Non-vascularized Fibular Graft Research Articles

Management of Forearm Nonunion

Forearm nonunion is rare but a possible complication after standard treatment of the fracture of radius and ulna. The importance of precise restoration of length and anatomical relationship of both bones are among usual concerns. The situation is more complex when the infection is present in the union site. The several techniques have been applied to manage forearm nonunion consisting of osteosynthesis and using cancellous autograft, allograft, nonvascularized fibular graft, fibular flap, bone transport, induced membrane (Masquelet technique), and pedicled flap such as posterior interosseous and radial forearm bone flap (RFBF). Reviewing the recent studies focusing on treating forearm nonunion is the purpose of this review.

Fibular regeneration following fibulectomy in children- evaluation minimum two years after fibular harvest

Background the literature on fibular regeneration once procuring non-vascularized fibular grafts in child continuous to be scanty. The non-vascularized fibular graft has distinction of fibular regeneration occurring at the donor area.Material and methods retrospectively analyzed the fibular regeneration at the donor leg following harvest of non-vascularized fibular graft. These patients had minimum 2 years follow up. The radiological regeneration was made in percentage by calculating the area of both operated and normal limb.Results A total of 30 patients were evaluated. The average patient age was 9.56 years. No pain or neuromuscular deficit in the operated limb. The mean follows up of 39.4 months. The continuity of the fibula in the longitudinal was restored in 27 cases.

Union, complication, reintervention and failure rates of surgical techniques for large diaphyseal defects: a systematic review and meta-analysis

To understand the potential and limitations of the different available surgical techniques used to treat large, long-bone diaphyseal defects by focusing on union, complication, re-intervention, and failure rates, summarizing the pros and cons of each technique. A literature search was performed on PubMed, Web of Science, and Cochrane databases up to March 16th, 2022; Inclusion criteria were clinical studies written in English, of any level of evidence, with more than five patients, describing the treatment of diaphyseal bone defects. The primary outcome was the analysis of results in terms of primary union, complication, reintervention, and failure rate of the four major groups of techniques: bone allograft and autograft, bone transport, vascularized and non-vascularized fibular graft, and endoprosthesis. The statistical analysis was carried out according to Neyeloff et al., and the Mantel–Haenszel method was used to provide pooled rates across the studies. The influence of the various techniques on union rates, complication rates, and reintervention rates was assessed by a z test on the pooled rates with their corresponding 95% CIs. Assessment of risk of bias and quality of evidence was based on Downs and Black’s “Checklist for Measuring Quality” and Rob 2.0 tool. Certainty of yielded evidence was evaluated with the GRADE system. Seventy-four articles were included on 1781 patients treated for the reconstruction of diaphyseal bone defects, 1496 cases in the inferior limb, and 285 in the upper limb, with trauma being the main cause of bone defect. The meta-analysis identified different outcomes in terms of results and risks. Primary union, complications, and reinterventions were 75%, 26% and 23% for bone allografts and autografts, 91%, 62% and 19% for the bone transport group, and 78%, 38% and 23% for fibular grafts; mean time to union was between 7.8 and 8.9 months in all these groups. Results varied according to the different aetiologies, endoprosthesis was the best solution for tumour, although with a 22% failure rate, while trauma presented a more composite outcome, with fibular grafts providing a faster time to union (6.9 months), while cancellous and cortical-cancellous grafts caused less complications, reinterventions, and failures. The literature about this topic has overall limited quality. However, important conclusions can be made: Many options are available to treat critical-size defects of the diaphysis, but no one appears to be an optimal solution in terms of a safe, satisfactory, and long-lasting outcome. Regardless of the bone defect cause, bone transport techniques showed a better primary union rate, but bone allograft and autograft had fewer complication, reintervention, and failure rates than the other techniques. The specific lesion aetiology represents a critical aspect influencing potential and limitations and therefore the choice of the most suitable technique to address the challenging large diaphyseal defects.

Évaluation de la régénération de la fibula après prélèvement chez les patients atteints de tumeurs osseuses bénignes : étude rétrospective comparant différents groupes d’âge

IntroductionUsing non-vascularized fibula as autogenous graft has gained much success in reconstruction after tumor resection owing to its simplicity. Donor-site morbidity related to fibula deficiency include valgus ankle, chronic pain and stress fractures of the ipsilateral tibia. HypothesisGrowth potential before skeletal maturity is the most important factor promoting fibular regeneration after non-vascularized harvesting, and its decline with skeletal maturity causes failure of fibular regeneration. Patients and methodsThis is a retrospective study of the patients with benign bone tumors who required bone defect reconstruction by non-vascularized fibular graft utilizing a periosteal preserving technique. The study entailed 118 patients below the age of 12, 100 age 12–18, and 80 above the age of 18 years. ResultsIn children below 12 years, regeneration was complete in 95%, incomplete in 4.2% and partial in 0.8% of the cases. In adolescents, regeneration was complete in 72%, incomplete in 15% and partial in 13% of the cases. After skeletal maturity, no regeneration occurred in 92.5%of the patients, while partial regeneration occurred in 7.5% of the cases. Valgus ankle occurred in 2.8% of the cases before skeletal maturity, and none in older patients. DiscussionComplete regeneration after non-vascularized fibula graft harvesting is the rule in pediatric patients and to a lesser extent in adolescent group. This is usually associated by near normal regaining of the regenerate strength and function. Non-regeneration dominates in older age group. The length of the harvested segment has no impact on the regeneration or the remodeling process. Level of evidenceIV; case series, retrospective comparative study.

Autologous Nonvascularized Fibula Graft and Locking Compression Plating for Failed Fixation of Humeral Shaft With Atrophic Gap Nonunion.

IntroductionThe surgical treatment of humeral shaft atrophic, gap nonunion following failed surgical fixation is challenging. We intended to evaluate the surgical outcome of failed fixation of humeral shaft atrophic, gap nonunions using locking compression plate (LCP) and autologous nonvascularized fibular graft (ANVFG) and autologous iliac crest bone graft (AICBG). MethodsThrough our database search between 2015 and 2018, we identified 12 patients with humeral shaft atrophic, gap nonunions with failed surgical fixation underwent open reduction and internal fixation using LCP with autologous fibula graft and iliac crest cancellous bone graft. ResultsWe have followed all twelve patients for a minimum period of 24 months. All patients had radiological and clinical union with a mean time to union of 17 weeks. In one case superficial surgical site infection was noted and successfully treated with intravenous antibiotics, and in another, transient peroneal nerve palsy was identified and resolved in six months. ConclusionLCP with ANVFG and AICBG is a reliable option for “complex” diaphyseal humerus atrophic and gap non unions, especially with significant bone loss. This construct provides mechanical stability and supports biological healing in these complex fractures.

Nonvascularized fibular harvest in children: impact on donor limbs.

Nonvascularized fibular graft is commonly used in children. We investigated periosteal intactness, proportion of harvested fibula and the distal remnant for their association to regeneration and development of ankle valgus in 25 donor limbs (n = 18 patients). The fibulae were harvested from healthy legs with all possible care to preserve periosteum. Intraoperatively, periosteal breach and length of graft obtained were recorded. Follow-up radiographs at 6 months documented lateral distal tibial angle, fibular station, and longitudinal continuous regeneration of fibula in the donor limb. Limbs with and without regeneration/ankle valgus were matched for proportion of harvested length and distal remnant, respectively. Odds ratios for periosteum breach versus nonregeneration and nonregeneration versus ankle valgus were additionally calculated. The average harvest length and distal remnant were 15.1 and 4.5 cm, respectively. The periosteum intactness was maintained in 18 (72%) limbs. At 6 months follow-up, regeneration of fibula was present in 15 (60%) limbs. The postharvest-acquired ankle valgus was present in five limbs (24%). There was almost 2.5 times increased likelihood of nonregeneration, if periosteum was breached. The odds ratio for nonregeneration versus regeneration to the development of ankle valgus stood at 12 ( P = 0.0483). Periosteal breach increased the odds of nonregeneration of harvested fibula. The length of harvested segment did not appear to have significant influence on regeneration nor did distal segment on ankle valgus. The nonregeneration of fibula, however, made the limb prone to ankle valgus.

Function after Wrist Arthrodesis with Non-Vascularized Fibular Graft in Distal Radius Giant Cell Tumor: Case Series

Giant cell tumor (GCT) of bone, the most common benign locally aggressive bone tumor, accounts for 4% to 5% of all primary bone neoplasms and 20% of benign bone tumors. The distal radius is the third commonest site of involvement in about 10% of GCT cases. Due to the high recurrence rate after curettage of the more progressed lesions, most surgeons prefer en bloc resection followed by reconstruction. Cases: Three distal radius GCT Campanacci III cases underwent en bloc resection and wrist arthrodesis with non-vascularized fibular graft. The mean follow-up period was nine months (6-12 months). Patients were evaluated with the Disabilities of the Arm, Shoulder, and Hand (DASH) Score. Results: Union had been achieved in 2 patients, and implant removal was done. One patient needs cancellous bone grafting after implant removal—no sign of recurrence after one year. DASH score showed moderate disability. Conclusion: Autogenous non-vascularized fibular graft reconstruction can be considered a reasonable option after en bloc resection of distal radius GCT.
 Giant Cell Tumor (GCT) adalah tumor tulang jinak yang paling sering dijumpai, bersifat agresif secara lokal, merupakan 4-5% dari seluruh neoplasma tulang primer dan 20% dari seluruh tumor tulang jinak. Radius distal merupakan lokasi GCT terbanyak ketiga, mencakup 10% kasus GCT. Mengingat tingginya rekurensi setelah prosedur kuretase, lebih disukai reseksi en bloc diikuti rekonstruksi. Kasus: Tiga pasien GCT pada radius distal (Campanacci III) menjalani reseksi en bloc disertai arthrodesis pergelangan tangan. Follow-up rata-rata selama 9 bulan (range 6-12 bulan). Pasien dinilai menggunakan skor Disabilities of the Arm, Shoulder, and Hand (DASH). Hasil: Union tulang tercapai pada 2 pasien, dan implan telah dicabut. Satu pasien membutuhkan graft dari tulanag cancellous setelah pencabutan implan. Tidak didapatkan rekurensi pada periode follow-up satu tahun. Skor DASH menunjukkan disabilitas sedang pada ketiga pasien. Simpulan: Prosedur rekonstruksi menggunakan nonvascularized fibular graft baik dilakukan setelah reseksi en bloc pada pasien GCT radius distal.

Giant Cell Tumor of the Middle Phalanx of Ring Finger Treated with Wide Excision and Reconstruction using Non-vascularized Fibular Graft: A Rare Case Report and Review of Literature

Giant cell tumor (GCT) involving the hand, specifically the phalangeal bones, is very rare, accounting for only 2% of cases of the bone. This type of GCT is associated with more aggressive behaviour and higher recurrence and metastasis rate. We present a rare case of large GCT of the middle phalanx of ring finger in a 33 year old female. The patient was treated with wide excision and reconstruction using non-vascularized fibular graft. At her most recent follow-up time, 1 year post-surgery, the patient showed no symptoms with neither complication nor recurrence reported.

Outcome Analysis of En bloc Resection and Reconstruction by Non-vascularized Proximal Fibular Autograft in Giant Cell Tumor of Distal Radius supplemented with Brachytherapy.

Giant cell tumors of the bone are aggressive and potentially malignant lesions. Juxtaarticular giant cell tumors of the lower end radius are common and is a challenge for reconstruction after tumor excision. Several reconstructive procedures like vascularized and non-vascularized fibular graft, osteoarticular allograft, ceramic prosthesis, and megapros thesis are in use for substitution of the defect in the distal radius following resection. Here, we have analyzed the results of aggressive benign Giant cell tumor of the distal radius treated by en bloc excision and reconstruction using autogenous non-vascularized fibular graft along with brachytherapy. Eleven patients with either Campanacci Grade II or III histologically proven giant cell tumors of lower end radius were treated with en bloc excision and reconstruction with ipsilateral non-vascularized proximal fibular autograft. Host graft junction was fixed with low contact dynamic compression plate (LC-DCP) in all cases. Fixation of the head of the fibula with carpal bones and distal end of the ulna, if not resected, using K-wires at graft host junction was done. Brachytherapy was given in all 11 cases. Routine radiographs and clinical assessments regarding pain, instability, recurrence, hand grip strength, and functional status were done using Mayo modified wrist score at regular intervals. The follow-up ranged from 12 to 15 months. At last follow-up, the average combined range of motion was 76.1%. The average union time was 19 weeks. Out of 11 patients, two patients had good results, five patients had fair results, and four patient had poor results. There was no case of graft fracture, metastasis, death, local recurrence, or significant donor site morbidity. En bloc resection of giant cell tumors of the lower end radius is a widely accepted method. Reconstruction with non-vascularized fibular graft and internal fixation with LC-DCP along with brachytherapy minimizes the problem and gives satisfactory functional results with no recurrence.

Functional outcome following excision of giant cell tumour of the distal radius and reconstruction by autologous non-vascularized osteoarticular fibula graft.

Giant cell tumour (GCT) of the bone is a benign but locally aggressive tumour, commonly occurs at the metaphyseal-epiphyseal junction of the distal femur, proximal tibia, and distal radius. For Campanacci grade II and III lesions of the distal radius and in cases of recurrence, we usually carry out wide resection and reconstruction. There are numerous publications on the treatment of GCT of the distal radius. Still, reports on the functional outcome using non-vascularized fibular graft arthroplasty without fusion remain limited. We reviewed patients who underwent wide resection and non-vascularized fibular graft arthroplasty from 2007 to May 2014. The assessment was done with Musculoskeletal Tumour Society Score (MSTS), Toronto Extremities Scoring System (TESS) and Disability of the Arm, Shoulder and Hand (DASH) scores. We also reviewed the radiographic results. Fifteen patients were recruited, of whom 10 cases used ipsilateral fibular graft and five used contralateral non-vascularized fibular graft. The average duration of follow up was 6years (3.25-9.92 years). The average grip strength was 48.1% compared to the non-operated hand. The average MSTS score was 78.4 %, TESS score was 84%, and DASH score was 25.2. The average time to radiological union was 12.5 weeks. 64% (29-78%) of the range of movement is preserved compared to the normal side. The complication rate was 20%. Fibula autograft arthroplasty is a feasible method of reconstruction after distal radius resection with good functional outcomes.

Giant cell tumor of distal end radius managed by en bloc resection with wrist arthrodesis using fibula bone: A novel technique

Introduction: Giant cell tumor is a benign but locally aggressive tumor typically found in the epiphysis of long bones. Patients are usually females typically presenting between ages 30 and 50. Confirm diagnosis is based on biopsy. Treatment includes radiation therapy, bisphosphonates, denosumab, extensive curettage with adjuvant treatment, and reconstruction. We managed our case by en bloc resection of the tumor with wrist arthrodesis with fibula bone. Result: The patient had a good functional grip with 80° of pronation and 60° of supination. Conclusion: Resection of the tumor along with ipsilateral nonvascularized fibular strut graft with wrist arthrodesis is a good option for wrist reconstruction and provides a good forearm function and strength.

Functional Outcome Of Delayed Presenting Fracture Neck Of Femur Managed By Cannulated Screw And Fibular Graft.

Delayed presenting Fracture neck of femur is one of the complex and challenging fracture to treat. Multiple treatment options are available with varying results. This study was conducted to assess the functional outcome of fracture neck of femur seeking medical attention several days after injury that are managed by cannulated screw and fibular. A total of 35 patients were included in the cross-sectional study performed at orthopaedic surgery department of United Medical & dental college Karachi. Adults aged 18 years and over both male and female with fracture neck of femur presenting 14 days after the injury for medical treatment were included in the study. Ethical approval was obtained from the ethical review committee and patients who provided written informed consent were included in study. Data analysis was performed through SPSS version 20. Thirty-five patients with fracture neck of femur of both sexes 25 (71.4%) male and 10 (28.6%) females were included in study. out of which 14 (40%) of the patients had sub-capital fracture and 21 (60%) patients had trans-cervical fracture neck of femur. Mean age of patients was 32.14±10.20 years. Twenty-eight (80%) patients out of 35 had excellent and good outcome, 4 (11.4%) cases had fair and 3 (8.5%) had poor outcome. Cannulated screw fixation along with non-vascularized fibular graft is effective technique to management of delayed presenting fracture neck of femur as it is easy, inexpensive and does not require any special instrumentation or expertise.

Assessment of fibular regeneration after graft harvesting in patients with benign bone tumors: A retrospective study comparing different age groups

IntroductionUsing non-vascularized fibula as autogenous graft has gained much success in reconstruction after tumor resection owing to its simplicity. Donor-site morbidity related to fibula deficiency includes valgus ankle, chronic pain and stress fractures of the ipsilateral tibia. HypothesisGrowth potential before skeletal maturity is the most important factor promoting fibular regeneration after non- vascularized harvesting, and its decline with skeletal maturity causes failure of fibular regeneration. Patients and MethodsThis is a retrospective study of the patients with benign bone tumors who required bone defect reconstruction by non-vascularized fibular graft utilizing a periosteal preserving technique. The study entailed 118 patients below the age of 12, 100 age 12–18, and 80 above the age of 18. ResultsIn children below 12, regeneration was complete in 95%, incomplete in 4.2% and partial in 0.8% of the cases. In adolescents, regeneration was complete in 72%, incomplete in 15% and partial in 13% of the cases. After skeletal maturity, no regeneration occurred in 92.5%of the patients, while partial regeneration occurred in 7.5% of the cases. Valgus ankle occurred in 2.8% of the cases before skeletal maturity, and none in older patients. DiscussionComplete regeneration after non-vascularized fibula graft harvesting is the rule in pediatric patients and to a lesser extent in adolescent group. This is usually associated by near normal regaining of the regenerate strength and function. Non-regeneration dominates in older age group. The length of the harvested segment has no impact on the regeneration or the remodeling process. Level of evidenceIV; case series, retrospective comparative study.

“Cage in Box” – A modification of AIIMS BOX technique for large gap nonunion in young patients with neglected femur neck fractures

Neck of femur fractures have often been termed as “The Unsolved Fractures”, since they have a guarded outcome even after improved understanding of biomechanics and biology of this area. Gap-nonunion is one such dreaded complication of this fracture, especially in younger (<60 years) population, where arthroplasty may not be the best go-to option.We have earlier described “The AIIMS BOX” technique to manage such cases of gap non-union in neglected neck femur fractures [1]. Here we intend to describe a more successful modification of this technique.We operated 7 cases of gap non-union with our new “Cage in Box” strategy and followed these cases for 5 years. 6 patients from this group achieved excellent to good outcomes and only 1 reported a poor outcome. All the patients, except the one with poor outcome, could walk without aid and do activities of daily living independently. 3 patients developed AVN but had no evidence of collapse. 3 patients also developed Coxa vara, but it was significant only in one case. 6/7 patients were able to squat.We describe this method in detail and feel this can be a viable option in the armamentarium of orthopedic surgeons, along with valgus osteotomy, vascularized and non-vascularized fibular strut graft as well as Meyer's Graft, to help them solve this unsolved fracture.

Wide Resection of Primary Malignant Bone Tumors of the Hand in Children and Reconstruction Using Nonvascularized Fibular Bone Graft: Case Series and Literature Review

Primary malignant bone tumors of the hand are rare in children. Resection and reconstruction of the digit are challenging and have been described in case reports. This retrospective study describes the functional and oncologic outcomes of resection and reconstruction using a nonvascularized fibular bone graft in a cohort of children. A total of 5 children were included. The mean age at diagnosis was 7.6 years (range, 1.6-12 years). Histologic diagnosis showed Ewing sarcoma in 3 and osteosarcoma in 2 patients. Four tumors were located in the metacarpal bones of the fingers, and 1 was located in the thumb. Four patients were treated with chemotherapy. All the patients were treated with wide resection and a cement spacer. This was followed by second stage reconstruction using a nonvascularized fibular bone graft. In tumors of the fingers, carpometacarpal joint fusion with a neighboring carpal bone was performed, whereas a pseudoarthrosis was created between the graft and the base of the proximal phalanx. In the thumb's case, the opposite was done, with fusion at the metacarpophalangeal joint and a pseudoarthrosis at the carpometacarpal joint. The mean follow-up duration was 5.5 years (range, 2-9 years). Surgical margins were negative in all the patients. At their latest follow-up visit, none of the patients developed systemic or local recurrence. Two complications required a revision surgery, one due to graft subluxation and the other due to nonunion. At their final follow-up examination, the mean total arc of movement was 80° (range, 60°-100°), and all the patients were able to resume their grasping and writing capabilities. The resection and reconstruction of primary malignant bone tumors of the metacarpals using a nonvascularized fibular bone graft in children can preserve the cosmesis and function of the digit without jeopardizing oncologic outcomes. Therapeutic V.

A Case Series: Non-vascularized Autologous Fibular Graft in the Treatment of Major Segmental Bone Defect after Post-traumatic at Diaphyseal Femur

BACKGROUND&#x0D; In the management of bony defects, autologous bone grafts can be used as the mechanical structure for reconstruction to restore aesthetics and function, Non-vascularized autologus fibular graft are often used to the treat large post traumatic defects caused by high-energy trauma with open fracture and nonunion cases for 1st and 2nd cases. Here we would like to present a 16-year-old woman and a 37-year-old man patients of major bone defect at the right femoral shaft region using 9 cm and 10 cm non-vascularized fibular autogenous grafts.&#x0D; &#x0D; OBJECTIVE&#x0D; The purpose of this case report was to determine the effectiveness of non-vascularized autologus fibular graft for major bone defect at the regio femoral shaft for the reconstruction of post traumatic case.&#x0D; &#x0D; MATERIAL AND METHODS&#x0D; We treat post traumatic of the major bone defect at the regio femoral shaft with 9 cm and 10 cm femoral non-vascularized autologus fibular graft and fixed by a limited contact dynamic compression plate and femoral locking plate methode by routine phisioteraphy.&#x0D; &#x0D; RESULTS&#x0D; The Patient have a good result with good functional outcome after open reduction internal fixation (ORIF) and using a non-vascularized autologus fibular graft for treating the major bone defect after post traumatic femoral shaft fracture.&#x0D; &#x0D; CONCLUSION&#x0D; Complete and comperhensive open reduction internal fixation (ORIF) with autologous non- vascularized fibular graft, stabilized fracture by limited contact dynamic compression plate for 1st patient and femoral locking plate for 2nd patient allowing with an early rehabilitation is an acceptable, Phisioteraphy and early mobilisation resulting better outcome for the patient, all of this are less expensive, can be accepted at the hospitals that limited facilities and health professionals for professional subspeciality and widely reproducible option to manage bone defects in open shaft femoral fractures to achieving union, preserving length and motion with no donor site morbidity, giving patients good functional outcome and radiologic result.&#x0D; &#x0D; KEYWORDS&#x0D; Major bone defect, non-vascularized autologus fibular graft, autologous bone grafts, femoral shaft fracture, Open Fracture, Muskuloskeletal Reconstruction, Bone Loss, Nonunion.

Rigid reconstruction with periacetabular multiple screws after the resection of malignant pelvic tumours involving the sacroiliac joint.

Reconstruction of the pelvic ring after the resection of pelvic tumours involving the sacroiliac joint is challenging. Although pedicle screw and rod system reconstructions are commonly performed, failure at the early stage has been reported. Surgical procedures Reconstruction involving two or more strong anchor screws (iliac, ischial, and pubis screws) into the residual pelvis, connecting with at least two rods with minimal bending to the residual lumbosacral vertebra and contralateral pelvis. The above reconstruction was performed for six malignant bone and soft-tissue pelvic tumours requiring Enneking type I + IV resection. A double-barreled free non-vascularized fibular graft was used in all patients, except for one. Patients were followed up for a mean period of 51months (range, 9 to 96months), and peri-operative complications, implant failure within the follow-up period, and the clinical results of surgery were investigated. The mean age of four females and two males at the initial surgery was 37.2years. One patient developed a deep wound infection. Two patients died due to metastasis of the tumor. All patients were able to walk on their own within 12weeks of surgery. There was no implant failure, except in two patients with contralateral lumbosacral rod fracture three and fouryears after surgery, for which one patient required rod replacement. The incidence of implant failure, particularly around the resection site, was low, which may be attributed to multiple periacetabular screws and rods with minimal bending. Our rigid reconstruction method enables the rapid resumption of walking.

Biological reconstruction of the proximal femur after treatment of benign lesions: comparison of functional and oncological outcomes for children and adults.

Describe and compare the functional and oncological outcomes and complications between paediatric and adult patients after intra-lesional treatment of benign tumours of the proximal femur, stabilised with an autologous non-vascularised fibular strut graft (NVFSG). Retrospective review including 54 patients with a benign histopathological diagnosis treated between 1987 and 2018. The mean age at operation was 17years (range, 3 to 37years) with a median follow-up of 39.5months (IQR 46.7months). Patients were grouped according to their age at diagnosis (< 16years versus ≥ 16years). Data collection included weight-bearing status, Musculoskeletal Tumour Society (MSTS) score, local recurrence, revision surgery and complications. Local recurrence-free survival (LRFS) and revision-free survival (RFS) were calculated and compared between groups. The median MSTS score for all patients was 98.3% (IQR 6.7%) without a statistically significant difference (p = 0.146) between both groups. The median time to full weight-bearing was 12weeks (IQR 0weeks). Local recurrence occurred in five (9%) patients. LRFS for all patients was 96% at 2years and 88% at 5years. Although local recurrence was more frequent in the paediatric group, LRFS did not significantly differ (p = 0.155, 95% CI 223.9 to 312.3) between both groups. Reoperation rate was 13% and was indicated for local recurrence, post-operative fracture, graft resorption and avascular necrosis. RFS for all patients was 90% at 2years and 85% at 5years. There was no statistically significant difference (p = 0.760, 95% CI 214.1 to 304.6) regarding RFS between both groups. The use of an autogenous NVFSG after intra-lesional curettage of benign proximal femoral lesions allows for a biological, structural stabilisation without additional osteosynthesis, hastening weight-bearing and avoiding metalwork-related complications with minimal post-operative morbidity and complications and excellent functional and oncological outcome for both children and adults.

Evaluation of patient's daily activities with Free Non-Vascularized Fibular Head Graft (FNVFHG) as a treatment after resection of proximal humeral tumors

Introduction: Free non-vascularized fibular head graft (FNVFHG) is a method in handling bone defect after wide resection of the tumor.Methods: This study used descriptive research with the sample of three cases of proximal humeral giant cell tumor that underwent bone resection and reconstructed with a free non-vascularized fibular head graft. The outcomes were measured by the Musculoskeletal Tumor Society (MSTS) score, range of motion of the shoulder, and activity of daily living.Results:Â The overall MSTS score of 3 patients was 73%. Two patients were able to perform all the shoulder motions, including flexion, extension, abduction, external rotation, internal rotation with limited range of motion, while the other patient could only perform restricted internal rotation. Two patients performed all of their daily activities with the affected extremity, including personal hygiene (tooth brushing), writing, eating, holding a glass, dressing, and riding a motorcycle. In contrast, the other patient encountered difficulty performing tooth brushing and self-feeding with the affected extremity, using the contralateral upper extremity.Conclusions: Free non-vascularized fibular head graft may serve as an option in handling bone defect after wide resection of musculoskeletal tumor at the proximal humerus. This method can be safely performed with an acceptable functional outcome.

Reconstruction of Metacarpal Bone with Giant Cell Tumour by Metatarsal Bone: A Rare Case

Giant cell tumour (GCT) of the metacarpal bone is rare, and it behaves more aggressively with a higher recurrence rate as compared to other long bones. Modalities such as bone curettage with or without bone grafting, ray amputation, or wide resection and reconstruction have been described as surgical management for this condition. Wide resection (en block) is often preferred as it has a lower recurrence rate among the rests. Reconstruction techniques options available include vascularised or non-vascularised fibular graft, iliac crest strut graft with loss of metacarpophalangeal joint function or with metatarsal substitution resulting in a more preserved function of the hand. This case report is about a 15-year-old teenager girl with a giant cell tumor of her left second metacarpal bone, which was confirmed with a plain radiograph and magnetic resonance imaging. This case report focuses the operative technique of the metacarpal reconstruction using the third metatarsal bone. The aim was to preserve hand function and cosmesis while achieving good local control of the disease without compromising the lower limb function. The transfer of osteoarticular ligamentous complex of the third metatarsal bone for the reconstruction of the second metacarpal bone defects is a possible operative procedure that provides good cosmetic and excellent functional outcomes while not compromising the donor’s foot function.