title: Triplate fixation: a new technique in limb-salvage surgery.
abstract: Massive endoprostheses using a cemented intramedullary stem are widely used to allow early resumption of activity after surgery for tumours. The survival of the prosthesis varies with the anatomical site, the type of prosthesis and the mode of fixation. Revision surgery is required in many cases because of aseptic loosening. Insertion of a second cemented endoprosthesis may be difficult because of the poor quality of the remaining bone, and loosening recurs quickly. We describe a series of 14 patients with triplate fixation in difficult revision or joint-sparing tumour surgery with a minimum follow-up of four years. The triplate design incorporated well within a remodelled cortex to achieve osseomechanical integration with all patients regaining their original level of function within five months. Our preliminary results suggest that this technique may provide an easy, biomechanically friendly alternative to insertion of a further device with an intramedullary stem, which has a shorter lifespan in revision or joint-sparing tumour surgery. A short segment of bone remaining after resection of a tumour will not accept an intramedullary stem, but may be soundly fixed using this method.
authors.affiliation: The London Bone and Soft Tissue Tumour Service, Middlesex Hospital, Mortimer Street, London W1N 8AA, UK. j.cobb@ucl.ac.uk
authors.forename: J P
authors.initials: JP
authors.lastname: Cobb
authors.forename: N
authors.initials: N
authors.lastname: Ashwood
authors.forename: G
authors.initials: G
authors.lastname: Robbins
authors.forename: J D
authors.initials: JD
authors.lastname: Witt
authors.forename: P S
authors.initials: PS
authors.lastname: Unwin
authors.forename: G
authors.initials: G
authors.lastname: Blunn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001858:Bone Nails; D001859:Bone Neoplasms / Q000601:surgery*; D001860:Bone Plates; D002648:Child; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007866:Leg / Q000000981:diagnostic imaging / Q000601:surgery; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016348:Osseointegration; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation / Q000379:methods; D016019:Survival Analysis; D016896:Treatment Outcome