A comparison of graft union time in vascularized and avascular fibula for reconstruction in tumors of the appendicular skeleton
Journal Title: Medpulse International Journal of Orthopedics - Year 2018, Vol 7, Issue 3
Abstract
Background: Resection of the tumor by a limb-sparing procedure followed by restoration of soft tissues makes a successful limb salvage surgery. Fibulais usually used because of its advantages. The reconstruction with fibula graft can vascular or avascular. The objective of the study is to assess and compare the graft union time in vascularized and avascular fibula when used for reconstruction in patients treated with wide resection of tumors of the appendicular skeleton. Methods: The study has been conducted in 17 patients who underwent resection of appendicular musculoskeletal tumors with fibular reconstruction. Retrospective and prospective comparative study was done. All clinical and surgical details were recorded. The patients were followed up regularly and a comparison was done between vascularized and avascular fibula regarding graft union time. Mann-Whitney Test was used to assess the difference in the union time between vascular and avascular fibula graft. Fisher’s Exact Test was done to assess significant differences in the presence or absence of fibular hypertrophy between vascularized and avascular fibula graft. Results: The patients included six cases with giant cell tumor, five patients with osteosarcoma, two with Ewing’s sarcoma and 1 each having fibrous dysplasia, osteoid osteoma, chondrosarcoma and metastasis from thyroid carcinoma. The chondrosarcoma and one case of giant cell tumor were cases of recurrence. Six patients had tumor in humerus, two in radius, seven people had in femur and one each in tibia and metatarsal (Age 7-58 Yrs). The mean resection length was 11.76 cm (6-19 cm). Among the 17 patients, 9 had vascularized fibula graft and rest of them had avascular fibula. The mean fibula length was 13.94 cm (7-24 cm). Fixation was done with appropriate implants and/or grafts. Fibula graft had united and hypertrophied in 7 patients out of which 5 of them were vascularized and 2 avascular ones. Bony union with no hypertrophy was seen in three vascularized and three of the avascular fibula grafts. 13 of 17 patients had solid union, two of them (avascular) united only at the distal graft site, one of them (vascular fibula) united only at the proximal site and one patient who had 75% resorption of fibula graft showed improvement in his functional score when compared to the preoperative status. Two patients succumbed after graft union has achieved. The mean union time of vascularized fibula graft was 6.63 months (3-12 Months). The mean union time of avascular fibula graft was 8 months (3-12 months). There was no statistical significance in the union time (Mann-Whitney test, p-value 0.415) and in the presence of hypertrophy (Fisher’s exact test, p value 0.413) when vascularized and avascular fibula groups were compared. Conclusions: Fibula grafting after resection of tumors of the appendicular skeleton offers a satisfactory technique in reconstructing circumferential bony defects. It provides good bony union and functional outcome. Even though the postoperative functional outcome is significant, there is no significant difference between vascularized and avascular fibula in terms of bony union and graft hypertrophy.
Authors and Affiliations
Joji Joshua Philipose, Renjit Kumar Jayachandran
Keywords
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