Functional outcome in reconstructions with fibula autograft in tumors of appendicular skeleton

Joji Joshua Philipose; Renjit Kumar Jayachandran

doi:10.18203/issn.2455-4510.IntJResOrthop20184377

Authors

Joji Joshua Philipose Department of Orthopaedics, Believers Church Medical College Hospital, St. Thomas Nagar, Kuttappuzha, Thiruvalla, Kerala
Renjit Kumar Jayachandran Div. of Spine and Musculoskeletal Oncology, Department of Orthopaedics, Khoula Hospital, Muscat

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20184377

Keywords:

Appendicular skeleton, Fibula autograft, Limb-sparing surgery, Reconstructions, Vascularized fibula graft

Abstract

Background: Resection by a limb-sparing surgery and restoration of bone and soft tissues makes a successful limb salvage. Several reconstructive procedures that maintain limb length and provide acceptable cosmetic and functional results include endoprosthetic reconstruction, use of allografts and/or autografts like vascular or avascular fibula graft. The objective of the study was to assess and compare the preoperative and postoperative functional and radiological outcome in patients treated with wide resection of tumors of the appendicular skeleton followed by reconstruction with fibula graft.

Methods: This retrospective and prospective comparative study was conducted in 17 patients in Amrita Institute of Medical Sciences, Kerala. The patients were followed up for a minimum of 9 months ranging to 65 months. Functional and radiological assessments were done. Wilcoxon signed ranks test was done to assess significant differences between preoperative and postoperative functional scores. The SPSS software was used to analyze the data collected.

Results: There was statistical significance as well as improvement in the postoperative functional scores (p=0.004) when compared to the preoperative status. There was no significance (2 tailed test) in postoperative functional scores between vascular and avascular fibula graft (p=1.000).

Conclusions: Fibula grafting after resection of appendicular tumors offers a wonderful technique in filling bony defects. It provides good functional outcome and better bony union. Even though the postoperative outcome is significant, there is no significant difference between vascularized and avascular fibula in terms of functional outcome, bony union and graft hypertrophy.

Metrics

Metrics Loading ...

Author Biographies

Joji Joshua Philipose, Department of Orthopaedics, Believers Church Medical College Hospital, St. Thomas Nagar, Kuttappuzha, Thiruvalla, Kerala

Orthopedics

Assistant Professor

Renjit Kumar Jayachandran, Div. of Spine and Musculoskeletal Oncology, Department of Orthopaedics, Khoula Hospital, Muscat

Sr Consultant,

Div. of Spine & Musculoskeletal Oncolory

References

Puri A. Limb salvage: When, where, and how?. Indian journal of orthopaedics. 2015;49(1):46.

Gebert C, Hillmann A, Schwappach A, Hoffmann CH, Hardes J, Kleinheinz J, et al. Free vascularized fibular grafting for reconstruction after tumor resection in the upper extremity. Journal of surgical oncology. 2006;94(2):114-27.

Sim IW, Tse LF, Ek ET, Powell GJ, Choong PF. Salvaging the limb salvage: management of complications following endoprosthetic reconstruct-tion for tumours around the knee. Euro J Surgical Oncol (EJSO). 2007;33(6):796-802.

Puri A. Limb salvage in musculoskeletal oncology: Recent advances. Indian journal of plastic surgery: official publication of the Association of Plastic Surgeons of India. 2014;47(2):175.

Kim MB, Lee YH, Baek JK, Choi HS, Baek GH. Reconstruction of Large Femur and Tibia Defect with Free Vascularized Fibula Graft and Locking Plate. Arch Reconstruct Microsurg. 2015;24(2):68-74.

Bae DS, Waters PM, Gebhardt MC. Results of free vascularized fibula grafting for allograft nonunion after limb salvage surgery for malignant bone tumors. J Pediatr Orthop. 2006;26(6):809-14.

Malizos KN, Beris AE, Xenakis TA, Korobilias AB, Soucacos PN. Free vascularized fibular graft: a versatile graft for reconstruction of large skeletal defects and revascularization of necrotic bone. Microsurgery. 1992;13(4):182-7.

Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Related Res. 1993;286:241-6.

Aboulafia AJ, Malawer MM. Surgical management of pelvic and extremity osteosarcoma. Cancer. 1993;71(S10):3358-66.

Dimitriou R, Jones E, McGonagle D, Giannoudis PV. Bone regeneration: current concepts and future directions. BMC Med. 2011;9(1):66.

Houdek MT, Wagner ER, Bishop AT, Shin AY, Rose PS, Sim FH, Moran SL. Complications and long-term outcomes of free fibula reconstruction following resection of a malignant tumor in the extremities. Plastic Reconstruct Surg. 2017;139(2):510e-9e.

Nakamura T, Abudu A, Grimer RJ, Carter SR, Jeys L, Tillman RM. The clinical outcomes of extracorporeal irradiated and re-implanted cemented autologous bone graft of femoral diaphysis after tumour resection. Int Orthop. 2013;37(4):647-51.

Yoo MC, Kim KI, Hahn CS, Parvizi J. Long-term followup of vascularized fibular grafting for femoral head necrosis. Clin Orthop Related Res. 2008;466(5):1133-40.

Plakseychuk A. CORR Insights®: Free Vascularized Fibular Grafting Improves Vascularity Compared With Core Decompression in Femoral Head Osteonecrosis: A Randomized Clinical Trial. Clin Ortho Related Res. 2017;475(9):2241-4.

Krieg AH, Lenze U, Gaston MS, Hefti F. The outcome of pelvic reconstruction with non-vascularised fibular grafts after resection of bone tumours. J Bone Joint Surg Br. 2010;92(11):1568-73.