medigraphic.com
ISSN 2007-6800 (Print)

2016, Number 2

<< Back Next >>

Rev Mex Traspl 2016; 5 (2)

Allograft for transepiphyseal intercalary reconstruction in the treatment of the osteosarcoma of the distal femur. Report of a case with analysis of associated oncological and orthopaedical circumstances

Sánchez-Torres LJ

Language: Spanish
References: 34
Page: 72-78
PDF size: 338.38 Kb.


ABSTRACT

Background: While limb-salvage surgery is an option universally accepted, the treatment of bone sarcomas in skeletally immature patients is a challenge for the condition of damage of up to 2 growth plates by the usual methods of reconstruction. Material and methods: A case of a patient diagnosed with osteosarcoma and treated with wide resection and reconstruction with allograft. Radiological integration was evaluated through the scale accepted by the International Society of Limb Salvage, and function by means of the criteria adopted by the Musculoskeletal Tumor Society. Orthopaedic and oncological circumstances are further analyzed. Results: 11 years old male patient with ostesarcoma treated with neoadjuvant chemotherapy, limb salvage surgery with allograft and adjuvant chemotherapy. Allograft fully integrated at 12 months after surgery. Satisfactory functional outcome. Discussion: The usual treatments of limb salvage in children and adolescents can produce limb discrepancy as a result of damage to the growth plates. Using intercalary allografts with epiphyseal preservation, it is possible to avoid this condition. Conclusions: There is sufficient evidence that in well – selected cases, transepiphyseal resections with intercalary allografts, are an excellent treatment option for skeletally immature patients with bone sarcomas.


REFERENCES

  1. Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res. 1980; 153: 106-120.

  2. Enneking WF, Spanier SS, Goodman MA. Current concepts review. The surgical staging of musculoskeletal sarcoma. J Bone Joint Surg Am. 1980; 62-4 (6): 1027-1030.

  3. Wolf RE, Enneking WF. The staging and surgery of musculoskeletal neoplasms. Orthop Clin North Am. 1996; 27 (3): 473-481.

  4. Enneking WF. Staging of musculoskeletal neoplasms. Skeletal Radiol. 1985; 13: 183-194.

  5. Fuchs B, Ossendorf C, Leerapun T, Sim FH. Intercalary segmental reconstruction after bone tumor resection. Eur J Surg Oncol. 2008; 34: 1271-1276.

  6. Cañadell J, Forriol F, Cara JA. Removal of metaphyseal bone tumors with preservation of the epiphysis. Physeal distraction before excision. J Bone Joint Surg Br. 1994; 76: 127-132.

  7. Betz M, Dumont CE, Fuchs B, Exner GU. Physeal distraction for joint preservation in malignant metaphyseal bone tumors in children. Clin Orthop Relat Res. 2012; 470: 1749-1754.

  8. Muscolo DL, Ayerza MA, Aponte-Tinao LA et al. Partial epiphyseal preservation and intercalary allograft reconstruction in high-grade metaphyseal osteosarcoma of the knee. J Bone Joint Surg Am. 2004; 86: 2686-2693.

  9. Muscolo DL, Ayerza MA, Aponte-Tinao LA et al. Intercalary femur and tibia segmental allografts provide an acceptable alternative in reconstructing tumor resections. Clin Orthop Relat Res. 2004; 426: 97-102.

  10. Muscolo DL, Ayerza MA, Aponte-Tinao LA. Transepiphyseal resection and intercalary reconstruction. In: Sim FH, Choong PFM, Weber KL. Orthopaedic oncology and complex reconstruction. Master Techniques in Orthopaedic Surgery. Wolters Kluwer-Lippincott Williams & Wilkins. 2011; 21: 233-238.

  11. San-Julian M, Aquerreta JD, Benito A et al. Indications for epiphyseal preservation in metaphyseal malignant bone tumors of children: relationship between image methods and histological findings. J Pediatr Orthop. 1999; 19: 543-548.

  12. Muscolo L, Ayerza MA, Aponte-Tinao L, Farfalli G. Allograft reconstruction after sarcoma resection in children younger than 10 years old. Clin Orthop Relat Res. 2008; 466: 1856-1862.

  13. McEwen W. Observation concerning transplantation of bone. Illustrated by a case of inter-human osseosus transplantation, where by over two-thirds of the shaft of the humerus was restored. Proc Roy Soc London. 1881; 32: 232-247.

  14. Calvo R, Figueroa D, Díaz-Ledezma C, Vaisman A, Figueroa F. Aloinjertos óseos y la función del banco de huesos. Rev Med Chile. 2011; 139: 660-666.

  15. Borjian A, Nazem K, Yassine H. Complications of massive allograft reconstruction for bone tumor. J Res Med Sci. 2006; 11 (4): 240-247.

  16. Lexer E. Die verwendung der freien knochenplastik nebst versuchen uber galenkversteifung und gelenktransplantation. Arch Klin Chir. 1908; 86: 939-954.

  17. Lexer E. Joint transplantations and arthroplasty. Surg Gynec Obst. 1925; 40: 782-809.

  18. Muscolo DL, Petracchi LJ, Ayerza MA, Calabrese ME. Massive femoral allografts followed for 22 to 36 years. J Bone Joint Surg Br. 1992; 74-B (6): 887-892.

  19. Brigman BE, Hornicek FJ, Gebhardt MC, Mankin HJ. Allografts about the knee in young patients with high-grade osteosarcoma. Clin Orthop Relat Res. 2004; 421: 232-239.

  20. San Julián AM, Moreno SJL, Forriol CF, Cañadel CJ. Integración biológica y radiológica de los aloinjertos óseos masivos. Rev Ortop Traumatol. 2000; 44: 477-483.

  21. Vicario EC. Los aloinjertos óseos en cirugía ortopédica y traumatología (II). Patología del Aparato Locomotor. 2004; 2 (4): 263-287.

  22. Enneking WF. Modification of the system for functional evaluation in the surgical management of musculoskeletal tumors. In: Enneking WF, ed. Limb salvage in musculoskeletal oncology. New York: Churchill Livingstone, 1987: pp. 626-639.

  23. Enneking WF, Dunham W, Gebhardt MC, Malawer M, Pritchard DJ. A system for the evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993; 286: 241-246.

  24. Sánchez-Torres LJ, Santos-Hernández M. Osteosarcoma. Rev Mex Ortop Ped. 2011; 13 (1): 10-19.

  25. Geller DS, Gorlick R. Osteosarcoma: a review of diagnosis, management, and treatment strategies. Clin Adv Hematol Oncol. 2010; 8 (10): 705-718.

  26. Majó J, Cubedo R, Pardo N. Tratamiento del osteosarcoma. Revisión. Rev Esp Cir Ortop Traumatol. 2010; 54 (5): 329-336.

  27. Muscolo L, Farfalli GL, Aponte-Tinao L, Ayerza MA. Actualización en osteosarcoma. Rev Asoc Argent Ortop Traumatol- 2009; 74 (1): 85-101.

  28. Aponte-Tinao L, Farfalli GL, Ritacco LE, Ayerza MA, Muscolo L. Intercalary femur allografts are an acceptable alternative after tumor resection. Clin Orthop Relat Res. 2012; 470: 728-734.

  29. Hwang N, Grimer RJ, Carter SR, Tillman RM, Abudu A, Jeys LM. Early results of a non-invasive expandible prosthesis for limb-salvage surgery in children with bone tumours. J Bone Joint Surg Br. 2012; 94-B (2): 265-269.

  30. Tsuchiya H, Tomita K, Minematsu K, Mori Y, Asada N, Kitano S. Limb salvage using distraction osteogenesis : a classification of the technique. J Bone Joint Surg Br. 1997; 79: 403-411.

  31. Cara JA, Laclériga A, Cañadell J. Intercalary bone allografts 23 tumor cases followed for 3 years. Acta Orthop Scand. 1994; 65 (1): 42-46.

  32. Bullens PHJ, Minderhoud NM, De Waal Malefijt MC, Veth RPH, Buma P, Schreuder HWB. Survival of massive allografts in segmental oncological bone defect reconstructions. Int Orthop (SICOT). 2009; 33: 757-760.

  33. Mankin HJ, Hornicek FJ, Raskin KA. Infection in massive allografts. Clin Orthop Relat Res. 2005; 432: 210-216.

  34. Velán O, Aponte-Tinao LA, Muscolo L, Ayerza MA. Transplantes de fémur distal. Planeamiento preoperatorio por tomografía computada. Rev Arg Radiol. 2004; 68: 245-250.




2020     |     www.medigraphic.com