J Korean Orthop Assoc.  2007 Dec;42(6):756-763. 10.4055/jkoa.2007.42.6.756.

The Primary Malignant Bone Tumors of Distal Tibia: Comparison between Limb Salvage and Amputation

• Lee SY
• Jeon DG
• Park JH
• Song WS
• Koh HS
• Cho WH

• KMID: 1947782
• DOI: http://doi.org/10.4055/jkoa.2007.42.6.756

Abstract

PURPOSE: The long term survival and indications of limb salvage surgery for primary malignant bone tumors of the distal tibia were evaluated, and the results of the reconstruction method using a pasteurized autograft alone or a pasteurized autograft and living fibular bone graft composite were examined.
MATERIALS AND METHODS
From March 1985 to June 2004, 13 cases were considered eligible. The diagnosis included 9 osteosarcomas, 2 chondrosarcomas, 1 parosteal osteosarcoma, and 1 malignant fibrous histiocytoma of the bone. There was 1 case of stage IB, 1 IIA, and 11 IIB according to the Enneking classification. Each case underwent surgery and 10 cases underwent additional chemotherapy. Six cases underwent a below-knee amputation and 7 cases had limb salvage surgery. The reconstruction methods were pasteurized bone alone (5), an additional living fibula bone graft (1) or a living fibula bone graft alone (1).
RESULTS
There was no recurrence or metastasis at the final follow up. The MSTS functional score of the limb salvage group and amputation group were 85% and 82% respectively. Two out of 5 cases of reconstruction with pasteurized bone alone achieved bony union at 6 and 9 months after surgery. The remaining 3 cases showed nonunion and fractures of the pasteurized bone that was followed by an additional living fibula graft (2 cases) and cancellous iliac bone graft (1 case). Two cases of primary living fibula grafts are in the course of healing.
CONCLUSION
The prognosis was good. Neurovascular invasion by the tumor and the necessity of a radical soft tissue excision indicated an amputation. There was no difference in the functional outcome between the limb salvage group and amputation group. A reconstruction method using pasteurized bone has bio-mechanical and economical benefits. However, primary additional living fibular bone graft is a promising method.

Keyword

Distal tibia; Malignant bone tumor; Reconstruction method

MeSH Terms

Amputation*
Autografts
Chondrosarcoma
Classification
Diagnosis
Drug Therapy
Extremities*
Fibula
Follow-Up Studies
Histiocytoma, Malignant Fibrous
Limb Salvage*
Neoplasm Metastasis
Osteosarcoma
Prognosis
Recurrence
Tibia*
Transplants

Figure

• 

  Fig. 1 (A) 28-year old woman diagnosed with an osteosarcoma. (A) The distal tibia and fibula were resected using the lateral approach. (B) The pasteurized bones were re-positioned and internal fixation was performed with a plate.

• 

  Fig. 2 A 20-year-old man diagnosed with an osteosarcoma. (A) The plain radiograph shows an osteoblastic lesion with a periosteal reaction in the epi-metaphysis of the distal tibia. (B) A reconstruction with pasteurized bone and a plate was performed after a wide resection of the tumor. (C) A 22-month follow-up radiograph shows junctional union.

• 

  Fig. 3 A 9-year-old man diagnosed with an osteosarcoma. (A) The plain radiograph shows nonunion and consequent angulation 8 months after surgery. (B) An additional living fibula bone graft was performed. The plain radiograph taken 50-month after surgery shows a junctional union.

• 

  Fig. 4 A 20-year-old man diagnosed with an osteosarcoma. (A) A fracture had occurred in the pasteurized bone 82 months after surgery. The arrow indicates the fracture site. (B) A cancellous iliac bone graft and internal fixation with a plate were performed.

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