Reliability of vascularized fibula in maintaining arthrodesis following extra-articular wide excisions of malignant musculoskeletal tumors

OBJECTIVE: To evaluate the reliability of vascularized fibula transfer in maintaining arthrodesis following wide excision of malignant tumors located at the metaphyseal ends of long bones.

METHODS: Fourteen patients underwent wide extra-articular excisions followed by arthrodesis with vascularized fibula and its variants at the Department of Orthopedic Surgery and Traumatology, University of Hacettepe Medical School, Ankara, Turkey, in the period from 1996 to 2003. There were 9 males and 5 females. Their mean age was 28 years (ranging 12-52 years). The mean follow-up time was 68 months (range 28-110 months). The most common diagnosis was malignant giant cell tumor (6), followed by Ewing's sarcoma (3), hemangioendothelioma (2), osteosarcoma (2) and chondrosarcoma (1). Three tumors were located at the distal end of the radius, 4 at the proximal humerus, 3 at the distal femur, one at the proximal tibia, one in distal tibia, one in distal humerus and one in proximal ulna. We used fibula as a vascularized graft in 4 patients; fibula osteoseptocutaneous flap in 4 cases; bilateral vascularized fibulae in 3; fibula with autoclaved autograft in 4 and free osteoseptocutaneous fibula in conjunction with a structural allograft and a circular external fixator in one patient.

RESULTS: In 4 cases, implant failure developed and revision was required in 3. One case had local infection around the distal interlocking screw. In one case, clawing of first and second toes were developed at the donor side. Two patients with metastatic Ewing's sarcoma had metastatic disease. We achieved union within 9 months in 12 cases. In 2 cases with implant failure, bony consolidations were maintained at 11th and 13th months.

CONCLUSION: Vascularized fibula transfer is reliable to achieve arthrodesis following extra-articular excision of malignant tumors from the metaphyseal ends.