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. 2014 Jun;15(2):95-101.
doi: 10.1007/s10195-013-0279-2. Epub 2013 Dec 15.

Ankle fusion with centralisation of the fibula after distal tibia bone tumour resection

Zile Singh Kundu  1 , Paritosh Gogna, Vinay Gupta, Rohit Singla, Sukhbir Singh Sangwan, Mukul Mohindra, Amanpreet Singh
Affiliations

Ankle fusion with centralisation of the fibula after distal tibia bone tumour resection

Zile Singh Kundu et al. J Orthop Traumatol. 2014 Jun.

Abstract

Background: Management of distal tibial tumours with limb salvage surgery poses a challenge for the orthopaedic surgeon. This study was done to evaluate the results of fibular centralisation as a technique to reconstruct defects that occurred after resection at this site.

Materials and methods: Nine patients with a mean age of 23.2 years (range 17-34) with diagnosis of osteosarcoma in four patients, Ewing's sarcoma in two, giant cell tumour in two and chondrosarcoma in one patient underwent surgical treatment for tumour in the distal tibia. All patients had wide resection of the tumour and ankle arthrodesis with centralisation of the fibula. Patients were assessed clinico-radiologically for bone union, infection and complications. The final functional outcome was estimated according to Musculoskeletal Tumor Society (MSTS) scores.

Results: The mean age at the time of surgery was 23.2 years (17-34). There were five females and four males. The mean follow-up was 37 months (range 28-54 months). One of the patients with osteosarcoma had a recurrence a year after limb salvage surgery, underwent above-knee amputation, and died 18 months later due to metastasis. One patient developed leg length discrepancy. The mean MSTS score was 22.75 (range 17-27).

Conclusion: Fibular centralisation is a durable reconstruction tool for defects of the distal tibial metaphysis with an acceptable functional outcome. It is an inexpensive and simple procedure, with a low rate of late complications, and reproducible results.

Level of evidence: IV Retrospective case series.

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Figures

Fig. 1
Fig. 1
a Radiograph showing osteosarcoma of the distal tibia in a 22-year-old male, b MRI of the same patient, c resected distal tibia, d X-ray at 8.5 months follow-up, e X-rays at 54 months follow-up showing hypertrophy of the fibula
Fig. 2
Fig. 2
a Radiograph showing giant cell tumour in a 30-year-old female, b MRI of the same patient, c post-operative radiographs
Fig. 3
Fig. 3
a Radiographs of a 20-year-old male, showing nonunion at the arthrodesis site. A streak of new bone formation from the remnant periostium can be seen at the site from which the fibla was harvested. b Secondary bone grafting was done, along with long K-wire fixation: radiographs at final follow-up showing union at the arthrodesis site along with hypertrophy of the fibula
See this image and copyright information in PMC

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