Novel \u201cdouble-strut\u201d fibula ankle arthrodesis for large tumor-related bone defect of distal tibia

Zhiqing Zhao,Rongli Yang,Xiaodong Tang,Taiqiang Yan,Wei Guo,Shun Tang

doi:10.1186/s12891-019-2742-6

Zhiqing Zhao, Rongli Yang + Show 4 more

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https://doi.org/10.1186/s12891-019-2742-6

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Abstract

BackgroundReconstruction for large bone defect of distal tibia after wide resection of tumor is difficult, and the best option remains controversial. This study presents a novel “double-strut” fibula ankle arthrodesis for this issue.MethodsNine patients with malignant or aggressive tumors of distal tibia underwent novel “double-strut” fibula ankle arthrodesis after wide tumor resection were retrospectively reviewed. We assessed the bone union time, complications and oncology outcome clinically and radiographically. The Musculoskeletal Tumor Society (MSTS) score and the Foot and Ankle Outcome Score (FAOS) were used to evaluate the functional outcome.ResultsThe average followup period was 53 ± 46 months. There was no deep infection or graft fracture observed in this series. Internal fixation loosening was found in one case. In these patients, eight achieved union at both proximal and distal junctions, while one achieved union only distally. The mean union time of the proximal junctions and distal junctions was 10.5 ± 1.6 months and 8.7 ± 2.3 months, respectively. The mean postoperative MSTS score was 83% ± 8%. The subscales of FAOS indicating the most problem was Sport and Recreation Function with a mean score of 18 ± 11. At the final follow-up, one of them (1/9, 11%) experienced local recurrence in soft tissue and received another resection surgery, and four (4/9, 44%) patients developed lung metastases.ConclusionsFor large bone defect of distal tibia, this novel “double-strut” fibula reconstruction can be a viable alternative, which is capable of achieving durable ankle fusion and functional salvaged limb with low rate of complications.

Highlights

Reconstruction for large bone defect of distal tibia after wide resection of tumor is difficult, and the best option remains controversial
Nowadays, advanced chemotherapy and surgical techniques made limb salvage possible, and previous studies have proved that limb salvage can achieve acceptable functional outcome and survival rates compared with ablative technique [5,6,7,8,9,10,11,12,13]
We described a novel “double-strut” fibula reconstruction—the non-vascularized fibula transfer was inserted to remaining tibia canal and talus, which parallels to the ipsilateral fibula—to restore limb continuity (Fig. 1)

Summary

Introduction

Reconstruction for large bone defect of distal tibia after wide resection of tumor is difficult, and the best option remains controversial. In 1987, a study conducted by Jupiter et al reported the use of a divided fibular shaft with the peroneal and medullary vessels to the proximal strut and the peroneal vessels to the distal strut for treating large defect in the femoral shaft [28] This technique named “double barrel” or “double-strut” fibula reconstruction increases the volume of bone to a given length of defect by two-fold. We described a novel “double-strut” fibula reconstruction—the non-vascularized fibula transfer was inserted to remaining tibia canal and talus, which parallels to the ipsilateral fibula—to restore limb continuity (Fig. 1) Nine patients received this new technique after tumor resection of distal tibia and achieved satisfactory results. Our study aimed to provide a viable alternative for reconstruction of large bone defect of distal tibia

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