Highlights
- •The intramedullary nailing does not improve the union rate or decrease the incidence of mechanical complications for patients with extremity sarcoma after biological reconstruction, which is different from the traumatic fracture.
- •The intramedullary nailing may have potential advantages on the service life for the biological reconstruction after extremity sarcoma resection.
- •The compression effect of the plate can increase the graft union for the biological reconstruction after tumor resection compared to the intramedullary nailing.
Abstract
Introduction
This is a retrospective study that evaluate the outcome of patients with extremity
sarcoma between extramedullary plate and intramedullary nailing for the biological
reconstruction after tumor resection.
Methods
58 patients (40 treated with plate fixation and 18 with intramedullary nailing, IM
group) with sarcomas of the lower and upper extremity who received biological reconstruction
at our bone tumor center from November 2003 to November 2015 were reviewed for the
study. There were 29 male and 29 female patients with a mean age of 20.8 years (range,
5–72 years). The mean follow-up duration was 90.8 months (range, 12.2–244.4 months).
All data were obtained from the clinical, radiograph records and follow-up information.
The analysis of outcome, survival, local recurrence, function and complications of
patients in the plate group and IM group was performed.
Results
28 cases in the plate group lived at the last follow-up, of which 26 had no evidence
of disease, 2 lived with the pulmonary metastasis, whereas 15 in the IM group lived
at the last follow-up, of which all had no evidence of disease and no lived with the
pulmonary metastasis. There was no significant difference between the two groups for
the prognosis. Meanwhile, there was no significant difference of incidence of nonunion,
graft fracture and fixation breakage between the two groups, whereas the time to diaphysis
union in the plate group (11.6 ± 2.7 months) was shorter than that in IM group (14.7 ± 4.8
months, P = 0.015). It had the tendency that the time to mechanical complications
in the intramedullary nailing group (38.1 ± 39.6 months) was longer than that in the
plate group (15.7 ± 13.4 months, P = 0.058,95% CI,-45.6–0.8). Furthermore, the infection
occurred in 12 cases and five grafts of them developed the deep infection and the
mean time to deep infection was 14.8 ± 20.5 months. Furthermore, the incidence of
local recurrence for the patients who had plate fixation was similar to the incidence
of patients who had nailing fixation. At the last follow-up, the functional evaluation
was performed for 39 patients. There was no significant difference in MSTS and VAS
functional score for patients between in the plate group (n = 32) and IM group (n = 7).
Conclusions
The findings of the present study showed that intramedullary nailing does not improve
the union rate or decrease the incidence of mechanical complications for patients
with extremity sarcoma after biological reconstruction. However, intramedullary nailing
may have potential advantages on the service life for the biological reconstruction
after extremity sarcoma resection.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to InjuryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Mid-term radiological and functional results of biological reconstructions of extremity-located bone sarcomas in children and young adults.J Pediatr Orthop Part B. 2015; 24: 469-478
- Biological reconstruction using massive bone allograft with intramedullary vascularized fibular flap after intercalary resection of humeral malignancy.J Surg Oncol. 2011; 104: 244-249
- Intercalary defects reconstruction of the femur and tibia after primary malignant bone tumour resection. A series of 13 cases.Orthop Traumatol Surg Res. 2011; 97: 512-519
- Evaluation of clinical results and complications of structural allograft reconstruction after bone tumor surgery.Arch Bone Jt Surg. 2016; 4: 236-242
- Intercalary femur allografts are an acceptable alternative after tumor resection.Clin Orthop Relat Res. 2012; 470: 728-734
- Survival of massive allografts in segmental oncological bone defect reconstructions.Int Orthop. 2009; 33: 757-760
- Extracorporeally frozen tumour-bearing bone combined with free vascularised fibula for the intercalary reconstruction of femoral defect after resection of bony sarcoma.J Plast Reconstr Aesthet Surg. 2016; 69: 856-863
- The long-term outcomes following the use of inactivated autograft in the treatment of primary malignant musculoskeletal tumor.J Orthop Surg Res. 2015; 10: 177
- Reconstruction of segmental bone defect of long bones after tumor resection by devitalized tumor-bearing bone.World J Surg Oncol. 2015; 13: 282
- Intramedullary nailing of femoral diaphyseal metastases: is it necessary to protect the femoral neck?.Clin Orthop Relat Res. 2015; 473: 1499-1502
- Intramedullary nailing for treatment of pathologic femoral fractures due to metastases.Injury. 2014; 45: 412-417
- Femoral recon nails for metastatic disease: indications, technique, and results.Am J Orthop. 2000; 29: 34-42
- Spontaneous healing of fractures and osteotomy within intercalary allograft reconstruction after distal femur osteosarcoma resection in a child.J Pediatr Orthop Part B. 2016;
- Intercalary reconstructions with vascularised fibula and allograft after tumour resection in the lower limb.Sarcoma. 2013; 2013160295
- Reconstruction using massive allografts after resection of extremity osteosarcomas the study design: a retrospective cohort study.Int J Surg. 2015; 21: 108-111
- Intercalary allograft reconstructions using a compressible intramedullary nail : a preliminary report.Clin Orthop Relat Res. 2010; 468: 2507-2513
- Open reduction-internal fixation versus intramedullary nailing for humeral shaft fractures: an expected value decision analysis.J Shoulder Elbow Surg/Am Shoulder Elbow Surg. 2018; 27: 204-210
- Nail or plate in the management of distal extra-articular tibial fracture, what is better? Valutation of outcomes.Sicot-J. 2018; 4: 2
- Minimally invasive plate osteosynthesis in humerus nonunion after intramedullary nailing.Int Orthop. 2018; 42: 2685-2689
- Comparative study between biologic plating and intramedullary nailing for the treatment of subtrochanteric fractures: Is biologic plating using LCP-DF superior to intramedullary nailing?.Injury. 2017; 48: 2207-2213
- Comparison of intramedullary nail, plate, and external fixation in the treatment of distal tibia nonunions.Int Orthop. 2017; 41: 1925-1934
- Treatment of infection following intramedullary nailing of tibial shaft fractures—results of the ORS/ISFR expert group survey.Int Orthop. 2018;
- Comparison of three fixation methods in treatment of tibial fracture in adolescents.ANZ J Surg. 2018; 88 (E480-E5)
- Low-heat treated autograft versus allograft for intercalary reconstruction of malignant bone tumors.J Surg Oncol. 2014; 110: 823-827
- A comparison of the effect of autogenous vs. frozen homogenous grafts on the healing of non-union of forearm bones.Ortop Traumatol Rehabil. 2008; 10: 146-151
- Intercalary segmental reconstruction after bone tumor resection.Eur J Surg Oncol. 2008; 34: 1271-1276
- Treatment of allograft nonunions with recombinant human bone morphogenetic proteins (rhBMP).Acta Orthop Belg. 2004; 70: 591-597
- Bisphosphonate delivery to tubular bone allografts.Clin Orthop Relat Res. 2008; 466: 1871-1879
- Retrieved human allografts: a clinicopathological study.J Bone Joint Surg Am. 2001; 83-A: 971-986
- The effect of internal fixation on the healing of large allografts.J Bone Joint Surg Am. 1994; 76: 657-663
- Intercalary allograft reconstructions using a compressible intramedullary nail: a preliminary report.Clin Orthop Relat Res. 2010; 468: 2507-2513
- Infection after surgical resection for pelvic bone tumors: an analysis of 270 patients from one institution.Clin Orthop Relat Res. 2014; 472: 349-359
- Similar survival but better function for patients after limb salvage versus amputation for distal tibia osteosarcoma.Clin Orthop Relat Res. 2012; 470: 1735-1748
Article info
Publication history
Published online: February 06, 2019
Identification
Copyright
© 2019 Elsevier Ltd. All rights reserved.
