title: Intercalary segmental reconstruction of long bones after malignant bone tumor resection using primary methyl methacrylate cement spacer interposition and secondary bone grafting: the induced membrane technique.
abstract: BACKGROUND
  Bone reconstruction after surgical resection of malignant bone tumor in children remains a difficult challenge and various techniques exist. Induced membrane reconstruction as described by Masquelet et al has been reported in traumatic large bone defects. We have been using this 2-stage technique after primary malignant bone tumors resection in children since 2000.
  
  
  METHODS
  We retrospectively studied 12 cases: 6 Ewing sarcomas and 6 osteosarcomas. Mean age of the patients was 9 years old (range, 3 to 15.5 y). Surgical treatment consisted of wide resection and insertion of a cement spacer then secondary bone grafting. All patients had neoadjuvant and adjuvant chemotherapy and 2 patients had adjuvant radiotherapy.
  
  
  RESULTS
  Surgical excision was complete in all cases. There was no local recurrence at 6.2 years (range, 4.6 to 9.1 y) follow-up. Three patients had pulmonary metastasis (of whom 1 deceased) and 1 had a metastasis on the contralateral limb. The 11 patients operated on the lower limb achieved weight bearing 4.1 months (range, 0.2 to 14.2 mo) after the second stage of the procedure. Complications were numerous with 7 nonunions (4 unifocal and 3 bifocal), 5 fractures (in 4 patients), 5 protruding wires (in 4 patients), and 2 femoral varus deformities. There was no infection.
  
  
  CONCLUSIONS
  Induced membrane reconstruction seems to be a simple and reliable technique in pediatric bone tumors and these results are promising. Extended use of locking nails could reduce the high rate of nonunion though it is not always possible in skeletally immature patients.
  
  
  METHODS
  IV (case series).
authors.affiliation: Université F. Rabelais, CHU de Tours. Service de Chirurgie Orthopédique et Traumatologique, Centre Pédiatrique Gatien de Clocheville, 49 boulevard Béranger 37044 TOURS, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Villemagne
authors.forename: Christian
authors.initials: C
authors.lastname: Bonnard
authors.forename: Franck
authors.initials: F
authors.lastname: Accadbled
authors.forename: Mohamed
authors.initials: M
authors.lastname: L'kaissi
authors.forename: Benoit
authors.initials: B
authors.lastname: de Billy
authors.forename: Jérôme
authors.initials: J
authors.lastname: Sales de Gauzy
mesh_terms: D000293:Adolescent; D001843:Bone Cements / Q000494:pharmacology; D001859:Bone Neoplasms / Q000175:diagnosis / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005269:Femur; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D020366:Methylmethacrylate / Q000494:pharmacology*; D019637:Orthopedic Procedures / Q000379:methods; D012516:Osteosarcoma / Q000175:diagnosis / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012512:Sarcoma, Ewing / Q000175:diagnosis / Q000601:surgery; D013977:Tibia; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements; D020366:Methylmethacrylate