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Saving a Child's Elbow Joint: A Novel Reconstruction for a Tumour of the Distal Humerus.

Graci C, Gaston CL, Grimer R, Jeys L, Ozkan K - Case Rep Orthop (2015)

Bottom Line: We inserted a nonvascularised fibular autograft through the middle of irradiated graft to obtain a greater stability.We have not recorded any complication associated with this technique such as nonunion, pathological fracture, infection, and bone necrosis and we obtained an excellent functional result. 10 years after surgery, the patient had no recurrence.In this way we avoid all the problems related to the adaptation of the shape and size.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics and Traumatology, University Hospital "Agostino Gemelli", School of Medicine, Catholic University of the Sacred Heart, Largo A. Gemelli 1, 00168 Rome, Italy.

ABSTRACT
Reconstruction after wide resection of a malignant bone tumor can be obtained using several techniques such as the use of prostheses, allograft, autograft, or combined procedure. We describe a 12-year-old girl with parosteal osteosarcoma of the distal right humerus treated by en bloc resection, intraoperative extracorporeal irradiation, and implantation. We inserted a nonvascularised fibular autograft through the middle of irradiated graft to obtain a greater stability. We have not recorded any complication associated with this technique such as nonunion, pathological fracture, infection, and bone necrosis and we obtained an excellent functional result. 10 years after surgery, the patient had no recurrence. Extracorporeal irradiation and reimplantation is a valid and inexpensive technique for the treatment of bone tumors when there is reasonable residual bone stock. With this procedure we have a precise fit being the patient's own bone. In this way we avoid all the problems related to the adaptation of the shape and size.

No MeSH data available.


Related in: MedlinePlus

Postoperative X-ray.
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Related In: Results  -  Collection


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fig6: Postoperative X-ray.

Mentions: Reconstructing a segmental defect at this site is fraught with difficulties. Although we have reported good results with distal humerus replacements [7], we anticipated long term complications such as aseptic loosening using this option in a 12-year-old. Reconstruction with bone transport was not attractive because of the length of time that would have been required and the associated risk of elbow stiffness. Reconstruction with strut allografts requires an adequate bone banking service and presents inherent risks of graft rejection and imperfect fit of the donated graft to the recipient bone defect. Therefore we planned to do an en bloc resection of tumor bearing bone, extracorporeal irradiation of excised bone segment to eradicate the tumoral cells, and reimplantation of the autograft with preservation of the elbow joint. We resected 10 cm of the humerus, stopping 2 cm from the elbow joint and dividing the bone a further 10 cm proximal to this. We then stripped the tumor from the bone surface and underlying intramedullary canal using osteotomes, curettes, and a burr. Samples were sent for histology and microbiology. The humerus segment was wrapped in a sterile moist swab immersed in saline containing 2 grams of vancomycin and placed in a sterile bag. This was placed in another sterile bag and was securely packed in a sterile container. This container was taken to the radiotherapy suite, where the segment bone was irradiated with 90 Gy, and the container was returned to the operation theater. Transport and irradiation took about one hour, during which time the host bone was prepared for reconstruction. The irradiated humeral segment was reimplanted, inserting a nonvascularised fibular autograft through the middle of it to provide extra stability (Figures 3 and 4). The construct was held in place with 2 plates running up each side of the humerus (Figures 5 and 6).


Saving a Child's Elbow Joint: A Novel Reconstruction for a Tumour of the Distal Humerus.

Graci C, Gaston CL, Grimer R, Jeys L, Ozkan K - Case Rep Orthop (2015)

Postoperative X-ray.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4306397&req=5

fig6: Postoperative X-ray.
Mentions: Reconstructing a segmental defect at this site is fraught with difficulties. Although we have reported good results with distal humerus replacements [7], we anticipated long term complications such as aseptic loosening using this option in a 12-year-old. Reconstruction with bone transport was not attractive because of the length of time that would have been required and the associated risk of elbow stiffness. Reconstruction with strut allografts requires an adequate bone banking service and presents inherent risks of graft rejection and imperfect fit of the donated graft to the recipient bone defect. Therefore we planned to do an en bloc resection of tumor bearing bone, extracorporeal irradiation of excised bone segment to eradicate the tumoral cells, and reimplantation of the autograft with preservation of the elbow joint. We resected 10 cm of the humerus, stopping 2 cm from the elbow joint and dividing the bone a further 10 cm proximal to this. We then stripped the tumor from the bone surface and underlying intramedullary canal using osteotomes, curettes, and a burr. Samples were sent for histology and microbiology. The humerus segment was wrapped in a sterile moist swab immersed in saline containing 2 grams of vancomycin and placed in a sterile bag. This was placed in another sterile bag and was securely packed in a sterile container. This container was taken to the radiotherapy suite, where the segment bone was irradiated with 90 Gy, and the container was returned to the operation theater. Transport and irradiation took about one hour, during which time the host bone was prepared for reconstruction. The irradiated humeral segment was reimplanted, inserting a nonvascularised fibular autograft through the middle of it to provide extra stability (Figures 3 and 4). The construct was held in place with 2 plates running up each side of the humerus (Figures 5 and 6).

Bottom Line: We inserted a nonvascularised fibular autograft through the middle of irradiated graft to obtain a greater stability.We have not recorded any complication associated with this technique such as nonunion, pathological fracture, infection, and bone necrosis and we obtained an excellent functional result. 10 years after surgery, the patient had no recurrence.In this way we avoid all the problems related to the adaptation of the shape and size.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics and Traumatology, University Hospital "Agostino Gemelli", School of Medicine, Catholic University of the Sacred Heart, Largo A. Gemelli 1, 00168 Rome, Italy.

ABSTRACT
Reconstruction after wide resection of a malignant bone tumor can be obtained using several techniques such as the use of prostheses, allograft, autograft, or combined procedure. We describe a 12-year-old girl with parosteal osteosarcoma of the distal right humerus treated by en bloc resection, intraoperative extracorporeal irradiation, and implantation. We inserted a nonvascularised fibular autograft through the middle of irradiated graft to obtain a greater stability. We have not recorded any complication associated with this technique such as nonunion, pathological fracture, infection, and bone necrosis and we obtained an excellent functional result. 10 years after surgery, the patient had no recurrence. Extracorporeal irradiation and reimplantation is a valid and inexpensive technique for the treatment of bone tumors when there is reasonable residual bone stock. With this procedure we have a precise fit being the patient's own bone. In this way we avoid all the problems related to the adaptation of the shape and size.

No MeSH data available.


Related in: MedlinePlus