Distraction osteogenesis and arthrodesis as a new surgical option for chondrosarcoma in the distal tibia

Abstract

Recent advances in the management of bone tumors have led to a significant increase in the survival rates of patients with malignant bone tumors. Thus, limb salvage surgery has gained importance for preserving limb function in the management of bone tumors. However, surgery presents unique difficulties in terms of the biomechanics and obtaining a soft-tissue cover, such as when the ankle is involved in the primary malignant bone tumor. We report a case of chondrosarcoma of the distal tibia treated with wide en bloc resection arthrodesis and reconstruction of the defect using distraction osteogenesis, which offers an effective alternative protocol for limb salvage. The patient has remained disease free for 3 years since the initial surgery and can maintain normal limb athletic function.

Surgical options and reconstruction strategies for primary bone tumors of distal tibia: A systematic review of complications and functional outcome

“…Twenty-three articles [2], [15], [18], [19], [20], [21], [23], [24], [25], [26], [27] including 198 (139 osteosarcoma) patients documented the detailed survival outcome. 27 (19 osteosarcoma) of 198 patients died of disease.…”

“…Of the 33 publications selected for this review, four studies [4], [20], [21], [25] including 10 cases investigated the outcome of distraction osteogenesis for large bone defect after tumor resection of distal tibia. The mean followup time was 52.3 (range, 16–109) months.…”

“…Is it necessary to perform ankle arthrodesis? In this systematic review, twenty-one studies [2], [3], [4], [5], [6], [11], [13], [14], [15], [16], [17], [19], [20], [21], [23], [25], [26], [30], [33], [34], [35] including 142 cases of ankle arthrodesis and six studies [3], [4], [15], [18], [28], [31], [32], [34] including 111 cases of ankle joint preservation were included for comparative analysis. Most researchers hold the notion that arthrodesis was the best way to provide excellent ankle stability, and the final functional outcome further confirmed this theory.…”

“…prosthetic replacement [7], [8], [9], [10], and biological methods, i.e. autograft (vascularized or non-vascularized fibula [2], [4], [6], [11], [12], [13], [14], [15], recycled tumor-bearing bone [15], [16], [17]), allograft [3], [6], [15], [18], [19] and distraction osteogenesis [4], [20], [21]. However, the outcomes of each method are not well known as most studies with a small sample size due to its rarity.…”

Reconstructive Challenges of Distal Tibia Bone Tumors: Extracorporeally Irradiated Autograft Combined with a Nonvascularized Autograft Fibula for Superior Reconstruction and Functional Outcomes When Compared to Ipsilateral Pedicled Fibula Transfer Alone

“…Most resections include the articular surface, and reconstructions of these defects pose unique challenges including a complex bony anatomy and a thin soft tissue cover. Unlike around the knee or hip, there seems to be no reliable endoprosthetic or biological reconstruction for creating a functional joint at the ankle [1][2][3][4][5][6][7]. A below-knee amputation can give excellent functional outcomes and is therefore a suitable alternative to any reconstruction that fuses the tibiotalar joint [8,9].…”