1
|
El-Gammal TA, Refai OA, Morsy M, Eisa AA. Reconstruction of a Pediatric Lateral Femoral Condyle After Septic Necrosis with a Free Vascularized Fibular Epiphysis: A Case Report. JBJS Case Connect 2023; 13:01709767-202303000-00058. [PMID: 36893288 DOI: 10.2106/jbjs.cc.22.00736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
CASE A 5-year-old girl presented with severe valgus deformity of the right knee after septic necrosis of the lateral femoral condyle. Reconstruction was performed using the contralateral proximal fibular epiphysis on the anterior tibial vessels. Union was evident after 6 weeks, and full weight bearing was permitted after 12 weeks. Two years of follow-up showed no deformity or length discrepancy and 90° range of motion. CONCLUSION The pattern of 1 femoral condyle resorption due to osteomyelitis is a rare presentation. The presented method of reconstruction could be implemented as a novel technique to reconstruct the growing knee joint in such a condition.
Collapse
Affiliation(s)
- Tarek Abdalla El-Gammal
- Reconstructive Microsurgery Unit, Department of Orthopedics and Traumatology, Assiut University Hospitals and School of Medicine, Assiut, Egypt
| | | | | | | |
Collapse
|
2
|
|
3
|
Stevenson JD, Doxey R, Abudu A, Parry M, Evans S, Peart F, Jeys L. Vascularized fibular epiphyseal transfer for proximal humeral reconstruction in children with a primary sarcoma of bone. Bone Joint J 2018; 100-B:535-541. [DOI: 10.1302/0301-620x.100b4.bjj-2017-0830.r1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Aims Preserving growth following limb-salvage surgery of the upper limb in children remains a challenge. Vascularized autografts may provide rapid biological incorporation with the potential for growth and longevity. In this study, we aimed to describe the outcomes following proximal humeral reconstruction with a vascularized fibular epiphyseal transfer in children with a primary sarcoma of bone. We also aimed to quantify the hypertrophy of the graft and the annual growth, and to determine the functional outcomes of the neoglenofibular joint. Patients and Methods We retrospectively analyzed 11 patients who underwent this procedure for a primary bone tumour of the proximal humerus between 2004 and 2015. Six had Ewing’s sarcoma and five had osteosarcoma. Their mean age at the time of surgery was five years (two to eight). The mean follow-up was 5.2 years (1 to 12.2). Results The overall survival at five and ten years was 91% (confidence interval (CI) 95% 75% to 100%). At the time of the final review, ten patients were alive. One with local recurrence and metastasis died one-year post-operatively. Complications included seven fractures, four transient nerve palsies, and two patients developed avascular necrosis of the graft. All the fractures presented within the first postoperative year and united with conservative management. One patient had two further operations for a slipped fibular epiphysis of the autograft, and a hemi-epiphysiodesis for lateral tibial physeal arrest. Hypertrophy and axial growth were evident in nine patients who did not have avascular necrosis of the graft. The mean hypertrophy index was 65% (55% to 82%), and the mean growth was 4.6 mm per annum (2.4 to 7.6) in these nine grafts. At final follow-up, the mean modified functional Musculoskeletal Tumour Society score was 77% (63% to 83%) and the mean Toronto Extremity Salvage Score (TESS) was 84% (65% to 94%). Conclusion Vascularized fibular epiphyseal transfer preserves function and growth in young children following excision of the proximal humerus for a malignant bone tumour. Function compares favourably to other limb-salvage procedures in children. Longer term analysis is required to determine if this technique proves to be durable into adulthood. Cite this article: Bone Joint J 2018;100-B:535–41.
Collapse
Affiliation(s)
- J. D. Stevenson
- Royal Orthopaedic Hospital, The Woodlands,
Birmingham, Aston University Medical School, Aston
Express Way, Birmingham, B4
7ET, UK
| | - R. Doxey
- University of Birmingham Medical School, Birmingham, UK
| | - A. Abudu
- Royal Orthopaedic Hospital, The
Woodlands, Bristol Road South, Birmingham
B31 2AP, UK
| | - M. Parry
- Royal Orthopaedic Hospital, The Woodlands,
Birmingham, Aston University Medical School, Aston
Express Way, Birmingham, B4
7ET, UK
| | - S. Evans
- Royal Orthopaedic Hospital, The
Woodlands, Bristol Road South, Birmingham
B31 2AP, UK
| | - F. Peart
- Royal Orthopaedic Hospital, The
Woodlands, Bristol Road South, Birmingham
B31 2AP, UK
| | - L. Jeys
- Royal Orthopaedic Hospital, The Woodlands,
Bristol Road South, Birmingham, University
of Aston, Aston Expressway, Birmingham, B4
7ET, UK
| |
Collapse
|
4
|
|
5
|
Aldekhayel S, Govshievich A, Neel OF, Luc M. Vascularized proximal fibula epiphyseal transfer for distal radius reconstruction in children: A systematic review. Microsurgery 2015; 36:705-711. [DOI: 10.1002/micr.22521] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 08/12/2015] [Accepted: 10/02/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Salah Aldekhayel
- Division of Plastic and Reconstructive Surgery; Montreal General Hospital, McGill University Health Centre; Montreal QC Canada
| | - Alexander Govshievich
- Division of Plastic and Reconstructive Surgery; Montreal General Hospital, McGill University Health Centre; Montreal QC Canada
| | - Omar Fouda Neel
- Division of Plastic and Reconstructive Surgery; Montreal General Hospital, McGill University Health Centre; Montreal QC Canada
| | - Mario Luc
- Division of Plastic and Reconstructive Surgery; Montreal General Hospital, McGill University Health Centre; Montreal QC Canada
| |
Collapse
|
6
|
Houdek MT, Wagner ER, Wyles CC, Nanos GP, Moran SL. New options for vascularized bone reconstruction in the upper extremity. Semin Plast Surg 2015; 29:20-9. [PMID: 25685100 DOI: 10.1055/s-0035-1544167] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Originally described in the 1970s, vascularized bone grafting has become a critical component in the treatment of bony defects and non-unions. Although well established in the lower extremity, recent years have seen many novel techniques described to treat a variety of challenging upper extremity pathologies. Here the authors review the use of different techniques of vascularized bone grafts for the upper extremity bone pathologies. The vascularized fibula remains the gold standard for the treatment of large bone defects of the humerus and forearm, while also playing a role in carpal reconstruction; however, two other important options for larger defects include the vascularized scapula graft and the Capanna technique. Smaller upper extremity bone defects and non-unions can be treated with the medial femoral condyle (MFC) free flap or a vascularized rib transfer. In carpal non-unions, both pedicled distal radius flaps and free MFC flaps are viable options. Finally, in skeletally immature patients, vascularized fibular head epiphyseal transfer can provide growth potential in addition to skeletal reconstruction.
Collapse
Affiliation(s)
- Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Eric R Wagner
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Cody C Wyles
- School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - George P Nanos
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Steven L Moran
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota ; Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|