Abstract
BackgroundThe reconstruction of meta−/diaphyseal bone defects following bone tumour resection is challenging, and biological treatment options should be applied whenever possible, especially in benign lesions and early stage sarcomas. We aimed to evaluate the results of segmental (SR) and hemicortical reconstructions (HR) at the extremities using non-vascularised fibula grafts.MethodsWe retrospectively enrolled 36 patients who were treated with non-vascularised fibula reconstructions (15 SR, 21 HR) after bone tumour resection (15 malignant, 21 benign). All cases were evaluated regarding consolidation, hypertrophy at the graft-host junctions, and complications; moreover, the functional and oncological results were assessed. The mean follow-up was 8.3 years (2.1–26.6 years).ResultsPrimary union was achieved in 94% (SR 87%, HR 100%) of patients, and 85% (SR 81%, HR 88%) showed hypertrophy at the graft-host junction. The overall complication rate was 36% with 4 patients (11%) developing local recurrence. There was a significant correlation between the development of mechanical complications (fracture, delayed-/non-union) and a defect size of ≥12 cm (p = 0.013), segmental defects (p = 0.013) and additional required treatment (p = 0.008). The functional outcome was highly satisfactory (mean MSTS score 86%).ConclusionsDue to encouraging results and advantages (such as their remodelling capacity at the donor site), non-vascularised fibula reconstructions should be considered a valuable alternative treatment option for patients with hemicortical defects or segmental reconstructions of less than 12 cm in which no additional neo-/adjuvant treatment is necessary.
Highlights
The reconstruction of meta−/diaphyseal bone defects following bone tumour resection is challenging, and biological treatment options should be applied whenever possible, especially in benign lesions and early stage sarcomas
There are a few reports on defect reconstructions after bone tumour resection using nonvascularised fibulae, but most of these studies did not focus on the extremities or have a rather small cohort of patients [13, 16,17,18,19,20]
Hypertrophy and biological activity Significant hypertrophy (>20%) was observed in 52% (SR 58%, hemicortical reconstructions (HR) 48%) of the evaluable graft-host junctions (102); hypertrophy of 20% or less was observed in 33% (SR 23%, HR 40%)
Summary
The reconstruction of meta−/diaphyseal bone defects following bone tumour resection is challenging, and biological treatment options should be applied whenever possible, especially in benign lesions and early stage sarcomas. The use of non-vascularised fibula grafts originated at the beginning of the twentieth century and was the gold standard for biological reconstructions for more than 60 years. Advantages of this method compared to the use of vascularised autografts consist of the remodelling capacity at the donor site, an easier operative technique and a shorter operative time [13, 14]. There are a few reports on defect reconstructions after bone tumour resection using nonvascularised fibulae, but most of these studies did not focus on the extremities or have a rather small cohort of patients [13, 16,17,18,19,20]
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