Abstract

BackgroundThe reconstruction of an intercalary bone defect after a tumor resection of a long bone remains a challenge to orthopedic surgeons. Though several methods have been adopted to enhance the union of long segmental allografts or retrieved segmental autografts to the host bones, still more progresses are required to achieve a better union rate. Several methods have been adopted to devitalize tumor bone for recycling usage, and the results varied. We describe our experiences of using devitalized tumor-bearing bones for the repairing of segmental defects after tumor resection.MethodsTwenty-seven eligible patients treated from February 2004 to May 2012 were included. The segmental tumor bone (mean length, 14 cm) was resected, and then devitalized in 20 % sterile saline at 65 °C for 30 min after the tumor tissue was removed. The devitalized bone was implanted back into the defect by using nails or plates.ResultsComplete healing of 50 osteotomy ends was achieved at a median time of 11 months (interquartile range (IQR) 9–13 months). Major complications included bone nonunion in four bone junctions (7.4 %), devitalized bone fracture in one patient (3.7 %), deep infection in three patients (11.1 %), and fixation failure in two patients (7.4 %). The bone union rates at 1 and 2 years were 74.1 and 92.6 %, respectively. The average functional score according to the Musculoskeletal Tumor Society (MSTS) 93 scoring system was 93 % (IQR 80–96.7 %).ConclusionsIncubation in 20 % sterile saline at 65 °C for 30 min is an effective method of devitalization of tumor-bearing bone. The retrieved bone graft may provide as a less expensive alternative for limb salvage. The structural bone and the preserved osteoinductivity of protein may improve bone union.

Highlights

  • The reconstruction of an intercalary bone defect after a tumor resection of a long bone remains a challenge to orthopedic surgeons

  • One patient with nonunion in the proximal humerus received iliac bone grafting, and bone union was found after 9 months

  • Autograft or allograft chips were used in ten patients, but there is no significant difference between the patients with grafting and those without about union rate and union time

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Summary

Introduction

The reconstruction of an intercalary bone defect after a tumor resection of a long bone remains a challenge to orthopedic surgeons. A more accurate resection of the tumor allows a nearby joint to be preserved in some patients with a tumor adjacent to it without increasing the local recurrence rate. Several surgical techniques may be applied to reconstruct large defects of long bones after tumor resection. These techniques include intercalary prostheses [4], allografts [5], devitalized tumor-bearing bones [6], and the induced membrane technique [7]. The shape of the devitalized bone and the osteoinductivity of proteins in the bone may be preserved by several devitalization methods, which may facilitate bone union and make these methods favorable options for intercalary bone reconstruction [6]

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