Resection Arthrodesis of the Ankle for Aggressive Tumors of the Distal Tibia in Children

Abstract

There is no consensus on the ideal treatment for malignant tumors of the distal tibia. Many favor amputation. Thirteen children, at an average age of 12 years (8 to 16 y) sustained conservative surgical treatment for a tumor of the distal tibia. All patients had "en bloc" resection of the tumor with ankle arthrodesis achieved by nail or plate accompanied by autograft. The results were assessed retrospectively with an average follow-up of 8.8 years. Nine patients were in complete remission. Two patients had died. Two patients were lost to follow-up. Two patients had a local recurrence, which required amputation. There were 4 infections, which responded well to therapy. Four patients required additional bone grafting because of nonunion. Three patients required osteotomy for malalignment. Bone healing was achieved for the 9 patients seen at last follow-up. All were able to walk with an average functional score of 24.7/30 (23 to 26) on the Musculoskeletal Tumor Society score. Several reconstructive techniques are available: mega prosthesis of distal tibia and ankle, reconstruction by vascularized fibula or by autograft. All series reported significant rates of infections, cutaneous necrosis, and nonunion. Conservative treatment with ankle arthrodesis is a possible alternative to amputation for the management of malignant tumors of the distal tibia in selected patients. Survival results and functional outcome were good despite initial complications. This is a retrospectively therapeutic study graded level 2 as level of evidence.