Page 98 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

Chapter 5
Eighty-seven patients (46 male patients and 41 female patients) with a median age of 17 years (1.5 to 77.5) matched our inclusion criteria. Twenty-eight patients (32%) were younger than 14 years of age and 44 patients (51%) were younger than 18 years of age. The most common diagnoses were osteosarcoma (34 patients [39%]), Ewing sarcoma (17 patients [20%]), adamantinoma (15 patients [17%]), and chondrosarcoma (11 patients [13%]). Fifty-two patients (60%) received chemotherapy (34 for conventional osteosarcoma, 17 for Ewing sarcoma, and one for juxta-cortical osteosarcoma, according to EURAMOS [European and American Osteosarcoma Study Group] or Euro-EWING protocol), and nine patients (10%) underwent radiation therapy. The median follow-up was 84 months (25 to 262). Fifty-seven patients (66%) had follow-up for more than ve years and 29 patients (33%) had follow-up for more than ten years ( gure 2).
Tumor localizations included the femur (44 patients [51%]), the tibia (34 patients [39%]), the humerus (seven patients [8%]), and the radius (two patients [2%]). Twenty reconstructions (23%) were located in the proximal third of the bone and 24 reconstructions (28%) were located in the distal third of the bone. The remaining 43 reconstructions (49%) were diaphyseal. Thirty- ve reconstructions (40%) spanned diaphysis to metaphysis, and nine reconstructions (10%) also a ected the epiphysis. The median allograft reconstruction length (and standard deviation) was 14.0 ± 4.8 cm (5.0 to 30.0) and did not di er signi cantly among reconstructions of femur (16.0 cm), tibia (14.0 cm), humerus (14.0 cm), and radius (13.0 cm).
Allografts were harvested under sterile conditions during postmortem tissue donation and were stored at -80°C by our national bone bank. Processing was performed by either Osteotech (Eatontown, New Jersey) or the Musculoskeletal Transplant Foundation (Edison, New Jersey). Allografts were thawed in saline solution and antibiotics in the operating room during tumor resection. All patients received perioperative antibiotics according to protocol.
Allografts were attached to host bones with an array of plate-and-screw combinations in 62 patients (71%) (examples in gures 3A and 3B), a combination of intramedullary nails and plate(s) in 12 patients (14%), intramedullary nails only (in all cases locked at both ends) in eight patients (9%) (examples in gures 4A, 4B, and 4C), and screws with or without cerclage wires in ve patients (6%). In the latter group, patients were 1.5 to 12 years of age. Primary hybrid reconstructions, combining intercalary allografts with vascularized bular autografts, were performed in six patients (7%).
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