A New Proximal Femur Reconstruction Technique after Bone Tumor Resection in a Very Small Patient: An Exemplificative Case
Abstract
:1. Background
- (1)
- Expandable prosthesis: this can be used only in older children where the residual bone is sufficiently long for a prosthesis with an elongation system to be inserted. Expandable prostheses are potentially able to compensate for the bone shortening after tumor resection, but results are poor due to loosening and breakage [9].
- (2)
- Custom-made prosthesis: this is considered the most common treatment when modular prostheses are not available. Their use is very common in children. Custom-made prostheses can provoke aseptic loosening, and cause loss of bone stock, making revision surgery difficult and obtaining low functional results [11].
- (3)
- Vascularized fibular flap: this technique was proposed by Manfrini et al., who replaced the femur by modeling the autogenous fibula, reproducing the femoral shape. The fibular epiphysis was used to imitate the femoral head [12]. The advantage of this technique is the potential growth of the fibula and its remodeling; nevertheless, it is a very difficult technique, and the success rate is quite low. Indeed, there are no case series in the literature.
- (4)
- Extracorporeal irradiated autograft: this technique consists of reimplantation of the resected specimen after irradiation and soft tissue removal. It has the advantage of a perfect anatomical correspondence, although non-union is common [13]; moreover, it does not furnish complete information about histology and tumor necrosis after neoadjuvant chemotherapy. Although the hypothetical risk of local recurrence is present, it seems similar to that of other techniques which do not include the reimplantation of the specimen [14].
- (5)
- Osteoarticular homograft: this is rarely used in isolation for the inferior limb, principally because it collapses under body weight and cannot articulate with the acetabulum, undergoing precocious resorption [15]. Moreover, these are not available for children, due to the absence of donors.
- (6)
- Composite prosthesis (association of a joint prosthesis and a cemented homograft): this has the advantage of increasing the bone stock [16]; the prosthetic component should also guarantee a good articular motion. The corresponding homograft segment would be the best solution, but unfortunately, it is impossible to have child donors, so homografts from adult donors have to be adapted for young patients [10]. The homograft medullary canal is completely filled with cement in order to obtain higher resistance in weight-bearing.
2. Case Report
3. Discussion
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Zoccali, C.; Careri, S.; Attala, D.; Florio, M.; Milano, G.M.; Giordano, M. A New Proximal Femur Reconstruction Technique after Bone Tumor Resection in a Very Small Patient: An Exemplificative Case. Children 2021, 8, 442. https://doi.org/10.3390/children8060442
Zoccali C, Careri S, Attala D, Florio M, Milano GM, Giordano M. A New Proximal Femur Reconstruction Technique after Bone Tumor Resection in a Very Small Patient: An Exemplificative Case. Children. 2021; 8(6):442. https://doi.org/10.3390/children8060442
Chicago/Turabian StyleZoccali, Carmine, Silvia Careri, Dario Attala, Michela Florio, Giuseppe Maria Milano, and Marco Giordano. 2021. "A New Proximal Femur Reconstruction Technique after Bone Tumor Resection in a Very Small Patient: An Exemplificative Case" Children 8, no. 6: 442. https://doi.org/10.3390/children8060442