Lower Limb Reconstruction using Tibial Strut Autograft after Resection of Primary Malignant Bone Tumors in Skeletally Immature Patients

Document Type : RESEARCH PAPER


1 Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan

2 1 Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan 2 Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine


Background: Reconstruction of large bone defects in skeletally immature patients remains a surgical challenge.
We report the long-term clinical outcomes of a novel surgical technique for lower limb reconstruction using the tibia
as a strut autograft following resection of primary malignant bone tumors in skeletally immature patients.
Methods: We retrospectively reviewed the medical records of six patients diagnosed with lower limb primary bone
sarcoma. All patients underwent tumor resection and reconstruction using tibial strut autograft. The radiological and
clinical outcomes including complications at the recipient and donor sites were assessed.
Results: The mean age at presentation was ten years (range 6-15 years). Two cases had osteosarcoma and
four had Ewing sarcoma. The mean length of the resected tumor and tibial autografts were 20.83 and 19.33 cm
respectively. Union at both ends was achieved in five grafts while one graft achieved union only at the distal end.
The mean time for union of the proximal and distal junctions was 4 and 8.8 months respectively. The mean follow-up
period was 8.4 years (range 14 months–20 years). One patient developed a foot drop, and three patients underwent
subsequent joint arthrodesis (2 knees and 1 ankle). The mean musculoskeletal tumor society functional score was
80.8%. Two patients had clinically significant leg-length discrepancy that needs further lengthening procedure.
Four patients survived with no evidence of disease and two patients died due to their primary oncologic disease. All
donor sites regenerated, with the earliest signs of new bone formation at (2-4) weeks post-operatively.
Conclusion: Reconstruction using non-vascularized tibia strut autograft after resection of primary malignant lower
limb bone tumors can be a viable alternative method for reconstructing large bone defects in the immature skeleton.
Level of evidence: IV


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Volume 9, Issue 5
September and October 2021
Pages 567-577
  • Receive Date: 23 December 2020
  • Revise Date: 03 February 2021
  • Accept Date: 13 February 2021