Ankle arthrodesis with bone graft after distal tibia resection for bone tumors.
BACKGROUND
Treatment of distal tibial tumors is challenging due to the scarce soft tissue coverage of this area. Ankle arthrodesis has proven to be an effective treatment in primary and post-traumatic joint arthritis, but few papers have addressed the feasibility and techniques of ankle arthrodesis in tumor surgery after long bone resections.


METHODS
Resection of the distal tibia and reconstruction by ankle fusion using non-vascularized structural bone grafts was performed in 8 patients affected by malignant (5 patients) or aggressive benign (3 patients) tumors. Resection length of the tibia ranged from 5 to 21 cm. Bone defects were reconstructed with cortical structural autografts (from contralateral tibia) or allografts or both, plus autologous bone chips. Fixation was accomplished by antegrade nailing (6 cases) or plating (2~cases).


RESULTS
All the arthrodesis successfully healed. At followup ranging from 23 to 113 months (average 53.5), all patients were alive. One local recurrence was observed with concomitant deep infection (a below-knee amputation was performed). Mean functional MSTS score of the seven available patients was 80.4% (range, 53 to 93).


CONCLUSIONS
Resection of the distal tibia and arthrodesis of the ankle with non-vascularized structural bone grafts, combined with autologous bone chips, can be an effective procedure in bone tumor surgery with durable and satisfactory functional results. In shorter resections, autologous cortical structural grafts can be used; in longer resections, allograft structural bone grafts are needed.
Campanacci
Domenico Andrea
DA
Firenze, Italy.
Scoccianti
Guido
G
Beltrami
Giovanni
G
Mugnaini
Marco
M
Capanna
Rodolfo
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000601:surgery*; D001174:Arthrodesis; D001858:Bone Nails; D001859:Bone Neoplasms / Q000601:surgery*; D001860:Bone Plates; D005260:Female; D005360:Fibula / Q000637:transplantation; D005500:Follow-Up Studies; D018212:Giant Cell Tumor of Bone / Q000601:surgery; D006390:Hemangioendothelioma / Q000601:surgery; D018219:Histiocytoma, Benign Fibrous / Q000601:surgery; D006801:Humans; D007085:Ilium / Q000637:transplantation; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011183:Postoperative Complications; D012189:Retrospective Studies; D012509:Sarcoma / Q000601:surgery; D013977:Tibia / Q000601:surgery* / Q000637:transplantation; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome