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Strategies Trauma Limb Reconstr. 2016 Apr;11(1):37-49. doi: 10.1007/s11751-016-0244-8. Epub 2016 Feb 12.

External fixation reconstruction of the residual problems of benign bone tumours.

Author information

1
Department of Orthopaedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, 34390, Topkapi, Istanbul, Turkey.
2
Department of Orthopaedics and Traumatology, Memorial Health Group, 34385, Okmeydani, Istanbul, Turkey. bilenfe@gmail.com.
3
Hospital for Special Surgery, Limb Lengthening and Complex Reconstruction Service (LLCRS), Weill Cornell Medical College, Cornell University, 535 East 70th Street, New York, NY, 10021, USA.
4
Department of Orthopaedics and Traumatology, Memorial Health Group, 34385, Okmeydani, Istanbul, Turkey.
5
Orthopedic Department, Faculty of Medicine, Al-Azhar University Hospitals, Nasr City, Cairo, 11884, Egypt.

Abstract

The mechanical features of and biologic response to using distraction osteogenesis with the circular external fixator are the unique aspects of Ilizarov's contribution that allows deformity correction and reconstruction of bone defects. We present a retrospective study of 20 patients who suffered from a variety of benign tumours for which external fixators (EF) were used to treat deformity, bone loss, and limb-length discrepancy. A total of 26 bony segments in twenty patients (10 males, 10 females; mean age 17 years; range 7-58 years) were treated with EF for residual problems from the tumour itself (primary treatment) in 8 patients and for complications related to the primary surgery (secondary treatment) in 12 patients. Histological diagnoses were Ollier's disease (n = 4), Fibrous Dysplasia (n = 5), Congenital multiple exostosis (n = 5), giant cell tumour (n = 2) and one case for chondromyxoid fibroma, desmoid fibroma, chondroma and unicameral bone cyst. Various types of external fixators used to treat these problems. These were Ilizarov, unilateral fixator, multiaxial correction frame (Biomet, Parsippany, NJ), Taylor spatial frame (Memphis, TN) and smart correction multiaxial frame. The mean follow-up time was 69.5 months (range 35-108 months). The mean external fixation time was 159.5 days (range 27-300 days). The mean external fixation index was 67.4 days/cm (12-610) in 26 limbs who underwent distraction osteogenesis. The mean length of distraction was 4.9 cm (range 0.2-14 cm). At final follow-up, all patients had returned to normal activities. Complications were in the form of knee arthrodesis in one patient, pin tract infection in six and residual shortening in eight patients. The use of EF and the principles of distraction osteogenesis, in the management of problems associated with benign bone tumours and related surgery yields successful results especially in young patients. With this approach, the risk for recurrence of shortening and deformity may be minimized with overcorrection or over-lengthening as dictated by preoperative planning.

KEYWORDS:

Benign bone tumours; Bone deformity; Distraction osteogenesis; External fixation; Limb reconstruction; Shortening

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