Page 122 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

Chapter 6
Most lesions were located in the tibia (n = 54; 49%) ( gures 1A, 1B, and 1C) or femur (n = 48; 43%) ( gures 2A, 2B, and 2C). Forty-four (40%) extended from metaphyseal into diaphyseal bone, and 40 (36%) were strictly diaphyseal. The median length of the reconstruction was 8 cm (2 to 20). In most cases, <25% (n = 46; 41%) or 25% to 50% (n = 46; 41%) of the cortical circumference was resected. The mean surgical duration was 3.0 hours (standard deviation [SD] = 1.7 hours).
Allografts were laid into the defect with cortical contact and xed under compression, with the use of screws in 78 (70%) of the patients and a plate with or without additional lag screws in 20 (18%), 15 of whom had a femoral reconstruction. Plate xation was applied signi cantly more often in reconstructions of the femur (p = 0.002). No osteosynthesis was applied to 11 allografts (10%), eight of which were <8 cm in length and all of which comprised <25% of the cortex. Seventy- eight patients (70%) had additional bone grafting, with either allogeneic (n = 73; 66%) or autologous (n = 5; 5%) bone, to obtain an optimal t.
Table 1. Study data
Sex
Male
Female
Diagnosis
No. %
44 40 67 60
120
Adamantinoma 37 33
Parosteal osteosarcoma
Periosteal chondrosarcoma Chondrosarcoma, grade 1 Chondrosarcoma, grade 2 Osteosarcoma (conventional type) Periosteal osteosarcoma Chondromyxoid broma
Ewing sarcoma
Giant cell tumor of bone
High-grade surface osteosarcoma Leiomyosarcoma
Osteoblastoma
Reactive bone and cartilage formation
Aneurysmal bone cyst
Bizarre parosteal osteochondromatous proliferation Hemangioma
Low-grade osteosarcoma
Non-ossifying broma
Osteochondroma
Osteo brous dysplasia
Sarcoma not otherwise speci ed
Synovial sarcoma
18 16 8 7 7 6 6 5 6 5 6 5 2 2 2 2 2 2 2 2 2 2 2 2 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1