BackgroundThe reconstruction of an intercalary bone defect after a tumor resection of a long bone remains a challenge to orthopedic surgeons. Though several methods have been adopted to enhance the union of long segmental allografts or retrieved segmental autografts to the host bones, still more progresses are required to achieve a better union rate. Several methods have been adopted to devitalize tumor bone for recycling usage, and the results varied. We describe our experiences of using devitalized tumor-bearing bones for the repairing of segmental defects after tumor resection.MethodsTwenty-seven eligible patients treated from February 2004 to May 2012 were included. The segmental tumor bone (mean length, 14 cm) was resected, and then devitalized in 20 % sterile saline at 65 °C for 30 min after the tumor tissue was removed. The devitalized bone was implanted back into the defect by using nails or plates.ResultsComplete healing of 50 osteotomy ends was achieved at a median time of 11 months (interquartile range (IQR) 9–13 months). Major complications included bone nonunion in four bone junctions (7.4 %), devitalized bone fracture in one patient (3.7 %), deep infection in three patients (11.1 %), and fixation failure in two patients (7.4 %). The bone union rates at 1 and 2 years were 74.1 and 92.6 %, respectively. The average functional score according to the Musculoskeletal Tumor Society (MSTS) 93 scoring system was 93 % (IQR 80–96.7 %).ConclusionsIncubation in 20 % sterile saline at 65 °C for 30 min is an effective method of devitalization of tumor-bearing bone. The retrieved bone graft may provide as a less expensive alternative for limb salvage. The structural bone and the preserved osteoinductivity of protein may improve bone union.

Background Because of the anatomic complexity of the pelvis, there is no standard surgical treatment for giant cell tumors (GCTs) of the pelvic bones, especially in the periacetabular region. Treatment options include intralesional curettage with or without adjunctive techniques and wide resection. The best surgical treatment of a pelvic GCT remains controversial.

Purpose The aim of this article is to summarize our experience in treating sacral wound complications after sacrectomy. We focus, in particular, on factors associated with wound complications, including surgical site infection (SSI) and wound dehiscence. Methods The definition of SSI devised by Horgan et al. was applied. Wound dehiscence was defined as a wound showing breakdown in the absence of clinical signs meeting the diagnostic standard for SSI. Between September 1997 and August 2009, 387 patients with a sacral tumor underwent sacrectomy performed by the same team of surgeons and were followed up for C12 months. Potential risk factors were evaluated for univariate associations with SSI and wound complications. Multivariable conditional logistic regression was used to identify the combined effects of several risk factors. Results Of the 387 wounds studied, 274 healed uneventfully, and 113 (29.2 %) broke down because of infection or dehiscence. Fifty-one (13.2 %) patients developed a postoperative SSI, and 62 (16.0 %) patients developed wound dehiscence. Gram-negative bacteria grew in 45 cultures (91.8 %) and included 38 cases of Escherichia coli. Previous radiation, rectum rupture, longer duration of surgery, and cerebrospinal fluid leakage were significantly associated with increased likelihood of developing an SSI. Previous radiation, rectum rupture, age \40 years, history of diabetes mellitus, maximum tumor diameter C10 cm, and instrumentation used were risk factors for wound complications. Conclusions The incidence of wound complications is not so high at a musculoskeletal tumor center with surgeons experienced in treating sacral tumors. Controlling for these risk factors when possible may improve clinical outcomes.

Twenty-one patients underwent excision of a Campanacci grade III giant cell tumour of the distal radius and had reconstruction using a proximal fibula autograft. We compared the functional results of wrist arthrodesis versus arthroplasty. All 21 patients healed in an average of 8 months, and all have remained disease free. The Musculoskeletal Tumor Society 93, the Disabilities of the Arm, Shoulder, and Hand scores and the grip strength of the operated wrist compared with the contralateral wrist were 93%, 7, and 71% for the arthrodesis group and 83%, 17, and 40% for the arthroplasty group. Arthrodesis of the reconstructed radiocarpal joint provided better grip strength and functional outcomes than arthroplasty. Level of evidence: III

We determined the efficacy of a devitalised autograft (n = 13) and allograft (n = 16) cortical strut bone graft combined with long-stem endoprosthetic reconstruction in the treatment of massive tumours of the lower limb. A total of 29 patients (18 men:11 women, mean age 20.1 years (12 to 45) with a ratio of length of resection to that of the whole prosthesis of > 50% were treated between May 2003 and May 2012. The mean follow-up was 47 months (15 to 132). The stem of the prosthesis was introduced through bone graft struts filled with cement, then cemented into the residual bone. Bone healing was achieved in 23 patients (86%). The mean Musculoskeletal Tumour Society functional score was 85% (57 to 97). The five-year survival rate of the endoprostheses was 81% (95% confidence intervals 67.3 to 92.3). The mean length of devitalised autografts and allografts was 8.6 cm (5 to 15), which increased the ratio of the the length of the stem of the prosthesis to that of the whole length of the prosthesis from a theoretical 35% to an actual 55%. Cortical strut bone grafting and long-stem endoprosthetic reconstruction is an option for treating massive segmental defects following resection of a tumour in the lower limb. Patients can regain good function with a low incidence of aseptic loosening. The strut graft and the residual bone together serve as a satisfactory bony environment for a revision prosthesis, if required, once union is achieved.