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
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.
Available from: Soodeh Alidadi
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ABSTRACT: The most prevalent primary malignant bone tumor affecting
children and adolescents is osteosarcoma. Osteosarcoma is
characterized by the formation of immature bone or osteoid
tissue by neoplastic cells. They arise predominantly in the long
bones, occasionally in the axial bones, and seldom in the soft
tissues. Patients with osteosarcoma are currently treated with
preoperative (neoadjuvant) chemotherapy followed by tumor
resection, and further postoperative chemotherapy. Wide
margin resection often is necessary and leave large bone defects.
These defective bones must be reconstructed and repaired using
appropriate materials and methods to restore function and
structure. Currently, autograft, allograft, prosthetic implant, or a
combination is used for defect reconstruction. Despite the
available options, reconstruction of large bone defects and
improvement in survival rates are still challenging. Tissue
engineering and regenerative medicine (TERM) may be promising
alternative strategies to regenerate bone and may change
conventional treatment strategies in patients with osteosarcoma.
TERM in the form of scaffolds, healing promotive factors, or
stem cells could be designed to be useful for bone reconstruction
and regeneration and also for delivery of anti-cancer
therapeutic agents. Combining TERM approaches with immunotherapy,
chemoimmunotherapy, radioimmunotherapy, and
gene therapy together with advances in diagnostic procedures
may change palliative results to curative achievements in the
future. This review comprehensively discusses current options,
challenges, possible strategies, and future directions in managing
patients with osteosarcoma.
Available from: Masoud Roudbari
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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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