- Department of Orthopaedic and Trauma Surgery, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
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Stevenson JD, Doxey R, Abudu A, Parry M, Evans S, Peart F, Jeys L. Vascularized fibular epiphyseal transfer for proximal humeral reconstruction in children with a primary sarcoma of bone. Bone Joint J 2018; 100-B:535-541. [DOI: 10.1302/0301-620x.100b4.bjj-2017-0830.r1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Aims Preserving growth following limb-salvage surgery of the upper limb in children remains a challenge. Vascularized autografts may provide rapid biological incorporation with the potential for growth and longevity. In this study, we aimed to describe the outcomes following proximal humeral reconstruction with a vascularized fibular epiphyseal transfer in children with a primary sarcoma of bone. We also aimed to quantify the hypertrophy of the graft and the annual growth, and to determine the functional outcomes of the neoglenofibular joint. Patients and Methods We retrospectively analyzed 11 patients who underwent this procedure for a primary bone tumour of the proximal humerus between 2004 and 2015. Six had Ewing’s sarcoma and five had osteosarcoma. Their mean age at the time of surgery was five years (two to eight). The mean follow-up was 5.2 years (1 to 12.2). Results The overall survival at five and ten years was 91% (confidence interval (CI) 95% 75% to 100%). At the time of the final review, ten patients were alive. One with local recurrence and metastasis died one-year post-operatively. Complications included seven fractures, four transient nerve palsies, and two patients developed avascular necrosis of the graft. All the fractures presented within the first postoperative year and united with conservative management. One patient had two further operations for a slipped fibular epiphysis of the autograft, and a hemi-epiphysiodesis for lateral tibial physeal arrest. Hypertrophy and axial growth were evident in nine patients who did not have avascular necrosis of the graft. The mean hypertrophy index was 65% (55% to 82%), and the mean growth was 4.6 mm per annum (2.4 to 7.6) in these nine grafts. At final follow-up, the mean modified functional Musculoskeletal Tumour Society score was 77% (63% to 83%) and the mean Toronto Extremity Salvage Score (TESS) was 84% (65% to 94%). Conclusion Vascularized fibular epiphyseal transfer preserves function and growth in young children following excision of the proximal humerus for a malignant bone tumour. Function compares favourably to other limb-salvage procedures in children. Longer term analysis is required to determine if this technique proves to be durable into adulthood. Cite this article: Bone Joint J 2018;100-B:535–41.
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Affiliation(s)
- J. D. Stevenson
- Royal Orthopaedic Hospital, The Woodlands,
Birmingham, Aston University Medical School, Aston
Express Way, Birmingham, B4
7ET, UK
| | - R. Doxey
- University of Birmingham Medical School, Birmingham, UK
| | - A. Abudu
- Royal Orthopaedic Hospital, The
Woodlands, Bristol Road South, Birmingham
B31 2AP, UK
| | - M. Parry
- Royal Orthopaedic Hospital, The Woodlands,
Birmingham, Aston University Medical School, Aston
Express Way, Birmingham, B4
7ET, UK
| | - S. Evans
- Royal Orthopaedic Hospital, The
Woodlands, Bristol Road South, Birmingham
B31 2AP, UK
| | - F. Peart
- Royal Orthopaedic Hospital, The
Woodlands, Bristol Road South, Birmingham
B31 2AP, UK
| | - L. Jeys
- Royal Orthopaedic Hospital, The Woodlands,
Bristol Road South, Birmingham, University
of Aston, Aston Expressway, Birmingham, B4
7ET, UK
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20
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Landau MJ, Badash I, Yin C, Alluri RK, Patel KM. Free vascularized fibula grafting in the operative treatment of malignant bone tumors of the upper extremity: A systematic review of outcomes and complications. J Surg Oncol 2018. [PMID: 29513891 DOI: 10.1002/jso.25032] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Vascularized bone grafting after tumor resection can be an important component in the treatment of bony neoplasms of the upper extremity. The purpose of this study was to determine the outcomes of free vascularized fibula grafting (FVFG) in the treatment of upper extremity sarcomas. METHODS A systematic review of the literature of FVFG used in the treatment of upper extremity sarcomas was performed. RESULTS A total of 56 studies were included in final analysis. The most common diagnosis was osteosarcoma (35.1%) and the most common recipient site was the humerus (57.3%). FVFG had a median union rate of 93.3%, with the median time to union being 5.0 months. The most common complications were fracture (11.7%), nerve injury (7.5%), infection (5.7%), and hammer toe deformity (3.3%). The reoperation rate was 34.5%. The most commonly reported standardized assessment of clinical outcomes following treatment was the Musculoskeletal Tumor Society Score, which had a median of 80% postoperatively. CONCLUSIONS FVFG in the treatment of malignant bony neoplasms of the upper extremity has a high rate of union and good overall outcomes; however, postoperative complication rates are high. A greater degree of standardization is needed in the reporting of patient-centered outcomes to facilitate future comparative studies.
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Affiliation(s)
- Mark J Landau
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, Los Angeles, California
| | - Ido Badash
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, Los Angeles, California
| | - Christine Yin
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, Los Angeles, California
| | - Ram K Alluri
- Department of Orthopedic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California
| | - Ketan M Patel
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, Los Angeles, California
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