Non-vascularised fibula grafts for reconstruction of segmental and hemicortical bone defects following meta- /diaphyseal tumour resection at the extremities

Abstract

Background: The reconstruction of meta-/diaphyseal bone defects following bone tumour resection is challenging, and biological treatment options should be applied whenever possible, especially in benign lesions and early stage sarcomas. We aimed to evaluate the results of segmental (SR) and hemicortical reconstructions (HR) at the extremities using non-vascularised fibula grafts.

Methods: We retrospectively enrolled 36 patients who were treated with non-vascularised fibula reconstructions (15 SR, 21 HR) after bone tumour resection (15 malignant, 21 benign). All cases were evaluated regarding consolidation, hypertrophy at the graft-host junctions, and complications; moreover, the functional and oncological results were assessed. The mean follow-up was 8.3 years (2.1-26.6 years).

Results: Primary union was achieved in 94% (SR 87%, HR 100%) of patients, and 85% (SR 81%, HR 88%) showed hypertrophy at the graft-host junction. The overall complication rate was 36% with 4 patients (11%) developing local recurrence. There was a significant correlation between the development of mechanical complications (fracture, delayed-/non-union) and a defect size of ≥12 cm (p = 0.013), segmental defects (p = 0.013) and additional required treatment (p = 0.008). The functional outcome was highly satisfactory (mean MSTS score 86%).

Conclusions: Due to encouraging results and advantages (such as their remodelling capacity at the donor site), non-vascularised fibula reconstructions should be considered a valuable alternative treatment option for patients with hemicortical defects or segmental reconstructions of less than 12 cm in which no additional neo-/adjuvant treatment is necessary.

Keywords: Autograft; Bone defects; Bone tumour; Defect reconstruction; Non-vascularised fibula; Sarcoma.

Fig. 1

Extended osteoid osteoma of the left proximal radius in a 9-year-old male patient a Postoperative conventional X-rays 3 months after segmental resection b The single strut was fully integrated 5 months after surgery and exhibits hypertrophy at its junctions c Plate removal was performed 7 months after the initial surgery d

Fig. 2

Preoperative imaging of a 28-year-old male patient with periosteal chondrosarcoma (G2) of the left proximal femur: conventional X-rays a STIR MRI sequence b e-Thrive MRI sequence with contrast agent c. Postoperative conventional antero-posterior d and latero-lateral e X-rays following wide resection and hemicortical reconstruction with two non-vascularised fibula struts. Complete integration of both struts and remodelling of the resected segment on conventional X-rays was observed 10 months after surgery f, g

Fig. 3

Ewing’s sarcoma of the distal fibula in a 15-year-old female national squad triathlete a After wide resection of the tumour under preservation of the malleolar tip, the distal fibula was reconstructed with a non-vascularised fibula strut by performing a tibio-fibular synostosis b After complete integration and bony consolidation of the fibula graft c removal of the plate as well as the screws was planned as the patient felt bothered during sports activities d Partial remodelling of the fibula with ossifications along the periosteum was seen on conventional X-rays of this patient d