Unipolar allograft reconstruction for post-traumatic avascular necrosis of the distal tibia: A review of the literature, technique, and case series

Vier, David; Royer, Christian

doi:10.1016/j.fas.2018.04.005

Cited by 4 publications

(11 citation statements)

References 39 publications

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“…These procedures have also been used successfully in similar cases. 21 Subjectively, 8 of 10 patients were satisfied or very satisfied with the outcome. In analogy, validated outcome measurements tailored to foot and ankle function 6,15,35,38,47 showed a significant improvement compared with the preoperative values.…”

Section: Discussionmentioning

confidence: 95%

“…In addition, high-energy trauma and a slightly higher proportion of women were observed in the literature and in the study group. 1,5,7,21,[26][27][28]39 Yet, the age of the patients does not seem to have any influence as AVN in the distal tibia was also detected in the MRI of 3 children with premature posttraumatic growth arrest 16 and in 2 cases each after Salter-Harris type I 37 and type II fractures. 4,42 Finally, posttraumatic AVN may result from inadequate perfusion and venous outflow.…”

Section: Discussionmentioning

confidence: 99%

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Joint-Preserving Osteotomy of the Lateral Tibial Plafond for Posttraumatic Osteonecrosis: A Prospective Cohort Study

Rammelt,

Walther

2024

Foot Ankle Int.

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Background: Posttraumatic osteonecrosis (ON) of the lateral distal tibia is a rare but severe complication of malleolar fractures. Treatment options include ankle fusion, arthroplasty, osteotomy, and drilling but clinical data on outcomes are limited to single case reports. The aim of this study was to prospectively evaluate the outcome following joint-preserving reconstruction. Methods: Over a 10-year period, 10 patients (8 females and 2 males, average age 36 years; range, 27-68 years) with posttraumatic ON were treated with intra-articular osteotomy of the distal tibia and bone grafting. All patients initially sustained a closed pronation injury, 7 with initial tibiotalar subluxation. Chronic syndesmotic instability following initial treatment was present in 4 patients and 5 were smokers. All patients were followed for a median of 68 (range, 12-103) months, 7 returned in person for clinical and radiographic follow-up. Results: No immediate postoperative complications were seen. Secondary ankle fusion was necessary in 1 case (10%) because of progressive osteoarthritis. At the time of follow-up, anterior ankle arthritis leading to impingement and requiring cheilectomy was noted in 4 cases, partial graft necrosis, and secondary syndesmotic instability requiring revision surgery was seen in 1 case each. Compared with the preoperative values, significant improvement in the Olerud-Molander Ankle Score ( P = .012), EuroQuol-5 Score ( P = .008), and Foot Function Index (FFI-D pain, P = .028; FFI-D restriction, P = .038) was seen. Average range of motion at the ankle was 45 degrees. Conclusion: In our limited series of patients with posttraumatic ON of the lateral distal tibia, we found that joint-preserving reconstruction using an intra-articular distal tibial osteotomy with autologous bone grafting usually provided significant functional improvement and pain relief. In our cohort secondary fusions by a median 5.5-year follow-up were rare, but secondary, joint-sparing surgeries were common. Level of Evidence: Level III, prospective study.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Joint-Preserving Osteotomy of the Lateral Tibial Plafond for Posttraumatic Osteonecrosis: A Prospective Cohort Study

Rammelt,

Walther

2024

Foot Ankle Int.

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“…Although below-knee amputations for distal tibia tumors may provide excellent function with modern prostheses, limb salvage continues to be offered as a standard of care in view of psychological impact and quality of life [8,9]. A variety of procedures have been described in the literature to achieve limb salvage; however, each of them are associated with their inherent problems, namely [7], delay in weight-bearing and graft failures seen with autogenous bone grafting [12,13] as well as fibular autograft and arthrodesis [1,8,10,14]; infection and graft subsidence/lysis concerned with osteoarticular allografts [15][16][17]; distraction osteogenesis [2,14]; and also endoprosthetic reconstruction [3,[18][19][20] failing with infection or inadequate soft tissue coverage. e best option however remains debatable.…”

Section: Discussionmentioning

confidence: 99%

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

Gundavda

Agarwal

Reddy

et al. 2021

Sarcoma

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Introduction. Traditionally, centralization of the fibula with fusion across the tibiotalar joint has been used to reconstruct distal tibial defects. Although effective, it requires long periods of protected weight-bearing. The fibula or the fixation often fails before fibular hypertrophy necessitating multiple additional surgeries. A method of using ECRT with the available ipsilateral fibula (nonvascularized) to reconstruct the distal tibia defect with the aim of early return to weight-bearing was evolved. This paper documents our early experience. Patients and Methods. Four patients; with the diagnosis of osteosarcoma in 3 patients and recurrent giant cell tumor of the bone in 1 patient, underwent resection of the distal tibia for tumors between 2017 and 2019. Extracorporeally irradiated (50 Gy) distal tibia along with ipsilateral nonvascularized fibula was used to bridge the defect and fuse the tibiotalar joint. A plate was used to rigidly hold the construct. The final outcome was compared to the historical control group that underwent only pedicled ipsilateral fibula transposition and ankle arthrodesis without recycled autograft or allograft between 2009 and 2017. Oncological reconstruction and functional outcomes were compared for each group. Patient reported outcomes on the acceptability of ankle fusion; cosmesis and function were analyzed and compared between the two groups. Results. The mean resection length in the study group (4 patients) was 7.75 cm (7 to 8.5 cm). As compared to the historical cohort of 7 patients, the study population showed statistically superior results in all reconstruction, functional, and patient-reported outcomes except time to proximal junction union ( p = 0.068 ). There were no reconstruction failures, infection, or nonunions in the study group, whereas the control comparative group had 2 proximal junction nonunions and a mean time to fibular hypertrophy of 143 weeks (82 to 430 weeks) with fibula centralization. Earlier weight-bearing was allowed (mean 26.75 weeks; median 27 weeks) compared to (mean 80.75 weeks; median 80 weeks) in the control group. Conclusion. We think that ECRT with ipsilateral vascularized fibula is a promising method of reconstructing the distal tibia. The recycled autograft tibia added strength to the distal tibia construct in our study and aided the anatomical reconstruction of the distal tibia. The patient-reported outcomes for cosmesis and acceptability add to the benefits of performing this procedure. Consistent early union across the proximal junction and earlier weight-bearing were clear advantages of this method.

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“…Among them, vascularized or nonvascularized grafts and arthrodesis were first offered. 4,11,15,16 Although arthrodesis are more acceptable by patients, limb function may be severely affected given the loss of ankle motion. In recent years, the possibility of using custom-made endoprosthesis for the distal tibia has offered the potential of a functional limb salvage for more patients.…”

Section: Discussionmentioning

confidence: 99%

“…The alternative to amputation was the use of vascularized or nonvascularized grafts and arthrodesis; the limb was preserved, but its functionality significantly diminished. 4,11,15,16 Joint mobility is particularly relevant in young patients. Therefore, better local control options are needed.…”

Section: Introductionmentioning

confidence: 99%

Distal Tibial Reconstruction in the Management of Primary Bone Tumors in Children and Adolescents

Raciborska¹,

Bilska²,

Malesza³

et al. 2021

Foot Ankle Int.

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Background: Distal tibial primary bone tumors are rare, and options for limb salvage surgery are limited and challenging. Importantly, local control has shown to be crucial and necessary for cure, and radical surgery is one of the most important components of therapy for some bone sarcomas. We investigated the feasibility and functional and oncological outcomes of distal tibial reconstruction using endoprosthesis in children with malignant bone tumors. Methods: Fourteen patients (median age 13.6 years) with primary bone tumors (4 Ewing sarcoma [ES], 10 osteosarcoma) of the distal tibiae were treated during 2013-2019. All patients had reconstruction using a modular (13 patients) or expandable custom-made titanium bone replacement system (1 patient). All patients received chemotherapy before and after surgery. Results: Twelve patients (85.7%) are alive with a median follow-up 20 months from diagnosis. Five-year estimates of event-free survival and overall survival were 60.6% and 76.4%, respectively. Three patients had postoperative complications requiring second surgery. Maximum dorsiflexion and plantar flexion of the foot were 20 degrees (range 0-20 degrees) and 20 degrees (range 5-20 degrees), respectively. Conclusion: For select distal tibial sarcomas, after neoadjuvant chemotherapy pretreatment and radical resection, reconstruction using an endoprosthesis as a radical surgery provides an option was associated with a low rate of short-term local complications and relatively good early function. Level of Evidence: Level IV, therapeutic study.

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Unipolar allograft reconstruction for post-traumatic avascular necrosis of the distal tibia: A review of the literature, technique, and case series

Cited by 4 publications

References 39 publications

Joint-Preserving Osteotomy of the Lateral Tibial Plafond for Posttraumatic Osteonecrosis: A Prospective Cohort Study

Joint-Preserving Osteotomy of the Lateral Tibial Plafond for Posttraumatic Osteonecrosis: A Prospective Cohort Study

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

Distal Tibial Reconstruction in the Management of Primary Bone Tumors in Children and Adolescents

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