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Salvage of a femoral nonunion after primary non-Hodgkin's lymphoma of bone: a case report and literature review.

Xie XT, Gao YS, Zhang CQ - Med. Sci. Monit. (2011)

Bottom Line: No recurrence of lymphoma occurred in the 61-month follow-up, nor did a stress fracture or failure of fixation.Limb salvage was achieved and the range of motion of the adjacent joints was acceptable.More cases have yet to be further investigated.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.

ABSTRACT

Background: With the advent of superb microsurgery techniques and advanced stabilization instruments, recent decades have seen great progress in treating nonunions secondary to traumatic fractures. However, those nonunions that are secondary to primary non-Hodgkin's lymphoma of bone and often related to irradiation still remain a challenging problem. The condition could be more perplexing when bone healing abilities are greatly compromised and reliable stabilization is difficult.

Case report: We performed an operation using free vascularized fibular graft in combination with a locking plate on a 47-year-old female patient who had suffered from a three-year femoral nonunion after courses of radiochemotherapy for the treatment of primary non-Hodgkin's lymphoma of bone, a spontaneous femoral shaft fracture, an intramedullary nailing, and some nonoperative interventions in sequence. Primary union of the graft was obtained at 9 months without wound infection. No recurrence of lymphoma occurred in the 61-month follow-up, nor did a stress fracture or failure of fixation. Limb salvage was achieved and the range of motion of the adjacent joints was acceptable.

Conclusions: Free vascularized fibular graft in combination with a locking plate can effectively enhance bone union in compromised bone and soft tissue milieu. More cases have yet to be further investigated.

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Related in: MedlinePlus

X-ray film following the revision performed in our institution. (A) A 9-cm FVFG and a femoral LISS plate were surgically implanted for reconstruction of the bone defect after debridement. The arrows indicate both ends of the fibular graft. At 61 months postoperatively, the X-ray (B) and coronal CT scan (C) demonstrated the gaps at graft-host junction sites disappeared and osseous continuity could be found (white arrows on X-ray films and black arrows on CT section). Hypertrophy of the fibular graft was also observed.
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f4-medscimonit-17-11-cs138: X-ray film following the revision performed in our institution. (A) A 9-cm FVFG and a femoral LISS plate were surgically implanted for reconstruction of the bone defect after debridement. The arrows indicate both ends of the fibular graft. At 61 months postoperatively, the X-ray (B) and coronal CT scan (C) demonstrated the gaps at graft-host junction sites disappeared and osseous continuity could be found (white arrows on X-ray films and black arrows on CT section). Hypertrophy of the fibular graft was also observed.

Mentions: The operation was performed under general anesthesia. First, a radical debridement was performed to ensure the removal of all necrotic or nonviable tissue in the nidus up to the bleeding tissue. The debrided bone and soft tissue were immediately collected for pathologic examination as well as microbiological testing. The wound was copiously irrigated with normal saline. Second, the screws and broken nail fragments were removed, and a 9-cm-long trough was created in the lateral cortex. Third, contralateral FVFG was harvested through a lateral approach under tourniquet control according to our previous technique [7]. The graft was 9 cm in length, leaving at least 6 cm of the distal fibula to ensure ankle stability. Fourth, the graft was placed in the slot made in the femur cortex, and a 13-hole locking plate (LISS for femur) was applied to fix both junctions (Figure 4A). After fixation was completed, an end-to-end microvascular anastomosis of the peroneal vessels with the descending branch of lateral femoral circumflex vessels was performed under guidance of an operating microscope. Finally, the wound was closed directly after insertion of drain tubes.


Salvage of a femoral nonunion after primary non-Hodgkin's lymphoma of bone: a case report and literature review.

Xie XT, Gao YS, Zhang CQ - Med. Sci. Monit. (2011)

X-ray film following the revision performed in our institution. (A) A 9-cm FVFG and a femoral LISS plate were surgically implanted for reconstruction of the bone defect after debridement. The arrows indicate both ends of the fibular graft. At 61 months postoperatively, the X-ray (B) and coronal CT scan (C) demonstrated the gaps at graft-host junction sites disappeared and osseous continuity could be found (white arrows on X-ray films and black arrows on CT section). Hypertrophy of the fibular graft was also observed.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3539489&req=5

f4-medscimonit-17-11-cs138: X-ray film following the revision performed in our institution. (A) A 9-cm FVFG and a femoral LISS plate were surgically implanted for reconstruction of the bone defect after debridement. The arrows indicate both ends of the fibular graft. At 61 months postoperatively, the X-ray (B) and coronal CT scan (C) demonstrated the gaps at graft-host junction sites disappeared and osseous continuity could be found (white arrows on X-ray films and black arrows on CT section). Hypertrophy of the fibular graft was also observed.
Mentions: The operation was performed under general anesthesia. First, a radical debridement was performed to ensure the removal of all necrotic or nonviable tissue in the nidus up to the bleeding tissue. The debrided bone and soft tissue were immediately collected for pathologic examination as well as microbiological testing. The wound was copiously irrigated with normal saline. Second, the screws and broken nail fragments were removed, and a 9-cm-long trough was created in the lateral cortex. Third, contralateral FVFG was harvested through a lateral approach under tourniquet control according to our previous technique [7]. The graft was 9 cm in length, leaving at least 6 cm of the distal fibula to ensure ankle stability. Fourth, the graft was placed in the slot made in the femur cortex, and a 13-hole locking plate (LISS for femur) was applied to fix both junctions (Figure 4A). After fixation was completed, an end-to-end microvascular anastomosis of the peroneal vessels with the descending branch of lateral femoral circumflex vessels was performed under guidance of an operating microscope. Finally, the wound was closed directly after insertion of drain tubes.

Bottom Line: No recurrence of lymphoma occurred in the 61-month follow-up, nor did a stress fracture or failure of fixation.Limb salvage was achieved and the range of motion of the adjacent joints was acceptable.More cases have yet to be further investigated.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.

ABSTRACT

Background: With the advent of superb microsurgery techniques and advanced stabilization instruments, recent decades have seen great progress in treating nonunions secondary to traumatic fractures. However, those nonunions that are secondary to primary non-Hodgkin's lymphoma of bone and often related to irradiation still remain a challenging problem. The condition could be more perplexing when bone healing abilities are greatly compromised and reliable stabilization is difficult.

Case report: We performed an operation using free vascularized fibular graft in combination with a locking plate on a 47-year-old female patient who had suffered from a three-year femoral nonunion after courses of radiochemotherapy for the treatment of primary non-Hodgkin's lymphoma of bone, a spontaneous femoral shaft fracture, an intramedullary nailing, and some nonoperative interventions in sequence. Primary union of the graft was obtained at 9 months without wound infection. No recurrence of lymphoma occurred in the 61-month follow-up, nor did a stress fracture or failure of fixation. Limb salvage was achieved and the range of motion of the adjacent joints was acceptable.

Conclusions: Free vascularized fibular graft in combination with a locking plate can effectively enhance bone union in compromised bone and soft tissue milieu. More cases have yet to be further investigated.

Show MeSH
Related in: MedlinePlus