- Long-term Results of Intercalary Endoprosthetic Short Segment Fixation Following Extended Diaphysectomy. [Journal Article]
- OOrthopedics 2017 Nov 01; 40(6):e964-e970
- Intercalary endoprosthetic reconstruction following diaphyseal resection of osseous tumors offers functional advantages through preservation of native joints adjacent to the resected defect. Use of s…
Intercalary endoprosthetic reconstruction following diaphyseal resection of osseous tumors offers functional advantages through preservation of native joints adjacent to the resected defect. Use of such implants is restricted by the amount of bone available for stem fixation adjacent to the defect. This study aimed to determine whether short osseous segment fixation with acceptable outcomes and complication rate can be reliably achieved with a customized intercalary endoprosthesis following extended diaphysectomy. A retrospective review of prospectively collected data was performed on 6 patients receiving customized anchor plugs for short segment fixation with a double compressive osseointegration intercalary implant to reconstruct segmental defects. Five of the implants were augmented with cement to support fixation in metaphyseal bone. Patient age at surgery ranged from 12 to 86 years. At mean follow-up of 39 months, mean Musculoskeletal Tumor Society functional score was 26.3, with 5 of 6 patients achieving scores of 27 or greater. Stable fixation was achieved in all patients, with the shortest segment of bone 3.7 cm in length. Three mechanical implant failures requiring revision surgery occurred. No patient required revision of the entire implant, secondary adjacent joint replacement, or secondary amputation. No patient exhibited aseptic loosening, and no case was complicated by infection. Excellent functional outcomes were seen with follow-up out to 9 years. This suggests that cement-augmented double compressive osseointegration intercalary endoprosthetic reconstruction can extend the benefits of intercalary replacement to many patients who otherwise might require adjacent joint or physeal sacrifice. However, patients should be counseled on the high risk of implant failure with subsequent need for revision surgery. [Orthopedics. 2017; 40(6):e964-e970.].
- Intercalary reconstructions after bone tumor resections: a review of treatments. [Review]
- EJEur J Orthop Surg Traumatol 2017; 27(6):737-746
- An intercalary reconstruction is defined as replacement of the diaphyseal portion of a long bone after segmental skeletal resection (diaphysectomy). Intercalary reconstructions typically result in su…
An intercalary reconstruction is defined as replacement of the diaphyseal portion of a long bone after segmental skeletal resection (diaphysectomy). Intercalary reconstructions typically result in superior function compared to other limb-sparing procedures as the patient's native joints above and below the reconstruction are left undisturbed. The most popular reconstructive options after segmental resection of a bone sarcoma include allografts, vascularized fibula graft, combined allograft and vascularized fibula, segmental endoprostheses, extracorporeal devitalized autograft, and segmental transport using the principles of distraction osteogenesis. This article aims to review the indications, techniques, limitations, pros and cons, and complications of the aforementioned methods of intercalary bone tumor resections and reconstructions in the context of the ever-growing, brave new field of limb-salvage surgery.
- Aneurysmal bone cyst involving the metacarpal bone in a child. [Case Reports]
- AJAm J Orthop (Belle Mead NJ) 2015; 44(3):E68-70
- Aneurysmal bone cysts associated with tubular bones of the hand occur rarely and require particular diagnostic and therapeutic management techniques. While optimal treatment has not been established,…
Aneurysmal bone cysts associated with tubular bones of the hand occur rarely and require particular diagnostic and therapeutic management techniques. While optimal treatment has not been established, accepted treatments range from aggressive radical treatment, including en bloc resection and excision diaphysectomy with strut bone grafting, to relatively simple techniques, such as thorough curettage followed by bone graft. Aggressive treatment approaches may be optimal for the cases with articular surface involvement, full-bone invasion of the phalanx or metacarpal, or more than 1 recurrence. We report a monocentric case of aneurysmal bone cysts involving metacarpal bone in a child who achieved favorable outcome with curettage and morselized cancellous bone grafts.
- [Diaphysectomy of the proximal phalanx in quintus varus supraductus and hammer toe in children]. [Clinical Trial]
- AOActa Ortop Mex 2013 Mar-Apr; 27(2):103-8
- The most frequent foot and ankle anatomical alterations in the pediatric population are found in the little toes. Several treatments are proposed for these conditions, ranging from total phalangeal r…
The most frequent foot and ankle anatomical alterations in the pediatric population are found in the little toes. Several treatments are proposed for these conditions, ranging from total phalangeal resections, phalangeal osteotomies, osteosynthesis, and soft tissue management. We propose a surgical technique based on the diaphysectomy of the proximal phalanx and the release of soft tissues that are under tension. The purpose is to assess the functional foot results after surgical treatment consisting of proximal phalanx diaphysectomy and soft tissue release using the functional AOFAS scale in pediatric patients. A prospective, longitudinal, descriptive, non-comparative clinical study was conducted from March 2008 to December 2010, with a follow-up of up to six months. Twenty patients (35 toes) were included; 15 females and five males, with a mean age of 14.65 years. Fifteen (30 toes) had bilateral involvement; 88.56% had greater involvement of the fifth toe. The surgical indication was determined based on the degree of functional disability for gait and the type of footwear. The functional assessment was conducted using the AOFAS criteria and a subjective assessment scale with a total score of 100 to assess the metatarsophalangeal and the interphalangeal joints of the smallest toes. Scores were as follows: < 50 points, poor; 51-70 points, fair; 71-90, good, and > 91, excellent. The assessment was done preoperatively and at postoperative month six. The mean preoperative score was 73.55 and the mean postoperative score was 85.75, with a 12.2 point difference (p > 0.5). Results were: 11 excellent, seven good and two fair. There were four relapses, so a salvage procedure was performed with the Ruiz-Mora technique; excellent results were obtained in all four. One case had soft tissue infection. Proximal phalanx diaphysectomy and soft tissue release provides appropriate alignment of the affected toes and relief of soft tissues under tension, thus avoiding broad resections leading to both esthetic and functional alterations. This is a simple and effective technique for the treatment of little toe deformities as it improves function and alignment.
- Two-stage surgical treatment for non-union of a shortened osteoporotic femur. [Case Reports]
- TMTrauma Mon 2013; 18(1):32-6
- CONCLUSIONS: Two-stage treatment succeeded to restore about 20 cm of the femoral shortening in a severely osteoporotic bone. It has also succeeded in reducing the treatment time of the external fixator.
- [Surgical treatment of hand deformities in multiple enchondromatosis: a case report]. [Case Reports]
- AOActa Orthop Traumatol Turc 2006; 40(1):89-93
- Multiple enchondromatosis (Ollier's disease) is a rare disease characterized by widespread enchondromas. In general, the short tubular bones of the hand are involved, with progressive lesions resulti…
Multiple enchondromatosis (Ollier's disease) is a rare disease characterized by widespread enchondromas. In general, the short tubular bones of the hand are involved, with progressive lesions resulting in cosmetic problems and functional deformities. Diaphysectomy and reconstruction with structural autografts or allografts are usually recommended in the treatment of extensive enchondromas involving the fingers. Curettage and grafting and ray amputation are other surgical procedures that can be applied depending on the severity of involvement. A 25-year-old woman with enchondromatosis presented with severe swelling and deformities on her fingers in both hands. The majority of the lesions were managed by diaphysectomy and reconstruction with structural grafts; ray amputation, curettage and grafting were performed for more severe lesions. During a long-term follow-up (left hand 6 years, right hand 5.5 years) cosmetic and functional results were acceptable.
- Muscle flaps in the treatment of osteomyelitis of the lower extremity. [Journal Article]
- JTJ Trauma 2005; 58(5):1019-23
- Thirty three consecutive patients with chronic osteomyelitis and deficient soft tissue coverage treated with a muscle flap from 1991-1998 were reviewed retrospectively. Osteomyelitis was diagnosed by…
Thirty three consecutive patients with chronic osteomyelitis and deficient soft tissue coverage treated with a muscle flap from 1991-1998 were reviewed retrospectively. Osteomyelitis was diagnosed by positive bone cultures and radiographic changes consistent with osteomyelitis. Osteomyelitis was divided into localized <50% diameter: 24 patients and diffuse >50% diameter or infected nonunion: 9 patients. The average age was 38 (18-74). The cause of the osteomyelitis was open fracture 23, closed fracture and open reduction internal fixation 5, gunshot wound 3, burn 1, and chronic venous stasis ulcer 1. Localized osteomyelitis was treated with saucerization and coverage with a free or rotational muscle flap. Pandiaphyseal osteomyelitis was treated with a complete diaphysectomy in 3, and wide saucerization in 2. Twenty three patients were treated with a free flap and 10 with a rotational flap.A reconstructive success was considered a limb that allowed full weight bearing with a stable wound, no drainage and no recurrence of infection. Patients were evaluated for risk factors: malnutrition, renal or liver failure, alcohol abuse, immune deficiency, chronic hypoxia, malignancy, diabetes, age over 70, steroid therapy, tobacco abuse, or drug abuse. Patients were followed an average of 34 months (12-58) after surgery. A reconstructive success was achieved in 91% (20/22) of patients with local osteomyelitis and in 56% (5/9) of patients with diffuse osteomyelitis (p < 0.05). A reconstructive success was achieved in 88% (7/8) patients with no risk factors and in 78% (18/23) of patients with one or more risk factors (not significant p = 0.05).
- Proximal femoral diaphysectomy in cerebral palsy. [Journal Article]
- COContemp Orthop 1994; 29(1):52-8
- A study was conducted to evaluate the outcome of massive proximal femoral shortening in the cerebral palsy patient with severe spastic quadriplegia and hip instability. A retrospective review of 13 …
A study was conducted to evaluate the outcome of massive proximal femoral shortening in the cerebral palsy patient with severe spastic quadriplegia and hip instability. A retrospective review of 13 children (age range: three to 19 years of age) representing 18 hips treated with massive shortening of the proximal femur was conducted. Bilateral procedures were performed in five patients. All procedures were performed between February 1986 and March 1990. Radiographs were evaluated for preoperative and postoperative migration percentage (MP) and femoral neck-shaft angle (NSA). Charts were reviewed for complications and clinical results. All femoral osteotomies healed without difficulty. Clinical follow-up averaged 27.6 months. Satisfactory results occurred in all but one hip. Radiographs taken an average of 19.5 months postoperatively showed improved MP in all but one hip. The average preoperative MP was 70% and postoperative MP was 18%. Femoral NSA also was improved. Heterotopic bone formed in 13 hips but caused no significant problems. Other complications included postoperative seizure, urinary tract infection, cast sores, transient arm weakness, weight loss, pin protrusion through skin, and femur fracture after cast removal. Based on the good results and minimal complications in this series, massive femoral shortening appears to be a superior alternative to proximal femoral resection in these difficult patients.
- Aneurysmal bone cysts in the hand treated by free non-vascular transfer of metatarsal or proximal phalanx from the foot. [Case Reports]
- JHJ Hand Surg Br 1993; 18(6):736-41
- Two cases of aneurysmal bone cyst in the hand are reported. In one case the entire first metacarpal was resected and grafted using the fourth metatarsal. In the second case diaphysectomy of the middl…
Two cases of aneurysmal bone cyst in the hand are reported. In one case the entire first metacarpal was resected and grafted using the fourth metatarsal. In the second case diaphysectomy of the middle phalanx of the index digit was performed, and the proximal phalanx of the second toe was used as graft. Satisfactory length and function were maintained, the grafts remained viable and there was no donor site morbidity. Transplant of a metatarsal or toe phalanx to the hand, as a free non-vascularized graft, is a relatively straight forward operation, requires minimal refashioning of the graft, provides articular surfaces for joint reconstruction and leaves little donor site morbidity.
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- Aneurysmal bone cyst of the proximal phalanx. [Case Reports]
- JHJ Hand Surg Br 1990; 15(4):482-3
- A case of aneurysmal bone cyst of the proximal phalanx in a young boy with unfused epiphysial plates is reported. Curettage failed, so diaphysectomy and cortical bone grafting were performed, sparing…
A case of aneurysmal bone cyst of the proximal phalanx in a young boy with unfused epiphysial plates is reported. Curettage failed, so diaphysectomy and cortical bone grafting were performed, sparing the epiphysial plate. This resulted in normal length and function, and the graft remodelled completely to a normal appearance of tubular bone.