Bone reconstruction after malignant tumour resection using a motorized lengthening intramedullary nail in adolescents: Preliminary results

Abstract

Purpose Bone reconstruction after malignant tumour of the lower limbs is a challenge. Our aim was to investigate the results of bone lengthening and transport using the Fitbone motorized lengthening nail. Methods Eight patients were included. Two patients had had a tumour involving soft tissue only without bone resection. In six patients, the initial bone defect was 15.5 cm (8 to 24). The first step of reconstruction had consisted of temporary fixation and a cement spacer. The second step had consisted of bone grafting in five patients. One patient was managed with bone transport. Eventually, five patients had a limb-length discrepancy (LLD) managed with bone lengthening only. Two patients had a LLD and a nonunion managed with bone transport and lengthening. Mean age at bone lengthening was 15.2 years (11 to 19). Mean follow-up was 30.5 months (10 to 48). Results In all, 11 nails were implanted in eight patients (eight femurs, three tibias). Mean length gain per procedure was 54.5 mm (30 to 80). Mean healing index was 48.4 days per cm (22.6 to 85.7). The complication rate was 18%. In two cases we observed a loose locking screw, which was revised. In all cases the lengthening involved the short bone (femur or tibia). Mean Musculoskeletal Tumor Society (MSTS) score improved from 52.7 (16.6 to 73.3) to 79.9 (63.3 to 96.6). Conclusions Bone reconstruction using a motorized intramedullary nail stands as a safe and reliable alternative after malignant tumour. It allows biological reconstruction with satisfactory clinical and radiological outcome and low complication rate. Level of evidence III

Complications common in motorized intramedullary bone transport for non-infected segmental defects: a retrospective review of 15 patients

“…To our knowledge, this study represents the largest case-series (Accadbled et al. 2019 , Baumgart et al. 1997 , Kold and Christensen 2014 ) of patients treated with a bone transport nail.…”

“…In comparison, Accadbled et al. ( 2019 ) reported successful healing with the FITBONE bone transport nail in 3 out of 3 femoral segmental bone defects after tumor resection. No tibial case series have been presented for bone transport nails, but in a recent systematic review of Ilizarov bone transport for treatment of tibial defects, the mean bone union rate was 90% (77–100) (Aktuglu et al.…”

“… 1997 , Kold and Christensen 2014 , Accadbled et al. 2019 ), and a recent systematic review has showed high complication rates in bone lengthening despite the use of externally controlled motorized bone lengthening nails (Frost et al. 2020).…”

Surgical Technique and Outcome of Joint Sparing Limb Salvage Surgery by Three-Dimensional-Printed Prothesis for Children with Osteosarcoma in Distal Femur

“…With the advancement of chemotherapy drugs and arti cial manufacturing system, joint-sparing limb salvage surgery (JSLSS) has been the standard treatment for children with osteosarcoma in order to maintain normal joint function and protect the epiphyseal plate [6]. Biological reconstruction with vascularized bular graft [9], treated autologous bone [10][11], allograft combined bula allograft [12] and segmental transport [13] would be acceptable techniques for this kind of patients. But, these reconstruction techniques would be usually associated with frequent complications, such as graft resorption, nonunion, pathological fractures and insu cient demand of weight-bearing [14].…”

Surgical Technique and Outcome of Joint Sparing Limb Salvage Surgery by Three-dimensional-printed Prothesis for Children With Osteosarcoma in Distal Femur

“…With the advancement of chemotherapy drugs and arti cial manufacturing system, joint-sparing limb salvage surgery (JSLSS) has been the standard treatment for children with osteosarcoma in order to maintain normal joint function and protect the epiphyseal plate [6]. Biological reconstruction with vascularized bular graft [9], treated autologous bone [10][11], allograftcombined bula allograft [12]and segmentaltransport [13] would be acceptable techniques for this kind of patients. But, these reconstruction techniques would be usually associated with frequent complications, such as graft resorption,nonunion, pathological fractures and insu cient demand of weight-bearing [14].…”