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Mustafa MAR, Lam A, Rodriguez AN, El Masry AM, Azmy SI, Abdel Aal MM, Abdelgawad AA. Novel Dual Bicolumnar Fibula Graft Reconstruction of Distal Humerus in Pediatric Patients After Massive Bone Resection: A Report of Two Cases. JBJS Case Connect 2024; 14:01709767-202406000-00056. [PMID: 38913790 DOI: 10.2106/jbjs.cc.23.00539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
CASE We describe 2 case studies, involving a 10-year-old girl with an aneurysmal bone cyst and a 12-year-old adolescent boy with Ewing sarcoma. The patient with Ewing sarcoma was previously managed with wide surgical excision and fibular graft reconstruction and subsequently experienced significant graft resorption, hardware failure, and fracture 24 months after operation. A revision limb salvage attempt was undertaken. In both cases, fibular strut grafts were harvested and fixed with intramedullary k-wires to recreate the medial and lateral columns of the distal humeral triangle. CONCLUSION The technique achieved complete osseous integration, structural support, and functional restoration of the elbow in both cases, with good functional outcomes.
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Affiliation(s)
| | - Aaron Lam
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Ariel N Rodriguez
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | | | - Sherif Ishak Azmy
- Department of Orthopaedic Surgery, Ain Shams University, Cairo, Egypt
| | | | - Amr Atef Abdelgawad
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
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Smida M, Ammar A, Fedhila F, Douira W, Sassi S. Periosteal preservation: a new technique in resection of bone high-grade malignant tumors in children-about eleven cases. World J Surg Oncol 2022; 20:312. [PMID: 36155622 PMCID: PMC9511720 DOI: 10.1186/s12957-022-02749-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022] Open
Abstract
Objective The purpose of this study was to describe a surgical technique of bone resection with periosteal preservation and reconstruction in patients with high-grade bone malignant tumors and to determine its effect on local recurrences, and time and quality of bone union in bone autografting reconstruction. Patients and methods We retrospectively reviewed 11 cases of high-grade malignant bone tumors in children aged 4 to 16 years, who were treated with chemotherapy and tumor resection while preserving partially the adjacent periosteum. Tumors were located in the lower limb in eight cases; three tumors were in the humerus. The mean length of the bone defect after resection was 15.8 cm (range, 6–34.5 cm). Reconstruction was provided by non-vascularized autograft in eight cases (lower limb) and polymethyl methacrylate spacer in three cases (upper limb). Patients were followed up for a mean of 71 months. Results At the last follow-up, no patients had local recurrence. Three patients were dead because of metastasis. Bone union was good in time and quality in all children who had bone autografting. In cases of PMMA reconstruction, there was periosteal bone formation around the spacer. According to the MSTS functional score, patients with lower limb localizations had a mean score of 27.75 points and patients with upper limb localizations had a score of 24/30. Conclusion Preservation of the periosteum in bone resection for malignant tumors could be a good adjuvant alternative for bone reconstruction, without increasing the risk of local recurrence. However, patients must be carefully selected.
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Affiliation(s)
- Mahmoud Smida
- Tunis Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia. .,Department of Trauma, Orthopedics Kassab Institute, 2010, Manouba, Tunisia.
| | - Ameni Ammar
- Tunis Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia.,Department of Trauma, Orthopedics Kassab Institute, 2010, Manouba, Tunisia
| | - Faten Fedhila
- Tunis Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia.,Oncology Unit, Tunis Children Hospital, 1007 Bab Saadoun, Tunis, Tunisia
| | - Wiem Douira
- Tunis Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia.,Department of Radiology, Tunis Children Hospital, 1007 Bab Saadoun, Tunis, Tunisia
| | - Samia Sassi
- Tunis Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia.,Department of Pathology, Salah Azaiez Institute, 1007 Bab Saadoun, Tunis, Tunisia
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Complete Spontaneous Bone Regeneration following Surgical Enucleation of a Mandibular Cemento-Ossifying Fibroma. Case Rep Dent 2022; 2022:7902602. [PMID: 36034160 PMCID: PMC9411006 DOI: 10.1155/2022/7902602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022] Open
Abstract
Background Cemento-ossifying fibroma (COF) is a type of benign fibro-osseous tumor that mainly occurs in the maxillofacial region. Bone reconstruction after the surgery is often performed with bone transplantation. However, the present case report describes the accurate diagnosis and successful surgical resection of a COF with periosteum preservation, after which the defect was completely and spontaneously filled with the newly formed bone through a natural process. Case Presentation. A 32-year-old Iranian female patient presented with a history of gradual development of painful swelling, spontaneous pain, and lower lip and chin hypoesthesia in the lower third of the left side of her face. The dome-shaped swelling was tender. The patient was suffering from renal infection and urethral prolapse and was taking folic acid. She also mentioned a positive family history of similar swellings in her mother and uncle. Intraoral examination indicated a lesion in buccal and lingual vestibules extending from the first premolar to the third molar teeth. It had a firm consistency, and the covering mucosa was normal in terms of color and texture. The aspiration test was negative. The lesion had caused severe mobility of the second premolar and first and second molar teeth. Panoramic radiography revealed an extensive well-defined unilocular radiolucency. Significant knife-edge resorption of the first and second molar roots at the involved site and thinning of the alveolar crest and inferior border of the mandible were also clear. Cone-beam computed tomography showed severe expansion in the buccal and moderate expansion in the lingual aspect, causing thinning of both the buccal and lingual cortical plates. Histopathological analysis revealed neoplastic tissue mixed with fibrous connective tissue and several round and oval-shaped calcification foci. Immunohistochemical analysis confirmed the final diagnosis (COF) with the presence of SMA-8. The lesion was removed by enucleation and curettage, while the periosteum was carefully preserved. Fixation with screw and plate was also performed. Conclusions Correct diagnosis of COF and precise implementation of the periosteal osteogenesis technique, in this case, resulted in entirely and spontaneously bone regeneration, which was a rare and favorable outcome with minimum cost and complications for the patient.
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Assessment of fibular regeneration after graft harvesting in patients with benign bone tumors: A retrospective study comparing different age groups. Orthop Traumatol Surg Res 2022; 108:103108. [PMID: 34634503 DOI: 10.1016/j.otsr.2021.103108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/19/2021] [Accepted: 10/04/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Using non-vascularized fibula as autogenous graft has gained much success in reconstruction after tumor resection owing to its simplicity. Donor-site morbidity related to fibula deficiency includes valgus ankle, chronic pain and stress fractures of the ipsilateral tibia. HYPOTHESIS Growth potential before skeletal maturity is the most important factor promoting fibular regeneration after non- vascularized harvesting, and its decline with skeletal maturity causes failure of fibular regeneration. PATIENTS AND METHODS This is a retrospective study of the patients with benign bone tumors who required bone defect reconstruction by non-vascularized fibular graft utilizing a periosteal preserving technique. The study entailed 118 patients below the age of 12, 100 age 12-18, and 80 above the age of 18. RESULTS In children below 12, regeneration was complete in 95%, incomplete in 4.2% and partial in 0.8% of the cases. In adolescents, regeneration was complete in 72%, incomplete in 15% and partial in 13% of the cases. After skeletal maturity, no regeneration occurred in 92.5%of the patients, while partial regeneration occurred in 7.5% of the cases. Valgus ankle occurred in 2.8% of the cases before skeletal maturity, and none in older patients. DISCUSSION Complete regeneration after non-vascularized fibula graft harvesting is the rule in pediatric patients and to a lesser extent in adolescent group. This is usually associated by near normal regaining of the regenerate strength and function. Non-regeneration dominates in older age group. The length of the harvested segment has no impact on the regeneration or the remodeling process. LEVEL OF EVIDENCE IV; case series, retrospective comparative study.
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D'Arienzo A, Ipponi E, Ruinato AD, De Franco S, Colangeli S, Andreani L, Capanna R. Proximal Humerus Reconstruction after Tumor Resection: An Overview of Surgical Management. Adv Orthop 2021; 2021:5559377. [PMID: 33828866 PMCID: PMC8004366 DOI: 10.1155/2021/5559377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/10/2021] [Indexed: 02/07/2023] Open
Abstract
Proximal humerus is one of the anatomical sites that are most frequently involved by bone and soft tissue malignant tumors. Alone or in association with adjuvant treatments, surgery represents the main therapeutic option to treat and eradicate these diseases. Once the first-line option, in the last decades, amputation lost its role as treatment of choice for the large majority of cases in favor of the modern limb sparing surgery that promises to preserve anatomy and-as much as possible-upper limb functionality. Currently, the main approaches used to replace proximal humerus after a wide resection in oncologic surgery can be summarized in biological reconstructions (allografts and autografts), prosthetic reconstructions (anatomic endoprostheses, total reverse shoulder prostheses), and graft-prosthetic composite reconstructions. The purpose of this overview is to present nowadays surgical options for proximal humerus reconstruction in oncological patients, with their respective advantages and disadvantages.
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Affiliation(s)
- Antonio D'Arienzo
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Edoardo Ipponi
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | | | - Silvia De Franco
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Simone Colangeli
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Lorenzo Andreani
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Rodolfo Capanna
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
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Colangeli M, Spinnato P, Manfrini M. Periosteum preservation in bone regeneration. CMAJ 2020; 192:E920. [PMID: 32778605 DOI: 10.1503/cmaj.200005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Marco Colangeli
- Departments of Musculoskeletal Oncology (Colangeli, Manfrini), and Diagnostic and Interventional Radiology (Spinnato), IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Spinnato
- Departments of Musculoskeletal Oncology (Colangeli, Manfrini), and Diagnostic and Interventional Radiology (Spinnato), IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Manfrini
- Departments of Musculoskeletal Oncology (Colangeli, Manfrini), and Diagnostic and Interventional Radiology (Spinnato), IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy
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Nonvascularized Bone Grafts for Reconstruction of Segmental Mandibular Defects: Is Length of Graft a Factor of Success? J Oral Maxillofac Surg 2019; 77:2557-2566. [PMID: 31228424 DOI: 10.1016/j.joms.2019.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 05/05/2019] [Accepted: 05/06/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of this study was to evaluate a long-debated question in the field of whether the success of reconstructing mandibular defects with nonvascularized bone grafts (NVBGs) is dependent on the length of the graft. MATERIALS AND METHODS The inclusion criteria were patients who had received NVBGs, such as anterior or posterior iliac crest and costochondral grafts, to reconstruct segmental defects of the mandible between 2008 and 2017 at the Department of Oral and Maxillofacial Surgery at Case Western Reserve University. Patients with a history of irradiation of the head and neck and patients with inadequate follow-up were excluded from this study. Data such as defect length, patient age, comorbidities, length of follow-up, location of defect, etiology of defect, and postoperative course were collected. Success was judged by radiographic and clinical evidence of bone continuity and stability at a minimum of 4 months postoperatively. Failures were considered loss of all or part of the graft, resulting in a residual continuity defect requiring further bone grafting. RESULTS We identified 61 potential cases, of which 29 met the inclusion and exclusion criteria. The mean age of the patients at the time of grafting was 55 years (range, 17 to 81 years), with a mean follow-up length of 18 months. The length of defects ranged from 2 to 22 cm. The grafts were 6 cm or less in length in 7 defects and greater than 6 cm in length in 22 defects. All cases were grafted at a minimum of 6 months after resection, and bone morphogenetic protein was used in 25 cases (86%). Failure occurred in 1 patient in the group with grafts of 6 cm or less and 2 patients in the group with grafts greater than 6 cm, corresponding to success rates of 86% and 91%, respectively. Eight patients experienced minor complications such as wound dehiscence or infection, which resolved with local measures and antibiotics. CONCLUSIONS The results of our study show that NVBGs are a viable, safe, and effective treatment option for segmental mandibular defects over 6 cm in length in non-irradiated patients.
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