Reconstruction of Pelvic Ring with Twin Non-vascularized Fibular Grafts After Excision of Bone Tumours: A Long Follow-Up
摘要
Reconstruction of the pelvic ring after excision of bone tumours has been challenged. Non-vascularized and vascularized fibular grafts have been used with different outcomes. Twin non-vascularized fibular grafts (NVFG) stabilized with the Kirschner wires have been reported for pelvic reconstruction with good results.
MethodDuring the last 5 decades, 14 patients with primary pelvic bone tumours were subjected to suitable resection and reconstruction with twin and triple NVFG. The tumours included 9 chondrosarcomas, 4 giant cell tumours and 1 Ewing sarcoma. Twin NVFG stabilized with intra-medullary Kirschner wires were used in 11 and triple struts in 3 cases. Single graft had not been used at this site. The size of the graft measured from 8 to 10 cm. The Ipsi-lateral proximal fibula was harvested up to 20 cm and divided into two struts. The age of the patients ranged from 15 to 46 years (mean of 37 years). Follow-ups from 2 to 10 years has been reported.
ResultTwin fibular struts put together had resulted in ‘lateral-union’. Primary healing with ‘lateral-union’ had taken place in 20–28 weeks. The construct had finally resulted in hypertrophy and in a sheet of bone in 36 weeks. The K-wires were removed after radiological union had taken place. Only one case had deep infection which did not damage the construct and needed exploration only. Five patients had superficial infection and 3 patients had transient peroneal nerve palsy.
ConclusionFourteen cases of pelvic tumours were suitably excised and reconstructed with twin and triple NVFG stabilized with Kirschner-wires. ‘Lateral-union’ could be demonstrated between the struts including the host-graft junctions in 20–28 weeks. Hypertrophy of the grafts could be observed in 36 weeks. The recommended technique is simple, biological, cost-effective and has led to improved results with minimum complications.