Osteogenic sarcoma arising from bony regenerate following Ilizarov femoral lengthening through fibrous dysplasia

Limb Length Discrepancy and Angular Deformity due to Benign Bone Tumors and Tumor-like Lesions

Benign bone tumors and tumor-like lesions are frequently diagnosed in children and adolescents. The immature skeleton is at risk for growth disturbances and deformity because of the effects of the lesions on normal bone architecture and the physis. The development, manifestation, and severity of the limb length inequality and deformity differs between the various bone pathologies. Distraction osteogenesis, osteotomy, and guided growth are key tools in the treatment of limb inequality and deformity using a combination of external and internal fixation devices.

Alveolar Rhabdomyosarcoma Following Mandibular Distraction Osteogenesis

The authors present a rare case of anaplastic alveolar rhabdomyosarcoma (ARMS) occurring after Mandibular Distraction Osteogenesis. A 16-month-old male presented with a rapidly enlarging left lower jaw mass after removal of mandibular distractors placed shortly after birth for Pierre Robin Sequence and severe obstructive sleep apnea. Incisional biopsy of the mass revealed ARMS with anaplastic features. Although ARMS is an extremely rare entity, craniofacial surgeons should have a low threshold for seeking further diagnostic modalities of a growing mass postmandibular distraction.

Distraction osteogenesis reconstruction of large segmental bone defects after primary tumor resection: pitfalls and benefits

Successful cure is achieved in almost 70% of patients with primary bone sarcomas with currently available therapies. Some soft tissue sarcomas require wide bone resection in order to achieve appropriate margins for cure of disease, and patients undergoing these procedures need durable reconstruction. Biological reconstruction has been shown to provide patients with superior long-term results over other alternatives. Distraction osteogenesis is well studied in the correction of deformities as well as in addressing some congenital musculoskeletal pathologies. The use of this technique in tumor settings has been avoided by many surgeons for a multitude of concerns, including infection risk, potential tumor activation, and uncertainty regarding the effect of systemic therapy on the callus regenerate. We review the use of this reconstruction technique using cases from our institutional experience to illustrate its incorporation into the successful management of orthopedic oncology patients. Distraction osteogenesis is an effective method for reconstructing even large bony defects and is safe in the setting of systemic therapy. This technique has the potential to address some of the common problems associated with orthopedic oncology resection, such as infection and leg length discrepancy.

Limb reconstruction in Ollier's disease

We present our experience of lengthening and correction of complex deformities in the management of patients with Ollier’s dysplasia (multiple enchondromatosis) from 1985 and 2002. All patients were under 18 years with a minimum follow-up time of 2 years (mean 9.6 years, range 2–15 years). There were a total of ten patients of which seven were male and three female. The mean age at presentation was 10.7 years (range 5–17 years; SD 3.7 years). The total length gain was 42.3 mm (range 30–110 mm; SD 28.9 mm). The number of days in external fixation was 164.8 days (range 76–244 days; SD 42.9 days). The bone healing index was 32.5 days/cm (18–50 days/cm; SD 10.3 days/cm). Patients with Ollier’s disease have limb length inequality and angular deformities and require multiple reconstructive procedures owing to a high incidence of recurrence. We identified a tendency for the osteotomy to prematurely consolidate and advise the latency period after surgery to be 4–5 days and for distraction to proceed at a faster rate.

Technique and complications of callus distraction in the treatment of bone tumors

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.

Limb sparing using a double bone-transport technique for treatment of a distal tibial osteosarcoma in a dog

OBJECTIVE

To evaluate the treatment of a spontaneously occurring osteosarcoma in a dog by means of tumor resection and bone regeneration of a 12-cm defect using double bone transport.

STUDY DESIGN

Case report.

ANIMALS OR SAMPLE POPULATION

An 11 year-old client-owned German shepherd.

METHODS

After tumor resection, a preassambled Ilizarov frame was secured to the proximal tibia and to the tarso-metatarsal region. Two osteotomies were performed in the proximal metaphysis. The two bone segments were transfixed with 1.5-mm-diameter wires, each secured to a ring, and bone transport was performed until the distal segment reached the talar surface. Cisplatin was administered 14, 35, and 59 days after surgery.

RESULTS

Bone regenerate was first visible radiographically 4 weeks after surgery. The frame was removed 162 days after surgery. The hock was protected with a plaster cast because the tarsal arthrodesis was not complete. The dog underwent tibiotarsal arthrodesis 201 days after osteosarcoma resection. The dog died of metastatic disease 239 days after the initial surgery.

CONCLUSIONS

Even though this dog died of systemic metastases, local recurrence did not develop. Cisplatin chemotherapy did not appear to negatively affect bone regeneration.

CLINICAL RELEVANCE

To our knowledge, the double transport technique has not been previously described in the veterinary literature. In this dog, this technique decreased the duration of treatment compared with a conventional single-segment transport technique.

Complications of limb-lengthening in children who have an underlying bone disorder

We retrospectively reviewed the results, particularly with regard to complications, of lengthening of long bones in eight children (nine limb segments) who had a limb-length discrepancy secondary to an underlying bone disorder (Group 1). The mean age of these patients was twelve years (range, six to sixteen years), the mean preoperative limb-length discrepancy was 6.0 centimeters (range, 2.7 to 8.8 centimeters), and the mean lengthening of the nine limb segments was 6.2 centimeters (range, 2.7 to 9.0 centimeters). Only two extremities were equalized. We compared the results in Group 1 with those of limb-lengthening in seven children (nine limb segments) who had a discrepancy secondary to post-traumatic growth arrest (Group 2) and seven children (seven limb segments) who had a discrepancy secondary to growth arrest following an infection in the bone (Group 3). All of the procedures were performed at our institution during the same time-period by the same surgeons. There were forty-one complications (twenty-five minor and sixteen major), with a mean of five complications per limb segment, in Group 1; twenty-six complications (twenty minor and six major), with a mean of three complications per limb segment, in Group 2; and twenty-two complications (fourteen minor and eight major), with a mean of three complications per limb segment, in Group 3. The results in Group 1 suggest that the Ilizarov technique for lengthening, although effective in restoring the length of the extremity, is associated with a higher rate of complications in patients who have a discrepancy due to an underlying bone disorder than in those who have a discrepancy due to growth arrest. Therefore, caution should be exercised before a lengthening procedure is recommended for a patient who has an underlying bone disorder.