Outcomes and complications of organ-sparing treatment of patients with tumor and tumor-like conditions of the forearm long bones

Abstract

Introduction.Surgical treatment of tumors of the distal part of the forearm has always been complicated. Though there are many methods of reconstruction of defects of the long bones of this area after resection, the optimal technique is still debated.The study objectiveis to analyze the results of surgical treatment of tumors and tumor-like conditions of the forearm long bones, rate of postoperative complications, and techniques of their correction.Materials and methods. The article presents data on 75 patients with tumor and tumor-like conditions of the forearm long bones. Diagnosis was histologically verified. In 58 (77.3 %) patients, benign giant cell tumor was diagnosed, in 3 (4 %) patients – malignant giant cell tumor, in 3 (4 %) patients – osteogenic sarcoma, in 3 (4 %) patients – chondrosarcoma, in 6 (8 %) patients – fibrous dysplasia. All patients underwent surgical treatment of varying volume. During the study, analysis of complications of surgical treatment was performed.Results.Postoperative complications of various nature developed in 17 (22.7 %) of 75 patients between 2 weeks and 2 years after treatment. They mostly developed after segmental resection of the forearm bones with autoplasty (38.1 %) and segmental bone resection (21.4 %), as well as after excochleation with cementoplasty (16.1 %). The most frequent complications were autotransplant lysis (in 4 (19.1 %) cases), its fracture (in 2 (9.5 %) cases), and infections and inflammatory complications (in 2 (9.5 %) cases). After segmental resection with endoprosthesis, only 1 (11.1 %) patient experienced endoprosthesis head instability in the early postoperative period which led to re-endoprosthesis. Local recurrence was observed in 6 (19.4 %) of 31 patients with gigantic-cell tumors after excochleation and in 4 (28.6 %) of 14 patients after segmental resection. In 2 (14.3 %) cases, progression of the main disease was observed in the form of pulmonary metastases.Conclusion.Excochleation with cementoplasty is the method of choice in benign tumors of the forearm bones in the absence of soft-tissue component, destruction of the cortical layer, advancement of the tumor to the joint surface. In case of benign tumors in the absence of soft-tissue component and destruction of the cortical layer, and in the presence of tumor advancement to the joint surface, the optimal technique is segmental bone resection with substitution of the defect with endoprosthesis.