Hemicortical allograft reconstruction after resection of low-grade malignant bone tumours

Abstract

Low-grade surface tumours of bone may theoretically be treated by hemicortical resection, retaining part of the circumference of the cortex. An inlay allograft may be used to reconstruct the defect. Since 1988 we have performed 22 hemicortical procedures in selected patients with low-grade parosteal osteosarcoma (6), peripheral chondrosarcoma (6) and adamantinoma (10). Restricted medullary involvement was not a contraindication for this procedure. There was no evidence of local recurrence or distant metastasis at a mean follow-up of 64 months (27 to 135). Wide resection margins were obtained in 19 patients. All allografts incorporated completely and there were no fractures or infections. Fractures of the remaining hemicortex occurred in six patients and were managed successfully by casts or by osteosynthesis. The functional results were excellent or good in all except one patient. Hemicortical procedures for selected cases of low-grade surface tumours give excellent oncological and functional outcomes. There was complete remodelling and fewer complications when compared with larger intercalary procedures. The surgery is technically demanding but gives good clinical results.

Non-vascularised fibula grafts for reconstruction of segmental and hemicortical bone defects following meta- /diaphyseal tumour resection at the extremities

“…2), which have presumably higher consolidation rates due to the larger contact area as well as the lower extent of soft tissue dissection [7]. Similar to our results, comparable studies on hemicortical reconstructions with auto- or allografts following tumour resection showed lower non-union rates of only 0–7% [7, 33–36]. …”

Resection of Parosteal Osteosarcoma of the Distal Part of the Femur: An Original Reconstruction Technique with Cement and Plate

“…In the literature, six cases of fractures of the remaining hemi cortex and two cases of minor subcortical resorption of the graft in the report of 22 cases of hemicortical allograft reconstruction after resection of low-grade malignant bone tumors are described. Reconstruction with allograft was not judges indicated when large resection was done, as in our case [12]. We used cement and plate (LISS-SINTHES) to reconstruct the bone defect, and we think that this is a new valid and alternative technique when it is not possible to use allograft and to prevent allograft complications such as fractures and bone resorption.…”

“…In this case, the minimal focal spread into the medullar canal did not prevent to obtain a wide surgical margin. This seems possible because invasions usually involve less than 25% of the medullar canal [7, 12]. Marginal excision usually results in hemicortical defect of the bone usually reconstructed with allograft [10].…”

Computer-assisted surgery for allograft shaping in hemicortical resection

“…Deijkers et al (2002) described 22 patients with low-grade malignant bone tumors who underwent hemicortical resections. A fracture of the remaining hemicortex occurred in 6 patients: in 3 patients during the operation and in 3 others shortly afterwards.…”

“…Several studies have shown the technique to be a safe alternative to larger segmental resections for low-grade chondrosarcoma (Deijkers et al 2002), pareostal osteosarcoma (Lewis et al 2000, Pezzillo et al 2008), and adamantinoma (Agarwal et al 2007). However, several complications have been reported with this resection and reconstruction, the most important being fractures of the host bone, inadequate margins, and infection.…”