Locking compression plate in musculoskeletal oncology 'a friend in need'

Abstract

Background: We are presenting our experience in the use of locking compression plate (LCP) after juxta-articular oncological resections in addition to its use in pathologic fracture.

Methods: A retrospective audit of skeletal reconstruction using LCP in 25 cases of long bone tumors was performed from 2008 to 2010. Reconstruction following limb salvage surgery was done in 17 patients and internal fixation of pathological fracture was done in 8 patients. All patients were available for > 12 months of follow-up, and thus assessed for union at the resected ends.

Results: There were 8 males and 17 females in the study. The average age at the time of surgery was 30 years (range, 9 to 66 years). The minimum follow-up was 12 months (range, 12 to 32 months). All patients except three went on to heal successfully. Complications occurred in those three patients: wound infection in one, nonunion in another, and periprosthetic fracture in the other patient. In the remaining patients, union was achieved at an average of 6.5 months after reconstruction in curative resection and 4.75 months after fixation of pathological fractures.

Conclusions: Joint sparing limb salvage surgery was made successfully possible after sekeletal reconstruction with LCP. Its use was also quite effective in pathological fractures with poor bone quality. Use of locking plates for musculoskeletal oncological reconstruction resulted in a good and predictable rate of union.

Keywords: Locking compression plate; Oncological resection; Skeletal reconstruction.

Fig. 1

(A) Preoperative radiograph of osteogenic sarcoma of proximal tibia. (B) Specimen radiographs of the excised bone and residual bone including knee joint. (C) Clinical photograph showing thin slice of remaining proximal tibia along with tibial tuberosity. (D) Postoperative radiograph after reconstruction with vascularised (ipsilateral) and non vascularised fibula. (E) Radiologic union at 6 months. (F) X-rays at 30-month follow-up. ^*Tibial tuberosity.

Fig. 2

(A) (a) Preoperative images showing distal femoral lesion (osteogenic sarcoma). (b) Magnetic resonance image showing the extent of lesion and sparing neurovascular bundles. (c) Immediate postoperative X-rays showing reconstruction with autoclaved bone and fibula and osteosynthesis with locking compression plate for distal femoral fracture. (B) (a) Nine-month postoperative X-ray showing angulation in saggital plane at the site of delayed union. (b) Revision of osteosynthesis with a longer plate and correction of angulation.