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Fulchignoni C, Pietramala S, Lopez I, Mazzella GG, Comisi C, Perisano C, Rocchi L, Greco T. Surgical Outcomes and Complications of Custom-Made Prostheses in Upper Limb Oncological Reconstruction: A Systematic Review. J Funct Morphol Kinesiol 2024; 9:72. [PMID: 38651430 PMCID: PMC11036263 DOI: 10.3390/jfmk9020072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/25/2024] Open
Abstract
Bone tumors of the upper limb are a common cause of bone pain and pathological fractures in both old and young populations. Surgical reconstruction and limb salvage have become valid options for these patients despite this kind of surgery being challenging due to the need for wide bone resection and the involvement of surrounding soft tissues. Computer-assisted technology helps the surgeon in pre-operative planning and in designing customized implants. The aim of this study was to investigate the surgical outcomes and complications of custom-made prostheses in oncologic reconstruction of the upper limb and if they are reliable options for patients suffering from aggressive tumors. An electronic search on PubMed, Google Scholar, and Web of Knowledge was conducted to identify all available articles on the use of custom-made prostheses in oncological resections of the upper limb. Twenty-one studies were included in the review, comprising a total of 145 patients with a mean age of 33.68 years. The bone involved was the humerus in 93 patients, and the radius was involved in 36 patients. There were only six cases involving proximal ulna, three cases involving the scapula, and seven cases involving the elbow as well as soft tissues around it. The most frequent primary tumor was the giant cell tumor, with 36 cases, followed by osteosarcoma with 25 cases, Ewing Sarcoma with 17 cases, and Chondrosarcoma with 7 total cases. Forty patients were affected by bone metastases (such as renal cell cancer, breast cancer, melanoma, and rectal cancer) or hematologic diseases involving bone (lymphoma, myeloma, or non-Hodgkin disease). Custom-made prostheses are a viable option for patients who suffer from malignant tumors in their upper limbs. They are a reliable aid for surgeons in cases of extensive resections.
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Affiliation(s)
| | | | | | | | | | | | | | - Tommaso Greco
- Hand Surgery and Orthopedics Unit, Department of Orthopaedics and Traumatology, Catholic University of Rome, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.F.); (S.P.); (I.L.); (G.G.M.); (C.C.); (C.P.); (L.R.)
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Satwikananda H, Wiratama MA, Putri KTC, Soebadi DM. Renal cell carcinoma in a patient with staghorn stones: A case report. Int J Surg Case Rep 2023; 110:108678. [PMID: 37603918 PMCID: PMC10445450 DOI: 10.1016/j.ijscr.2023.108678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/15/2023] [Accepted: 08/15/2023] [Indexed: 08/23/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Staghorn stone fills the renal pelvic and two or more branches of renal calyces. The incidence of staghorn stones is between 10 and 20 % of all urinary tract stones. We report the case of a man with right staghorn stones and renal mass who underwent right radical nephrectomy with pathology anatomy result of renal cell carcinoma (RCC). CASE PRESENTATION A 56-year-old man came with a complaint of right flank pain for two months. Physical examination is within normal limits, but an abdominal CT scan revealed a staghorn stone with enhancing mass in the upper pole of the right kidney. Patient subsequently underwent right radical nephrectomy. Pathology examination revealed RCC. CLINICAL DISCUSSION The presence of kidney stones in renal malignancy is rare. Kidney stones can be a risk factor for renal cell malignancy, and renal cell malignancies can cause urinary stasis, making it a risk factor for kidney stones. A study conducted by Nugroho and colleagues concluded that renal and caliceal biopsy should be considered in large and chronic renal stone due to potential experiencing kidney malignancy in patient with renal stone. Therefore, early diagnosis and definitive can be carried out. CONCLUSION Kidney stones and malignancy are rarely found. Renal pelvis, and caliceal wall biopsy should be considered in chronic and large renal stone, especially staghorn stone in patient that did not have any signs of malignancy on CT scan. Treatment in such case is focused on the oncological outcome. Therefore, radical nephrectomy is the treatment of choice.
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Affiliation(s)
- Handaru Satwikananda
- Department of Urology, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
| | - Made Adi Wiratama
- Department of Urology, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
| | - Karinda Triharyu Caesari Putri
- Department of Urology, Faculty of Medicine, Jenderal Soedirman University/Prof. Dr. Margono Soekarjo Hospital, Purwokerto, Central Java, Indonesia
| | - Doddy Moesbadianto Soebadi
- Department of Urology, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia.
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Sullivan MH, Townsley SH, Rizzo M, Moran SL, Houdek MT. Management of giant cell tumors of the distal radius. J Orthop 2023; 41:47-56. [PMID: 37324809 PMCID: PMC10267431 DOI: 10.1016/j.jor.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/24/2023] [Accepted: 06/01/2023] [Indexed: 06/17/2023] Open
Abstract
Background The distal radius is the most common location for giant cell tumors (GCT) in the upper extremity. Treatment should balance the goals of maximizing function and minimizing recurrence and other complications. Given the complexity in surgical treatment, various techniques have been described without clear standards of treatment. Objectives The purpose of this review is to provide an overview of evaluation of patients presenting with GCT of the distal radius, discuss management, and provide an updated summary on outcomes of treatment options. Conclusion Surgical treatment should consider tumor Grade, involvement of the articular surface, and patient-specific factors. Options include intralesional curettage and en bloc resection with reconstruction. Within reconstruction techniques, radiocarpal joint preserving and sparing procedures can be considered. Campanacci Grade 1 tumors can be successfully treated with joint preserving procedures, whereas for Campanacci Grade 3 tumors consideration should be given to joint resection to prevent recurrence. Treatment of Campanacci Grade 2 tumors is debated in the literature. Intralesional curettage and adjuvants can successfully treat cases where the articular surface can be preserved, while en-bloc resection should be used in cases where the articular surface cannot undergo aggressive curettage. A variety of reconstructive techniques are used for cases needing resection, with no clear gold standard. Joint sparing procedures preserve motion at the wrist joint, whereas joint sacrificing procedures preserve grip strength. Choice of reconstructive procedure should be made based on patient-specific factors, considering relative functional outcomes, complications, and recurrence rates.
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Affiliation(s)
| | | | - Marco Rizzo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Steven L. Moran
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA
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Gong T, Luo Y, Lu M, Wang J, Zhang Y, Wang Y, Tang F, Li Z, Zhou Y, Min L, Tu C. The optimal strategy for 3D-printed uncemented endoprosthesis for the bone defect reconstruction of the distal radius, based on biomechanical analysis and retrospective cohort study. J Surg Oncol 2023; 127:1043-1053. [PMID: 36825890 DOI: 10.1002/jso.27215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 02/25/2023]
Abstract
INTRODUCTION Prosthetic reconstruction after resecting giant cell tumor of bone (GCTB) of the distal radius has been proposed. However, this is generally associated with various complications. To improve the functional outcomes, we designed a three-dimensional (3D)-printed uncemented endoprosthesis. Meanwhile, using finite-element analysis and clinical observation, an optimization strategy was explored. MATERIALS AND METHODS We retrospectively analyzed patients with Campanacci III or recurrent GCTB of the distal radius who underwent 3D-printed uncemented endoprosthesis reconstruction. Clinically, according to the different palmar tilts of the endoprosthesis, patients were divided into the biological angle (BA) group and the zero-degree (ZD) group. We recorded and evaluated the differences in functional outcomes and complications between the two groups. Biomechanically, four 3D finite-element models (normal and customized endoprostheses with three different implemented palmar tilts) were developed. RESULTS We analyzed 22 patients (12 males and 10 females). The median follow-up period was 60 (range, 19-82) months. Of the 22 patients, 11 patients were included in the BA group and the remaining 11 patients were in the ZD group. Both groups showed no significant differences in the range of motion, Mayo score, and disabilities of the arm, shoulder, and hand scores postoperatively. The subluxation rate was significantly lower in the ZD group than in the BA group. The biomechanical results showed similar stress and displacement distribution patterns in the normal and prosthetic reconstruction models. Additionally, the endoprosthesis with 0° palmar tilt showed better biomechanical performance. CONCLUSION 3D-printed uncemented endoprosthesis provides acceptable midterm outcomes in patients undergoing distal radius reconstruction. Optimizing the design by decreasing the palmar tilt may be beneficial for decreasing the risk of wrist joint subluxation.
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Affiliation(s)
- Taojun Gong
- Department of Orthopedics, West China Hospital, Orthopaedic Research Institute , Sichuan University, Chengdu, People's Republic of China.,Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Yi Luo
- Department of Orthopedics, West China Hospital, Orthopaedic Research Institute , Sichuan University, Chengdu, People's Republic of China.,Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Minxun Lu
- Department of Orthopedics, West China Hospital, Orthopaedic Research Institute , Sichuan University, Chengdu, People's Republic of China.,Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Jie Wang
- Department of Orthopedics, West China Hospital, Orthopaedic Research Institute , Sichuan University, Chengdu, People's Republic of China.,Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Yuqi Zhang
- Department of Orthopedics, West China Hospital, Orthopaedic Research Institute , Sichuan University, Chengdu, People's Republic of China.,Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Yitian Wang
- Department of Orthopedics, West China Hospital, Orthopaedic Research Institute , Sichuan University, Chengdu, People's Republic of China.,Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Fan Tang
- Department of Orthopedics, West China Hospital, Orthopaedic Research Institute , Sichuan University, Chengdu, People's Republic of China.,Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Zhuangzhuang Li
- Department of Orthopedics, West China Hospital, Orthopaedic Research Institute , Sichuan University, Chengdu, People's Republic of China.,Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Yong Zhou
- Department of Orthopedics, West China Hospital, Orthopaedic Research Institute , Sichuan University, Chengdu, People's Republic of China.,Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Li Min
- Department of Orthopedics, West China Hospital, Orthopaedic Research Institute , Sichuan University, Chengdu, People's Republic of China.,Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Chongqi Tu
- Department of Orthopedics, West China Hospital, Orthopaedic Research Institute , Sichuan University, Chengdu, People's Republic of China.,Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, Chengdu, Sichuan, People's Republic of China
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Bodansky DMS, Sandow MJ, Volk I, Luria S, Verstreken F, Horwitz MD. Insights and trends review: the role of three-dimensional technology in upper extremity surgery. J Hand Surg Eur Vol 2023; 48:383-395. [PMID: 36748271 DOI: 10.1177/17531934221150498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The use of three-dimensional (3-D) technology in upper extremity surgery has the potential to revolutionize the way that hand and upper limb procedures are planned and performed. 3-D technology can assist in the diagnosis and treatment of conditions, allowing virtual preoperative planning and surgical templating. 3-D printing can allow the production of patient-specific jigs, instruments and implants, allowing surgeons to plan and perform complex procedures with greater precision and accuracy. Previously, cost has been a barrier to the use of 3-D technology, which is now falling rapidly. This review article will discuss the current status of 3-D technology and printing, including its applications, ethics and challenges in hand and upper limb surgery. We have provided case examples to outline how clinicians can incorporate 3-D technology in their clinical practice for congenital deformities, management of acute fracture and malunion and arthroplasty.
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Affiliation(s)
- David M S Bodansky
- Department of Plastic Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK
| | | | - Ido Volk
- Hadassah Medical Organisation, Jerusalem, Israel
| | - Shai Luria
- Hadassah Medical Organisation, Jerusalem, Israel
| | | | - Maxim D Horwitz
- Department of Plastic Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK
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Jiang X, Chen J, Zhou W, Zhang C, Wang G, Dong D, Xia P, Liu X, Xu F. Microwave in situ inactivation in the treatment of bone giant cell tumor: a mid-term descriptive study. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04348-9. [PMID: 36190550 DOI: 10.1007/s00432-022-04348-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/06/2022] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the mid-term clinical efficacy of microwave in situ inactivation combined with bone grafting or polymethyl methacrylate (PMMA) filling in the treatment of giant cell tumor of bone (GCTB). METHODS This is a retrospective, descriptive, and analytical study. A total of 30 GCTB patients received microwave in situ inactivation from January 2012 to January 2020, whose clinical recurrence rate was evaluated at the last follow-up after microwave in situ inactivation surgery. The Musculoskeletal Tumor Society (MSTS) function score was used to evaluate the postoperative clinical panoramic results. RESULTS All patients were followed up for 21 to 110 months, with an average of 63.79 months. Distal femur (40%) and proximal tibia (28%) had a higher rate of GCTB incidence. Seventeen percent of tumor patients suffered from associated pathologic fracture. The rate of Campanacci classification stage III was 60%. The average MSTS score was evaluated as 27.53 points overall at the last follow-up. In terms of complications, three, two, two and one cases developed fat liquefaction, controllable tissue rejection reaction, incision infection and degenerative changes around lesion joint, respectively, without in situ recurrences and reoperation as well as distant lung metastasis. CONCLUSIONS The method of microwave in situ inactivation combined with bone grafting or PMMA filling is prudently recommended as one of the options for the limb salvage treatment of giant cell tumor of long and periarticular bone. LEVEL OF EVIDENCE IV: case series.
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Affiliation(s)
- Xiang Jiang
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China
| | - Jianan Chen
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China
- The First School of Clinical Medicine, Southern Medical University, 1023-1063 Shatai South Road, Baiyun District, Guangzhou City, Guangdong Province, China
| | - Wei Zhou
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China
| | - Chen Zhang
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China
| | - Guodong Wang
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China
| | - Dan Dong
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China
| | - Pingguang Xia
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China.
| | - Ximing Liu
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China
| | - Feng Xu
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China
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Zoccali C, Formica VM, Sperduti I, Checcucci E, Scotto di Uccio A, Pagnotta A, Villani C. Wide resection for giant-cell tumor of the distal radius: which reconstruction? A systematic review of the literature and pooled analysis of 176 cases. HAND SURGERY & REHABILITATION 2022; 41:552-560. [PMID: 35868588 DOI: 10.1016/j.hansur.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/30/2022] [Accepted: 07/03/2022] [Indexed: 06/15/2023]
Abstract
Giant-cell tumor (GCT) is often more aggressive when located in the distal radius, and wide resection is then the gold-standard. No single reconstruction protocol is recommended, and the technique depends upon the surgeon's preferences. The aim of the present review was to determine the recurrence rate of GTC of the distal radius after intralesional treatment, to assess the results, advantages and complications of the various surgical techniques, and to draw up a decision-tree for surgical indications. The review of literature was performed in the main healthcare databases, searching for studies that reported results of wide resection and reconstruction of distal radius GCT. Local recurrence rates, metastasis rates, reconstruction techniques and respective results and complications were evaluated and analyzed. Sixteen studies were selected, for a total population of 226 patients; 6.0% and 0.9% experienced local recurrence and lung metastasis, respectively. Arthroplasty with non-vascularized or vascularized ipsilateral fibula were the most common techniques and were associated with the highest satisfaction rates: 86.4% and 88.0%, respectively. Arthroplasty with allograft presented a MusculoSkeletal Tumor Society (MSTS) score of 79.2% and arthroplasty with custom-made prosthesis presented an MSTS score of 81.8%. Arthrodesis was performed in 46 cases, with an MSTS score of 82.7%. Arthroplasty techniques are the most common in literature; they are used in patients who wish to conserve joint motion. Reconstruction with non-vascularized fibula seems to provide the best results, with lower morbidity. Arthrodesis is usually reserved for heavy manual workers or in case of arthroplasty failure.
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Affiliation(s)
- C Zoccali
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; Oncological Orthopaedics Department, IRCCS - Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy.
| | - V M Formica
- Hand and Microsurgery Unit, Jewish Hospital, Via Fulda 14, 00148 Rome, Italy
| | - I Sperduti
- Biostatistical Unit, IRCCS - Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - E Checcucci
- Oncological Orthopaedics Department, IRCCS - Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - A Scotto di Uccio
- Hepato-Biliary and Organ Transplant Unit, School of General Surgery, Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy
| | - A Pagnotta
- Hand and Microsurgery Unit, Jewish Hospital, Via Fulda 14, 00148 Rome, Italy
| | - C Villani
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
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[Application of LARS ligament combined with three-dimensional printed prosthesis in reconstruction of radial hemicarpal joint after tumor resection]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:822-827. [PMID: 35848177 PMCID: PMC9288910 DOI: 10.7507/1002-1892.202202086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To investigate the effectiveness of LARS ligament and three-dimensional (3D) printed prosthesis on the combined reconstruction of radial hemicarpal joint after distal radius tumor resection. METHODS The clinical data of 12 patients with combined reconstruction of radial hemicarpal joint with LARS ligament and 3D printed prosthesis after distal radius tumor resection between September 2017 and March 2021 were retrospectively analyzed. There were 7 males and 5 females with an average age of 41.8 years (range, 19-63 years). There were 8 cases on the left side and 4 cases on the right side, and 10 cases of giant cell tumor of bone and 2 cases of osteosarcoma. The disease duration ranged from 1 to 20 months, with an average of 8.1 months. The osteotomy length, operation time, and intraoperative blood loss were recorded, and the wrist function was evaluated by Mayo wrist score and Musculoskeletal Tumor Society (MSTS) score before and after operation. The grip strength of the affected limb was expressed by the percentage of grip strength of the healthy upper limb, and the range of motion (ROM) of the wrist joint was measured, including extension, flexion, radial deviation, and ulnar deviation; the bone ingrowth and osseointegration at the bone-prosthesis interface of the wrist joint were observed by radiographic follow-up; the possible wrist complications were recorded. RESULTS All 12 patients successfully completed the operation. The osteotomy length was 5.0-10.5 cm (mean, 6.8 cm), and the operation time was 180-250 minutes (mean, 213.8 minutes). The intraoperative blood loss was 30-150 mL (mean, 61.7 mL). All patients were followed up 11-52 months (mean, 30.8 months). Radiographic follow-up showed that bone ingrowth and osseointegration at the bone-prosthesis interface were observed in all patients, and biological fixation was gradually achieved. During the follow-up, the stability, motor function, and ROM of the wrist joint were good. There was no complication such as arthritis, subluxation, prosthesis loosening, and infection, and no tumor recurrence and metastasis. At last follow-up, the Mayo score was 82.1±5.4, and MSTS score was 27.5±1.5, which were significantly improved when compared with those before operation (48.8±13.5, 16.4±1.4; t=-10.761, P<0.001; t=-26.600, P<0.001). The grip strength of the affected side was 59%-88% of that of the healthy side, with an average of 70.5%. The ROM of wrist joint were 55°-80° (mean, 65.42°) in extension, 35°-60° (mean, 44.58°) in flexion, 10°-25° (mean, 17.92°) in radial deviation, 10°-25° (mean, 18.33°) in ulnar deviation. CONCLUSION The combined application of LARS ligament and 3D printed prosthesis is an effective way to reconstruct bone and joint defects after distal radius tumor resection. It can improve the function of wrist joint, reduce the incidence of complications, and improve the stability of wrist joint.
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Guo Z, Zhang R, Que Y, Hu B, Xu S, Hu Y. Case Report: 3D-Printed Prosthesis for Limb Salvage and Joint Preservation After Tibial Sarcoma Resection. Front Surg 2022; 9:873272. [PMID: 35711702 PMCID: PMC9195185 DOI: 10.3389/fsurg.2022.873272] [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: 02/10/2022] [Accepted: 05/09/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Reconstruction of massive tibial defects in ankle joint-preserving surgery remains challenging though biological and prosthetic methods have been attempted. We surgically treated a patient with only 18-mm distal tibia remaining and reconstructed with a unique three-dimensional printed prosthesis. Case Presentation, Intervention, and Outcomes A 36-year-old male presented to our clinic with complaints of gradually swelling left calf and palpable painless mass for five months. Imageological exam indicated a lesion spanning the entire length of the tibia and surrounding the vascular plexus. Diagnosis of chondrosarcoma was confirmed by biopsy. Amputation was initially recommended but rejected, thus a novel one-step limb-salvage procedure was performed. After en-bloc tumor resection and blood supply rebuilding, a customized, three-dimensional printed prosthesis with porous interface was fixed that connected the tumor knee prosthesis and distal ultra-small bone segment. During a 16-month follow-up, no soft tissue or prosthesis-related complications occurred. The patient was alive with no sign of recurrence or metastasis. Walking ability and full tibiotalar range of motion were preserved. Conclusions Custom-made, three-dimensional printed prosthesis manifested excellent mechanical stability during the follow-up in this joint-preserving surgery. Further investigation of the durability and rate of long-term complications is needed to introduce to routine clinical practice.
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Affiliation(s)
| | | | | | | | | | - Yong Hu
- Correspondence: Shenglin Xu Yong Hu
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10
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Reconstruction of the distal radius using a double-barrel vascularized fibula flap: a case series. HAND SURGERY & REHABILITATION 2021; 41:189-193. [PMID: 34959005 DOI: 10.1016/j.hansur.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/08/2021] [Accepted: 12/10/2021] [Indexed: 11/24/2022]
Abstract
Treatment of distal radius tumor sometimes requires sacrificing the epiphysis. We propose adding to currently available reconstruction options a technique using a double-barrel vascularized fibula flap fixed distally to the first carpal row, conserving midcarpal mobility. We monitored 4 cases of Campanacci III giant-cell tumor and 2 cases of osteosarcoma. After en-bloc tumor resection, a double-barrel vascularized fibula flap was lodged distally in the scaphoid and lunate and proximally in the radius. Follow-up was clinical and radiological, using DASH, PRWE and MSTS functional scores. At a median 3 years' follow-up, there were no cases of recurrence or non-union. Median ranges of motion were 23° flexion, 28° extension, 90° pronation and 62° supination. Median grip strength proportional to the contralateral side was 67%. Median DASH and PRWE functional scores were respectively 13.7 and 17 points. Median MSTS was 83%. Although this technique is challenging, with difficulties in double-barrel flap placement and in pedicle plication, the double-barrel vascularized fibula flap provided a stable and mobile wrist.
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Xu L, Qin H, Cheng Z, Jiang WB, Tan J, Luo X, Huang W. 3D-printed personalised prostheses for bone defect repair and reconstruction following resection of metacarpal giant cell tumours. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1421. [PMID: 34733973 PMCID: PMC8506718 DOI: 10.21037/atm-21-3400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/30/2021] [Indexed: 12/16/2022]
Abstract
Background Conventional surgical treatment for metacarpal giant cell tumours (GCTs) includes lesion scraping followed by bone grafting or bone cement filling and en bloc resection followed by repair and reconstruction using a vascularised bone flap. However, these methods have inherent shortcomings, including a high postoperative recurrence rate and poor mechanical stability. 3D-printing techniques are increasingly being applied in medicine, and 3D-printed personalised prostheses have achieved good clinical effects in orthopaedic repair and reconstruction. We aimed to investigate the clinical effects of 3D-printed personalised prostheses for bone defect repair and reconstruction following resection of metacarpal GCTs. Methods Three patients with metacarpal GCTs were examined in a retrospective cohort study. Through preoperative planning, a 3D-printed personalised prosthesis was designed and created for bone defect repair and reconstruction after tumour resection. Prosthesis fit, limb function, pain on the affected side, and the occurrence of complications were evaluated postoperatively. Results Postoperative X-ray examination revealed a satisfactory fit of the 3D-printed prosthesis in terms of bone defect size and overall metacarpal shape, as well as good transverse and longitudinal metacarpal arches. The patients also exhibited good function in the affected limb, with good flexion and extension functions in the carpal, metacarpophalangeal, and interphalangeal joints, plus the absence of obvious pain, tumour recurrence, and complications such as pathologic fractures and prosthetic loosening. Conclusions When using a 3D-printed personalised prosthesis for bone defect repair and reconstruction following resection of metacarpal GCTs, a good fit with the bone defect can be achieved during prosthetic installation when preoperative planning and design have been adequately performed. Therefore, three-dimensionally printed personalised prostheses can serve as an effective method for the treatment of metacarpal GCTs.
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Affiliation(s)
- Lin Xu
- Department of Human Anatomy, School of Basic Medical Sciences, Guangxi Medical University, Nanning, China.,Guangxi Clinical Research Center for Digital Medicine and 3D Printing (Guigang City People's Hospital), Guigang, China
| | - Hao Qin
- Guangxi Clinical Research Center for Digital Medicine and 3D Printing (Guigang City People's Hospital), Guigang, China.,Department of Orthopedics, Gaozhou People's Hospital, Maoming, China
| | - Zhilin Cheng
- Guangxi Clinical Research Center for Digital Medicine and 3D Printing (Guigang City People's Hospital), Guigang, China
| | - Wen-Bo Jiang
- Clinical and Translational Research Center for 3D Printing Technology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Tan
- Clinical and Translational Research Center for 3D Printing Technology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiang Luo
- Guangxi Clinical Research Center for Digital Medicine and 3D Printing (Guigang City People's Hospital), Guigang, China
| | - Wenhua Huang
- Department of Human Anatomy, School of Basic Medical Sciences, Guangxi Medical University, Nanning, China.,National Key Discipline of Human Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
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12
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Raciborska A, Bilska K, Malesza I, Rodriguez-Galindo C, Pachuta B. Distal Tibial Reconstruction in the Management of Primary Bone Tumors in Children and Adolescents. Foot Ankle Int 2021; 42:1447-1453. [PMID: 34116600 DOI: 10.1177/10711007211012690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Distal tibial primary bone tumors are rare, and options for limb salvage surgery are limited and challenging. Importantly, local control has shown to be crucial and necessary for cure, and radical surgery is one of the most important components of therapy for some bone sarcomas. We investigated the feasibility and functional and oncological outcomes of distal tibial reconstruction using endoprosthesis in children with malignant bone tumors. METHODS Fourteen patients (median age 13.6 years) with primary bone tumors (4 Ewing sarcoma [ES], 10 osteosarcoma) of the distal tibiae were treated during 2013-2019. All patients had reconstruction using a modular (13 patients) or expandable custom-made titanium bone replacement system (1 patient). All patients received chemotherapy before and after surgery. RESULTS Twelve patients (85.7%) are alive with a median follow-up 20 months from diagnosis. Five-year estimates of event-free survival and overall survival were 60.6% and 76.4%, respectively. Three patients had postoperative complications requiring second surgery. Maximum dorsiflexion and plantar flexion of the foot were 20 degrees (range 0-20 degrees) and 20 degrees (range 5-20 degrees), respectively. CONCLUSION For select distal tibial sarcomas, after neoadjuvant chemotherapy pretreatment and radical resection, reconstruction using an endoprosthesis as a radical surgery provides an option was associated with a low rate of short-term local complications and relatively good early function. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Anna Raciborska
- Department of Oncology and Surgical Oncology for Children and Youth, Institute of Mother and Child, Warsaw, Poland
| | - Katarzyna Bilska
- Department of Oncology and Surgical Oncology for Children and Youth, Institute of Mother and Child, Warsaw, Poland
| | - Iwona Malesza
- Department of Oncology and Surgical Oncology for Children and Youth, Institute of Mother and Child, Warsaw, Poland
| | | | - Bartosz Pachuta
- Department of Oncology and Surgical Oncology for Children and Youth, Institute of Mother and Child, Warsaw, Poland
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13
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Lunn K, Hoftiezer Y, Lans J, van der Heijden B, Chen N, Lozano-Calderón SA. Joint-sparing versus nonjoint-sparing reconstruction of the radius following oncologic resection: A systematic review. J Surg Oncol 2021; 124:1523-1535. [PMID: 34432294 DOI: 10.1002/jso.26660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/16/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Reconstructions of the distal radius are uncommon procedures. This systematic review compares joints-sparing (JS) versus nonjoint-sparing (NJS) reconstructions following oncologic resection of the distal radius. METHODS A search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Collected outcomes included patient-reported outcome measures (PROMs), range of motion and grip strength, and complication and reoperation rates. RESULTS A total of 52 nonrandomized cohort studies (n = 715) were included. PROMs were comparable between the cohorts, while the range of flexion-extension was greater in JS reconstructions (78.1° vs. 25.6°) and the range of pronation-supination was greater in NJS reconstructions (133.6° vs. 109.8°). Relative grip strength was greater following JS reconstruction (65.0% vs. 56.4%). About one in sixteen of the JS reconstructions were eventually revised to an NJS construct. CONCLUSIONS This systematic review demonstrates that JS reconstructive techniques can offer satisfying results in patients treated for oncologic distal radius defects. However, about 6% of JS reconstructions are eventually revised to a NJS construct. Further investigation is warranted to identify factors that affect or predict these findings, to aid in future in treatment selection and reduce the common need for reoperations following these procedures.
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Affiliation(s)
- Kiera Lunn
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yannick Hoftiezer
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Plastic, Reconstructive, and Hand Surgery, Radboud UMC, Nijmegen, Netherlands
| | - Jonathan Lans
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brigitte van der Heijden
- Department of Plastic, Reconstructive, and Hand Surgery, Radboud UMC, Nijmegen, Netherlands.,Department of Plastic Surgery, Jeroen Bosch Hospital, Den Bosch, Netherlands
| | - Neal Chen
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Santiago A Lozano-Calderón
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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14
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Damert HG, Kober M, Mehling I. Custom-made wrist prothesis (UNI-2™) in a patient with giant cell tumor of the distal radius: 10-year follow-up. Arch Orthop Trauma Surg 2020; 140:2109-2114. [PMID: 32876750 DOI: 10.1007/s00402-020-03593-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/16/2020] [Indexed: 11/28/2022]
Abstract
Wrist endoprosthesis is still an exceptional indication compared to the prosthesis of large joints, especially when a rescue surgery procedure of the wrist is no longer possible and the complete wrist arthrodesis is to be considered the ultima ratio. However, a suspended function in the wrist is accompanied by a significant restriction in the patient`s daily life. Using the fourth-generation endoprosthesis, the situation regarding long-term results for the hand has already improved. This means that a durability of more than 6 years is no longer a rarity. Defect situations in joints, in particular those which occur after tumor, still pose a greater challenge. If autologous reconstructions cannot be performed, custom-made prostheses can be considered as very rare indications for joint reconstruction. While these have been used for years on large joints such as shoulder, elbow, knee and hip, they have only been described on the hand in particular cases. We report the 10-year follow-up of implantation of a custom-made wrist prothesis (UNI-2™, KMI, Germany) in a 36-year-old patient with tumorous destruction of the distal radius by a giant cell tumor.
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Affiliation(s)
- H G Damert
- Klinik für Plastische, Ästhetische und Handchirurgie, HELIOS-Bördeklinik, Kreiskrankenhaus 4, 39387, Oschersleben, Germany.
| | - M Kober
- Klinik für Plastische, Ästhetische und Handchirurgie, HELIOS-Bördeklinik, Kreiskrankenhaus 4, 39387, Oschersleben, Germany
| | - I Mehling
- St. Vinzenz-Krankenkaus Hanau gGmbH, Am Frankfurter Tor 25, 63450, Hanau, Germany
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