Reconstruction of distal fibula with osteoarticular allograft after tumor resection.

Orthopaedic Surgery, Shafa Yahyaian Rehabilitation Center, Tehran University of Medical Sciences, Tehran, Iran.
Foot and Ankle Surgery 03/2013; 19(1):31-5. DOI: 10.1016/j.fas.2012.09.001
Source: PubMed

ABSTRACT Involvement of distal fibula by benign aggressive and malignant tumors usually necessitates resection of the involved segment of fibula. Numerous techniques have been proposed to reconstruct the ankle joint after this procedure, which can result in complications. We introduce reconstruction of ankle joint by fibular osteoarticular allograft.
Reconstruction of the distal fibula after wide resection of tumor was carried out in four patients. There were two cases of Ewing sarcoma, one case of osteosarcoma and one giant cell tumor. After wide resection of tumor, we reconstructed the lateral side of the ankle joint by osteoarticular fibular allograft, which was applied and internally fixed with semitubular plate and screws. In the follow up period, we did assessment of complications, pain and ankle joint instability.
The mean age of our patients was 24.2years (12-31). The mean follow-up was 3.2years (1.5-6.7). In follow up visits there were no signs of infection or wound healing problems. Union was achieved in all patients.
In cases of benign aggressive and malignant tumors involving the distal fibula, we can recommend resection of the distal fibula and reconstruction of the ankle with osteoarticular allograft of the distal fibula.
Case series level IV.

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    ABSTRACT: Curettage and bone grafting is a method which can eliminate benign bone tumors while restoring structural integrity, reducing the risk of pathological fractures. The aim of this research is to study the clinical outcomes of using allografts and autografts, in treating benign bone neoplasms. A Historical Cohort was conducted on 119 patients with benign bone tumors treated with curettage and grafting from 2005 to 2011 in Shafa Yahyaiyan Hospital. The variables were age, gender, tumor type and location, staging, graft type, bone incorporation and recurrence. Data was analyzed with SPSS software, using descriptive statistics, tables, Fisher exact and LogRank tests. The significance level was chosen to be less than 0.05. The study was approved in Iran University of Medical Sciences. One hundred and nineteen patients, consisting of 63 treated with an allograft and 56 treated with an autograft were studied with a mean follow up of 37.5 months. 96.6% of the patients had complete incorporation of the graft into host bone after 6 months of surgery. There was no significant relationship between graft type and bone incorporation (P = 0.121). The estimated median time of recurrence was 20 months (SE= 6.55) in the allograft group and 9 months (SE= 0.77) in the autograft group using survival analysis. Using LogRank test, there was no significant difference between the median in the two methods (P = 0.288). Autografts and allografts seem to yield similar success rates in the treatment of benign bone tumors. Although more detailed researches with higher sample sizes are recommended for future studies.
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