title: [Intercalary reconstruction for diaphyseal bone defects with a modular replacement system: Clinical results].
abstract: OBJECTIVE
  Reconstruction and long-term stabilization of segmental diaphyseal bone defects of the humerus, femur, and tibia.
  
  
  METHODS
  Segmental bone defects due to aggressive benign or primary malignant bone tumors, trauma, pathological fractures, osteomyelitis, or failed osteosynthesis.
  
  
  METHODS
  Acute or chronic local infections, large metadiaphyseal bone defects preventing adequate anchorage of the prosthesis, very short life expectancy (<3 months).
  
  
  METHODS
  Exposure and resection of the bony defect according to the preoperative planning. Reaming of the intramedullary canals proximally and distally followed by implantation of the stems (cemented or noncemented). Reducing sleeves can be used to bridge the difference in diameter between the nail and the spacer. Mounting of the spacer half shell with the threaded holes from underneath after adjusting for alignment and rotation. Assembling of the other half shell by guided pins to ensure proper alignment. Tightening of the clamping screws using a torque screwdriver. Connection of two spacers is possible.
  
  
  METHODS
  Active physiotherapy and full weight bearing; antibiotic prophylaxis.
  
  
  RESULTS
  The results of 14 consecutive patients treated with 15 modular intercalary endoprostheses (Osteobridge™, Merete, Berlin, Germany) between January 2007 and January 2012 with a mean follow up of 24 ± 12 months (range 12-51 months) were evaluated retrospectively. One patient had a primary malignant bone tumor, while all the other patients underwent resection for metastatic disease. The mean age at surgery was 65.9 ± 15.7 years (range 25-83 years). The mean diaphyseal reconstruction length was 110 ± 50 mm (range 50-190 mm). Three patients (20%) required revision of the distal stem due to aseptic loosening. Evaluation of the functional outcome using the MSTS score by Enneking revealed 3 very good (22%), 7 good (50%), 4 fair (28%), and no poor results.
authors.affiliation: Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland. max.friedrich@ukb.uni-bonn.de.
authors.forename: M J
authors.initials: MJ
authors.lastname: Friedrich
authors.affiliation: Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland.
authors.forename: J
authors.initials: J
authors.lastname: Schmolders
authors.affiliation: Unfallchirurgie, Chirurgische Klinik und Poliklinik, Klinikum Großhadern der Ludwigs-Maximilians-Universität München, München, Deutschland.
authors.forename: G
authors.initials: G
authors.lastname: Lob
authors.affiliation: Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland.
authors.forename: T M
authors.initials: TM
authors.lastname: Randau
authors.affiliation: Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Gravius
authors.affiliation: Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland.
authors.forename: D C
authors.initials: DC
authors.lastname: Wirtz
authors.affiliation: Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland.
authors.forename: P H
authors.initials: PH
authors.lastname: Pennekamp
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D001863:Bone Screws; D060826:Cementoplasty / Q000295:instrumentation* / Q000379:methods; D018483:Diaphyses / Q000293:injuries* / Q000601:surgery*; D019544:Equipment Failure Analysis; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D016896:Treatment Outcome
keywords: Bone diseases; Bone neoplasms; Diaphyses replacement; Neoplasm metastasis; Prostheses and implants