Application of Orthofix unilateral external fixator in the treatment of musculoskeletal tumors_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JI Tao ,  GUO Wei , YANG Rongli , TANG Xiaodong , LI Dasen , YANG Yi

Musculoskeletal Tumor Center, Peking University People’s Hospital, Beijing Key Laboratory of Musculoskeletal Tumor, Beijing, 100044, P.R.China;

Corresponding?author：

GUO Wei, Email: bonetumor@163.com

Keywords：

Musculoskeletal tumor; limb salvage; limb reconstruction; external fixator; limb lengthening

DOI：

10.7507/1002-1892.201705005

Video：

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Objective To investigate the surgical characteristics and preliminary effectiveness of Orthofix unilateral external fixator in the treatment of musculoskeletal tumors. Methods Twenty-two patients received Orthofix unilateral external fixator treatment for bone defect after tumor excision or complications after limb salvage surgery between June 2011 and March 2016. There were 11 males and 11 females with a median age of 23.5 years (range, 4-57 years). The bone defect or limb length discrepancy after tumor resection was at proximal femur in 6 cases, distal femur in 8 cases, diaphysis of femur in 3 cases, proximal tibia in 2 cases, and diaphysis of tibia in 3 cases. The external fixation was used for temporary fixation after reconstruction of bone defect in 10 cases [the length of bone defect was 6-19 cm (mean, 12.3 cm); using vascularized fibular graft in 2 cases, allograft bone and free fibular graft in 2 cases, allograft bone and autogenous bone graft in 5 cases, allograft bone reconstruction in 1 case]; bone distraction lengthening for limb length discrepancy in 5 cases [the length of shortening was 6.5-8.5 cm (mean, 7.5 cm)]; temporary fixation after open biopsy in 3 cases; bone transportation over locking plate in 1 case (the length of bone defect was 7.5 cm); fixation for preoperatively pathology fracture in 1 case; and joint distraction for dislocation after tumor ablation in 2 cases. Results All the patients were followed up 12-72 months (mean, 36 months). In 10 patients with bone defect reconstruction, the wearing external fixator time was 3-8 months (mean, 4.8 months); all got bone union with the healing time of 3-16 months (mean, 6.4 months); the Musculoskeletal Tumor Society 93 (MSTS 93) score was 73.3-93.3 (mean, 87.2); and no complication occurred during wearing external fixator. In 5 patients with bone distraction lengthening for limb length discrepancy, the wearing external fixator time was 7-15 months; 2 patients had axial deviation during distraction and2 had greenstick fracture after apparatus removal; pin site infection was observed in 2 cases with grade 1 and 1 case with grade 2 according to Checketts-Otterburn classification system; the MSTS 93 score was 80.0-96.7 (mean, 89.2). The remaining patients had no complications, the knee and ankle joint movement was normal. Conclusion Orthofix unilateral external fixator can be used in fixation for complex bone defect after tumor resection and to correct limb length discrepancy after limb salvage surgery.

Citation： JI Tao, GUO Wei, YANG Rongli, TANG Xiaodong, LI Dasen, YANG Yi. Application of Orthofix unilateral external fixator in the treatment of musculoskeletal tumors. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(10): 1161-1167. doi: 10.7507/1002-1892.201705005 Copy

1.	Gulabi D, Erdem M, Cecen GS, et al. Ilizarov fixator combined with an intramedullary nail for tibial nonunions with bone loss: is it effective? Clin Orthop Relat Res, 2014, 472(12): 3892-3901.
2.	Kim SJ, Pierce W, Sabharwal S. The etiology of short stature affects the clinical outcome of lower limb lengthening using external fixation. A systematic review of 18 trials involving 547 patients. Acta Orthop, 2014, 85(2): 181-186.
3.	Sabharwal S, Nelson SC, Sontich JK. What’s New in Limb Lengthening and Deformity Correction. J Bone Joint Surg (Am), 2105, 97(16): 1375-1384.
4.	Watanabe K, Tsuchiya H, Yamamoto N, et al. Over 10-year follow-up of functional outcome in patients with bone tumors reconstructed using distraction osteogenesis. J Orthop Sci, 2013, 18(1): 101-109.
5.	Wagner H. Operative lengthening of the femur. Clin Orthop Relat Res, 1978, (136): 125-142.
6.	黃雷, 謝明, 王金輝, 等. 應用 Orthofix 重建外固定架治療骨缺損. 中華創傷骨科雜志, 2004, 6(10): 1096-1101.0.
7.	Said GZ, el-Sherif EK. Resection-shortening-distraction for malignant bone tumours. A report of two cases. J Bone Joint Surg (Br), 1995, 77(2): 185-188.
8.	Stoffelen D, Lammens J, Fabry G. Resection of a periosteal osteosarcoma and reconstruction using the Ilizarov technique of segmental transport. J Hand Surg (Br), 1993, 18(2): 144-146.
9.	Tsuchiya H, Morsy AF, Matsubara H, et al. Treatment of benign bone tumours using external fixation. J Bone Joint Surg (Br), 2007, 89(8): 1077-1083.
10.	Tsuchiya H, Shirai T, Morsy AF, et al. Safety of external fixation during postoperative chemotherapy. J Bone Joint Surg (Br), 2008, 90(7): 924-928.
11.	Tsuchiya H, Tomita K, Minematsu K, et al. Limb salvage using distraction osteogenesis. A classification of the technique. J Bone Joint Surg (Br), 1997, 79(3): 403-411.
12.	Canadell J, Forriol F, Cara JA. Removal of metaphyseal bone tumours with preservation of the epiphysis. Physeal distraction before excision. J Bone Joint Surg (Br), 1994, 76(1): 127-132.
13.	Paley D, Fleming B, Catagni M, et al. Mechanical evaluation of external fixators used in limb lengthening. Clin Orthop Relat Res, 1990, (250): 50-57.
14.	Eralp L, Kocaoglu M, Yusof NM, et al. Distal tibial reconstruction with use of a circular external fixator and an intramedullary nail. The combined technique. J Bone Joint Surg (Am), 89(10): 2218-2224.
15.	Demir B, Yavuz U, Akpinar E, et al. A novel biological reconstruction of tibial bone defects arising after resection of tumors. Acta Orthop Traumatol Turc, 2016, 50(2): 248-254.
16.	Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res, 1990, (250): 81-104.
17.	Jennison T, McNally M, Pandit H. Prevention of infection in external fixator pin sites. Acta Biomater, 2014, 10(2): 595-603.
18.	Piza G, Caja VL, Gonzalez-Viejo MA, et al. Hydroxyapatite-coated external-fixation pins. The effect on pin loosening and pin-track infection in leg lengthening for short stature. J Bone Joint Surg (Br), 2004, 86(6): 892-897.
19.	W-Dahl A, Toksvig-Larsen S. Pin site care in external fixation sodium chloride or chlorhexidine solution as a cleansing agent. Arch Orthop Trauma Surg, 2004, 124(8): 555-558.
20.	Davies R, Holt N, Nayagam S. The care of pin sites with external fixation. J Bone Joint Surg (Br), 2005, 87(5): 716-719.
21.	Camathias C, Valderrabano V, Oberli H. Routine pin tract care in external fixation is unnecessary: a randomised, prospective, blinded controlled study. Injury, 2012, 43(11): 1969-1973.

1. Gulabi D, Erdem M, Cecen GS, et al. Ilizarov fixator combined with an intramedullary nail for tibial nonunions with bone loss: is it effective? Clin Orthop Relat Res, 2014, 472(12): 3892-3901.
2. Kim SJ, Pierce W, Sabharwal S. The etiology of short stature affects the clinical outcome of lower limb lengthening using external fixation. A systematic review of 18 trials involving 547 patients. Acta Orthop, 2014, 85(2): 181-186.
3. Sabharwal S, Nelson SC, Sontich JK. What’s New in Limb Lengthening and Deformity Correction. J Bone Joint Surg (Am), 2105, 97(16): 1375-1384.
4. Watanabe K, Tsuchiya H, Yamamoto N, et al. Over 10-year follow-up of functional outcome in patients with bone tumors reconstructed using distraction osteogenesis. J Orthop Sci, 2013, 18(1): 101-109.
5. Wagner H. Operative lengthening of the femur. Clin Orthop Relat Res, 1978, (136): 125-142.
6. 黃雷, 謝明, 王金輝, 等. 應用 Orthofix 重建外固定架治療骨缺損. 中華創傷骨科雜志, 2004, 6(10): 1096-1101.0.
7. Said GZ, el-Sherif EK. Resection-shortening-distraction for malignant bone tumours. A report of two cases. J Bone Joint Surg (Br), 1995, 77(2): 185-188.
8. Stoffelen D, Lammens J, Fabry G. Resection of a periosteal osteosarcoma and reconstruction using the Ilizarov technique of segmental transport. J Hand Surg (Br), 1993, 18(2): 144-146.
9. Tsuchiya H, Morsy AF, Matsubara H, et al. Treatment of benign bone tumours using external fixation. J Bone Joint Surg (Br), 2007, 89(8): 1077-1083.
10. Tsuchiya H, Shirai T, Morsy AF, et al. Safety of external fixation during postoperative chemotherapy. J Bone Joint Surg (Br), 2008, 90(7): 924-928.
11. Tsuchiya H, Tomita K, Minematsu K, et al. Limb salvage using distraction osteogenesis. A classification of the technique. J Bone Joint Surg (Br), 1997, 79(3): 403-411.
12. Canadell J, Forriol F, Cara JA. Removal of metaphyseal bone tumours with preservation of the epiphysis. Physeal distraction before excision. J Bone Joint Surg (Br), 1994, 76(1): 127-132.
13. Paley D, Fleming B, Catagni M, et al. Mechanical evaluation of external fixators used in limb lengthening. Clin Orthop Relat Res, 1990, (250): 50-57.
14. Eralp L, Kocaoglu M, Yusof NM, et al. Distal tibial reconstruction with use of a circular external fixator and an intramedullary nail. The combined technique. J Bone Joint Surg (Am), 89(10): 2218-2224.
15. Demir B, Yavuz U, Akpinar E, et al. A novel biological reconstruction of tibial bone defects arising after resection of tumors. Acta Orthop Traumatol Turc, 2016, 50(2): 248-254.
16. Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res, 1990, (250): 81-104.
17. Jennison T, McNally M, Pandit H. Prevention of infection in external fixator pin sites. Acta Biomater, 2014, 10(2): 595-603.
18. Piza G, Caja VL, Gonzalez-Viejo MA, et al. Hydroxyapatite-coated external-fixation pins. The effect on pin loosening and pin-track infection in leg lengthening for short stature. J Bone Joint Surg (Br), 2004, 86(6): 892-897.
19. W-Dahl A, Toksvig-Larsen S. Pin site care in external fixation sodium chloride or chlorhexidine solution as a cleansing agent. Arch Orthop Trauma Surg, 2004, 124(8): 555-558.
20. Davies R, Holt N, Nayagam S. The care of pin sites with external fixation. J Bone Joint Surg (Br), 2005, 87(5): 716-719.
21. Camathias C, Valderrabano V, Oberli H. Routine pin tract care in external fixation is unnecessary: a randomised, prospective, blinded controlled study. Injury, 2012, 43(11): 1969-1973.

Chinese Journal of Reparative and Reconstructive Surgery

Application of Orthofix unilateral external fixator in the treatment of musculoskeletal tumors

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