Frank Fitoussi1, Brice Ilharreborde. 1. Pediatric Orthopedic and Reconstructive Surgery, Trousseau Hospital, Paris 6 University, Paris, France, franck.fitoussi@trs.aphp.fr.
Abstract
BACKGROUND: Resection of primary malignant tumors often creates large bony defects. In children, this creates reconstructive challenges, and many options have been described for limb salvage in this setting. Studies have supported the use of an induced-membrane technique after placement of a cement spacer to aid in restoration of bone anatomy. QUESTIONS/PURPOSES: We asked: (1) What complications are associated with the induced-membrane technique? (2) How often is bone healing achieved after resection greater than 15 cm using this technique? (3) What is the functional outcome of patients treated with this technique? METHODS: We performed a retrospective evaluation of eight patients with a mean age of 13.3 years (range, 11-17 years) treated for a malignant bone tumor between 2002 and 2012 at our centers. The primary malignant tumors involved the proximal humerus, femur, and tibia. All patients were treated using the induced-membrane technique after a resection with mean bone loss of 18 cm (range, 16-23 cm). The general indication for using the induced-membrane technique during this time was a large diaphyseal defect after resection of the tumor. In addition to using cancellous graft as with the original technique, in the current patients an autogenous nonvascularized fibula was used to enhance stability. The patients were assessed at the last followup using the Musculoskeletal Tumor Society (MSTS) scoring system. Mean followup was 47.1 months (range, 24-120 months), and none of the patients were lost to followup before 2 years. RESULTS: A total of four unplanned reoperations were performed in these eight patients. A fracture of the reconstruction occurred in three patients and all were treated successfully, two with surgery and one with immobilization. Bone fusion was obtained in all patients within 4 to 8 months (mean, 5.6 months) after the reconstruction. The mean healing index was 0.31 month/cm of reconstruction (range, 0.23-0.5 month/cm). At last followup, the mean MSTS score was 74% (range, 67%-80%). CONCLUSIONS: Our findings suggest that the modified induced-membrane technique is a reasonable alternative to other limb reconstruction techniques for bone tumors in children and has the advantage of not requiring a bone bank or an expensive metal prosthesis. Although more patients will be needed to substantiate our findings, it has become a standard part of our arsenal in the treatment of large bone defects after resection of pediatric primitive bone tumors. LEVEL OF EVIDENCE: Level IV, therapeutic study.
BACKGROUND: Resection of primary malignant tumors often creates large bony defects. In children, this creates reconstructive challenges, and many options have been described for limb salvage in this setting. Studies have supported the use of an induced-membrane technique after placement of a cement spacer to aid in restoration of bone anatomy. QUESTIONS/PURPOSES: We asked: (1) What complications are associated with the induced-membrane technique? (2) How often is bone healing achieved after resection greater than 15 cm using this technique? (3) What is the functional outcome of patients treated with this technique? METHODS: We performed a retrospective evaluation of eight patients with a mean age of 13.3 years (range, 11-17 years) treated for a malignant bone tumor between 2002 and 2012 at our centers. The primary malignant tumors involved the proximal humerus, femur, and tibia. All patients were treated using the induced-membrane technique after a resection with mean bone loss of 18 cm (range, 16-23 cm). The general indication for using the induced-membrane technique during this time was a large diaphyseal defect after resection of the tumor. In addition to using cancellous graft as with the original technique, in the current patients an autogenous nonvascularized fibula was used to enhance stability. The patients were assessed at the last followup using the Musculoskeletal Tumor Society (MSTS) scoring system. Mean followup was 47.1 months (range, 24-120 months), and none of the patients were lost to followup before 2 years. RESULTS: A total of four unplanned reoperations were performed in these eight patients. A fracture of the reconstruction occurred in three patients and all were treated successfully, two with surgery and one with immobilization. Bone fusion was obtained in all patients within 4 to 8 months (mean, 5.6 months) after the reconstruction. The mean healing index was 0.31 month/cm of reconstruction (range, 0.23-0.5 month/cm). At last followup, the mean MSTS score was 74% (range, 67%-80%). CONCLUSIONS: Our findings suggest that the modified induced-membrane technique is a reasonable alternative to other limb reconstruction techniques for bone tumors in children and has the advantage of not requiring a bone bank or an expensive metal prosthesis. Although more patients will be needed to substantiate our findings, it has become a standard part of our arsenal in the treatment of large bone defects after resection of pediatric primitive bone tumors. LEVEL OF EVIDENCE: Level IV, therapeutic study.
Authors: Ruth Ladenstein; Ulrike Pötschger; Marie Cécile Le Deley; Jeremy Whelan; Michael Paulussen; Odile Oberlin; Henk van den Berg; Uta Dirksen; Lars Hjorth; Jean Michon; Ian Lewis; Alan Craft; Heribert Jürgens Journal: J Clin Oncol Date: 2010-06-14 Impact factor: 44.544
Authors: F Accadbled; P Mazeau; F Chotel; J Cottalorda; J Sales de Gauzy; R Kohler Journal: Orthop Traumatol Surg Res Date: 2013-04-19 Impact factor: 2.256
Authors: Olli-Matti Aho; Petri Lehenkari; Jukka Ristiniemi; Siri Lehtonen; Juha Risteli; Hannu-Ville Leskelä Journal: J Bone Joint Surg Am Date: 2013-04-03 Impact factor: 5.284
Authors: F Accadbled; C Thévenin Lemoine; E Poinsot; T Baron Trocellier; F Dauzere; J Sales de Gauzy Journal: J Child Orthop Date: 2019-06-01 Impact factor: 1.548