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Limb conservation using non vascularised fibular grafts
B Omololu, SO Ogunlade, TO Alonge
West African Journal of Medicine , 2002,
Abstract: This paper highlights the use of non-vascularised fibular graft in limb reconstruction from bone loss due to trauma and infection. Bone loss can occur from severe high velocity injuries due to road traffic accidents, severe neglected infections, and osteolytic tumours. In majority of cases, the surgeon is left with the only option of an amputation especially where there is no access to microvascular surgery and microvascular bone grafting devices. This is a major problem in the West African subregion hence the need for this article. We present illustrative cases of limb conservation in an adult involved in a high velocity trauma and a child with a destructive osteolytic infection culminating in bone loss. The patients are still been followed up in our surgical outpatient clinics.
En bloc excision and autogenous fibular reconstruction for aggressive giant cell tumor of distal radius: a report of 12 cases and review of literature
Raghav Saini, Kamal Bali, Vikas Bachhal, Aditya K Mootha, Mandeep S Dhillon, Shivinder S Gill
Journal of Orthopaedic Surgery and Research , 2011, DOI: 10.1186/1749-799x-6-14
Abstract: Twelve patients with a mean age of 34.7 years (21-43 years) with Campanacci Grade II/III GCT of distal radius were managed with wide excision of tumor and reconstruction with ipsilateral nonvascularised fibula, fixed with small fragment plate to the remnant of the radius. Primary autogenous iliac crest grafting was done at the fibuloradial junction in all the patients.Mean follow up period was 5.8 years (8.2-3.7 years). Average time for union at fibuloradial junction was 33 weeks (14-69 weeks). Mean grip strength of involved side was 71% (42-86%). The average range of movements were 52° forearm supination, 37° forearm pronation, 42° of wrist palmerflexion and 31° of wrist dorsiflexion with combined movements of 162°. Overall revised musculoskeletal tumor society (MSTS) score averaged 91.38% (76.67-93.33%) with five excellent, four good and three satisfactory results. There were no cases with graft related complications or deep infections, 3 cases with wrist subluxation, 2 cases with non union (which subsequently united with bone grafting) and 1 case of tumor recurrence.Although complication rate is high, autogenous non-vascularised fibular autograft reconstruction of distal radius can be considered as a reasonable option after en bloc excision of Grade II/III GCT.Giant cell tumor is a benign aggressive bone tumor of obscure origin presenting in 3rd and 4th decade of life, and carries a definite female preponderance [1]. After distal femur and proximal tibia, distal radius happens to be the most common site of occurrence for GCT [1,2]. This site has a further distinction of having more aggressive behaviour of GCT with higher chances of recurrences and malignant transformation [3,4]. Treatment options for GCT at this site include curettage with bone grafting or cementing, en bloc excision and reconstruction with non vascular or vascular fibular autograft, osteoarticular allograft, ulnar translocation, or endoprosthesis [5-14]. Although amputation would seem likely to
Ressec??o ampla e transposi??o fibular no tratamento do TCG da extremidade distal do rádio
Guedes, Alex;Baptista, Pedro Péricles Ribeiro;Santili, Cláudio;Yonamine, Eduardo Sadao;Garcia, Hélio Rubens Polido;Martinez, Emília Cardoso;
Acta Ortopédica Brasileira , 2009, DOI: 10.1590/S1413-78522009000300010
Abstract: objective: to functionally and oncologically assess the treatment of gct on radius distal end (stage b3) following wide resection and reconstruction with avascular autologous graft from proximal fibular end. methods: the residual function was assessed using isols score, measurement of the global residual arch of the operated wrist, residual percentage of the hand apprehension strength between thumb and index fingers. the oncologic monitoring was assessed by clinical examination of the operated limb and by imaging tests of the wrist and thorax. results: 17 patients were assessed: 10 females (58.8%) and seven males (41.2%), with aged ranging from 16 to 61 years (mean: 32.3 years), all of them right-handed. on the functional assessment (isols), the results were as follows: 11 excellent, two good, and one poor. the three cases requiring arthrodesis evolved with excellent scores. the global residual arch was 196.2 ± 116.6o. the residual arch of the operated wrist corresponded to 58.9% of the control. the "pinch" percentage was 80.6 ± 14.8 % of control. we did not find recurrences or metastasis in this case series. conclusion: this technique provided encouraging functional results, assuring patients' return to their usual activities. the absence of local recurrence and/or metastasis found even in the patients with longer follow-up times allow us to suggest this technique, which seems to be safe for oncologic control of the tumor.
Osteoclastoma of Proximal Ulna―Atypical Location in a 13-Year-Old Child  [PDF]
Siddaram Patil, Ranjit Kumar Yalamanchili
Open Journal of Orthopedics (OJO) , 2014, DOI: 10.4236/ojo.2014.43009
Abstract: Giant cell tumour (GCT) or osteoclastoma is a very rare locally invasive bone tumour that occurs close to the joint. The ulnar metaphysis is an unusual site for an Osteoclastoma with occurrence rate of 0.45% to 3.2% as reported in literature [1]. Most of the patients seek traditional methods of treatment before orthopaedic consultation and present lately with extensive involvement of the tumour into soft tissues and articular surface, making the joint preservation difficult or impossible. For reconstruction, several options have been described, which include fibular autografts, allografts and cement augmentation. Inherent to all these procedures is the risk of delayed union of the graft and preserving functional mobility of the joint. We report a rare case of a proximal ulna GCT diagnosed in a 13-year-old girl. It was treated with intralesional curettage, and autologous maternal iliac crest bone grafting augmented with bone cement reconstruction.
Distal Recurrence of Periosteal Osteosarcoma After Complete Excision of Proximal Primary Tumour With Good Excision Margins  [PDF]
M. J. Barakat,C. Collins,J. H. Dixon
Sarcoma , 2003, DOI: 10.1080/13577140310001607310
Abstract: We present this case of an unusual recurrence of a periosteal osteosarcoma in the distal right tibia 2 years after a successful proximal right tibia primary periosteal osteosarcoma excision with a successful fibular graft. This recurrence lead to a right below-knee amputation.
Distal tibial metaphyseal fractures: the role of fibular fixation
R. Varsalona,G. T. Liu
Strategies in Trauma and Limb Reconstruction , 2006, DOI: 10.1007/s11751-006-0005-1
Abstract: Distal tibial extra-articular fractures are often a result of complex high-energy trauma, which commonly involves associated fibular fractures and soft tissue injury. The goal of tibial fixation is to maximise fracture stability without increasing soft tissue morbidity from surgical intervention. The role of adjunctive fibular fixation in distal tibial metaphyseal fractures has been controversial; although fibular fixation has been shown to improve stability of distal tibial fractures, there has been increased potential for soft tissue-related complications and a delay to tibial fracture healing. Adjunctive fixation of concomitant fibular fractures without associated syndesmotic or ankle pathology is not necessary in surgically stabilised extra-articular metaphyseal fractures of the distal tibia.
Reconstruction of the Distal Radius following Tumour Resection Using an Osteoarticular Allograft  [PDF]
Katharina Rabitsch,Werner Maurer-Ertl,Ulrike Pirker-Frühauf,Thomas Lovse,Reinhard Windhager,Andreas Leithner
Sarcoma , 2013, DOI: 10.1155/2013/318767
Abstract: Reconstruction of the distal radius following tumour resection is challenging and various techniques are recorded. We retrospectively analysed the outcome of five patients (one male and four females) after reconstruction of the distal radius with osteoarticular allograft, following tumour resection. Mean followup was 32 months (range, 4–121). In three of the five patients the dominant limb was affected. Mean bone resection length was 6.5 centimetres (range, 5–11.5). Two grafts developed nonunion, both successfully treated with autologous bone grafting. No infection, graft fracture, or failure occurred. Mean flexion/extension was 38/60 degrees and mean pronation/supination was 77/77 degrees. The mean Mayo wrist score was 84 and the mean DASH score was 8, both representing a good functional result. Therefore we state the notion that osteoarticular allograft reconstruction of distal radius provides good to excellent functional results. 1. Introduction Although the distal radius is an untypical location for primary bone malignancies, about 10 percent of all giant cell tumour (GCT) affects this part of the skeleton. It represents the third most common location after the distal part of the femur and the proximal part of the tibia [1–4]. In recurrent or local aggressive cases of GCT as well as in malignant lesions, resection and subsequent reconstruction of the distal radius is indicated [2–4]. Reconstruction is challenging due to the high functional demands on the hand. Common reconstruction techniques include arthrodesis with different autografts [1, 5–9], prosthetic replacement [10–13], ulnar translocation [5, 14], arthroplasty using (vascularised [8, 15] or nonvascularised [5, 16–18]) autologous fibula graft, or osteoarticular allograft reconstructions (Figure 1) [5, 16, 17, 19–25]. Figure 1: (a–g). Preoperative X-ray (a-b) and MRI (c-d) of a 64-year-old patient with osteosarcoma of the left distal radius; X-ray 22?months after replacement with allograft (e–g). Functional outcome as well as durability is of high importance, as affected patients are generally young with high functional demand due to their long life expectancy. Therefore, we reviewed our experience in osteoarticular allografts to assess durability, complication rates, and functional outcome of this reconstruction method. 2. Material and Methods We started with searching our database for patients who received an osteoarticular allograft for reconstruction of the distal radius after tumour resection and determined age at operation, followup, resection length, complications, and revision
Ipsilateral vascularised ulnar transposition autograft for limb-sparing surgery of the distal radius in 2 dogs with osteosarcoma : clinical communication  [cached]
G.S. Irvine-Smith,R.G. Lobetti
Journal of the South African Veterinary Association , 2012, DOI: 10.4102/jsava.v77i3.364
Abstract: Canine osteosarcoma is the most commonly diagnosed primary bone tumour in the dog, affecting mainly large and giant breed dogs with the predilection site being the metaphysis of long bones, specifically the distal radius, proximal humerus, distal femur and proximal tibia and fibula. Treatment options are either palliative or curative intent therapy, the latter limb amputation or limb-sparing surgery together with chemotherapy. This article describes the use of an ipsilateral vascularised ulnar transposition autograft as well as chemotherapy in 2 dogs with osteosarcoma of the distal radius. Both dogs showed minimal complications with the technique and both survived over 381 days following the surgery. Complications seen were loosening of the screws and osteomyelitis. The procedure was well tolerated with excellent limb use. This technique is indicated for use in cases with small tumour size that have not broken through the bone cortex.
Treatment of a fibular autograft non-union with a resulting deformity by stabilization, progressive correction and callotasis using an Ilizarov fixator: a case study
Yasser Elbatrawy,Giby C. Philips
Strategies in Trauma and Limb Reconstruction , 2011, DOI: 10.1007/s11751-011-0106-3
Abstract: Bone tumours present a challenge to reconstructive surgery when the tumour breaches the physeal and periphyseal region of the growing bone. Though a host of options are available, these are not without complications. We report one such case of osteosarcoma of the tibia treated initially with wide resection of the tumour and intercalary fibular strut grafting using plate and screws. The operation was complicated by a non-union at the proximal tibio-fibular autograft junction. This leads to a multiplanar deformity with severe procurvatum at the proximal tibio-fibular graft junction, which was successfully treated by callotasis using an Ilizarov fixator. Appropriate consent was obtained from the patient and parents to publish this case report.
Fibular lengthening by Ilizarov method secondary to shortening by osteochondroma of distal tibia
A. J. Johnston,C. T. Andrews
Strategies in Trauma and Limb Reconstruction , 2008, DOI: 10.1007/s11751-007-0028-2
Abstract: Osteochondroma is the most common benign bone tumour. They most commonly affect the long tubular bones and almost half of osteochondromata are found around the knee. Osteochondroma arising from the distal metaphysis of the tibia typically result in a valgus deformity of the ankle joint secondary to relative shortening of the fibula. This case describes the use of Ilizarov technique for fibular lengthening following excision of a distal tibial osteochondroma. A 12-year-old girl presented with a 3-year history of a large swelling affecting the lateral aspect of the right distal tibia. Plain radiographs confirmed a large sessile osteochondroma arising from the postero-lateral aspect of the distal tibia with deformity of the fibula and 15 mm of fibular shortening. The patient underwent excision through a postero-lateral approach and subsequent fibular lengthening by Ilizarov technique. The patient made excellent recovery with removal of frame after 21 weeks and had made a full recovery with normal ankle function by 6 months. The Ilizarov method is a commonly accepted method of performing distraction osteogenesis for limb inequalities; however, this is mainly for the tibia, femur and humerus. We are unaware of any previous cases using the Ilizarov method for fibular lengthening. This case demonstrates the success of the Ilizarov method in restoring both fibular length and normal ankle anatomy.
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