BACKGROUND: There is no consensus on the ideal treatment for malignant tumors of the distal tibia. Many favor amputation. METHODS: Thirteen children, at an average age of 12 years (8 to 16 y) sustained conservative surgical treatment for a tumor of the distal tibia. All patients had "en bloc" resection of the tumor with ankle arthrodesis achieved by nail or plate accompanied by autograft. RESULTS: The results were assessed retrospectively with an average follow-up of 8.8 years. Nine patients were in complete remission. Two patients had died. Two patients were lost to follow-up. Two patients had a local recurrence, which required amputation. There were 4 infections, which responded well to therapy. Four patients required additional bone grafting because of nonunion. Three patients required osteotomy for malalignment. Bone healing was achieved for the 9 patients seen at last follow-up. All were able to walk with an average functional score of 24.7/30 (23 to 26) on the Musculoskeletal Tumor Society score. CONCLUSIONS: Several reconstructive techniques are available: mega prosthesis of distal tibia and ankle, reconstruction by vascularized fibula or by autograft. All series reported significant rates of infections, cutaneous necrosis, and nonunion. DISCUSSION: Conservative treatment with ankle arthrodesis is a possible alternative to amputation for the management of malignant tumors of the distal tibia in selected patients. Survival results and functional outcome were good despite initial complications. LEVEL OF EVIDENCE: This is a retrospectively therapeutic study graded level 2 as level of evidence.
BACKGROUND: There is no consensus on the ideal treatment for malignant tumors of the distal tibia. Many favor amputation. METHODS: Thirteen children, at an average age of 12 years (8 to 16 y) sustained conservative surgical treatment for a tumor of the distal tibia. All patients had "en bloc" resection of the tumor with ankle arthrodesis achieved by nail or plate accompanied by autograft. RESULTS: The results were assessed retrospectively with an average follow-up of 8.8 years. Nine patients were in complete remission. Two patients had died. Two patients were lost to follow-up. Two patients had a local recurrence, which required amputation. There were 4 infections, which responded well to therapy. Four patients required additional bone grafting because of nonunion. Three patients required osteotomy for malalignment. Bone healing was achieved for the 9 patients seen at last follow-up. All were able to walk with an average functional score of 24.7/30 (23 to 26) on the Musculoskeletal Tumor Society score. CONCLUSIONS: Several reconstructive techniques are available: mega prosthesis of distal tibia and ankle, reconstruction by vascularized fibula or by autograft. All series reported significant rates of infections, cutaneous necrosis, and nonunion. DISCUSSION: Conservative treatment with ankle arthrodesis is a possible alternative to amputation for the management of malignant tumors of the distal tibia in selected patients. Survival results and functional outcome were good despite initial complications. LEVEL OF EVIDENCE: This is a retrospectively therapeutic study graded level 2 as level of evidence.
Authors: Andreas F Mavrogenis; Caterina Novella Abati; Carlo Romagnoli; Pietro Ruggieri Journal: Clin Orthop Relat Res Date: 2012-01-24 Impact factor: 4.176