The Primary Malignant Bone Tumors of Distal Tibia: Comparison between Limb Salvage and Amputation

Lee, Soo Yong; Jeon, Dae Geun; Park, Jong Hoon; Song, Won Seok; Koh, Han Sang; Cho, Wan Hyung

Abstract

PURPOSE: The long term survival and indications of limb salvage surgery for primary malignant bone tumors of the distal tibia were evaluated, and the results of the reconstruction method using a pasteurized autograft alone or a pasteurized autograft and living fibular bone graft composite were examined.
MATERIALS AND METHODS
From March 1985 to June 2004, 13 cases were considered eligible. The diagnosis included 9 osteosarcomas, 2 chondrosarcomas, 1 parosteal osteosarcoma, and 1 malignant fibrous histiocytoma of the bone. There was 1 case of stage IB, 1 IIA, and 11 IIB according to the Enneking classification. Each case underwent surgery and 10 cases underwent additional chemotherapy. Six cases underwent a below-knee amputation and 7 cases had limb salvage surgery. The reconstruction methods were pasteurized bone alone (5), an additional living fibula bone graft (1) or a living fibula bone graft alone (1).
RESULTS
There was no recurrence or metastasis at the final follow up. The MSTS functional score of the limb salvage group and amputation group were 85% and 82% respectively. Two out of 5 cases of reconstruction with pasteurized bone alone achieved bony union at 6 and 9 months after surgery. The remaining 3 cases showed nonunion and fractures of the pasteurized bone that was followed by an additional living fibula graft (2 cases) and cancellous iliac bone graft (1 case). Two cases of primary living fibula grafts are in the course of healing.
CONCLUSION
The prognosis was good. Neurovascular invasion by the tumor and the necessity of a radical soft tissue excision indicated an amputation. There was no difference in the functional outcome between the limb salvage group and amputation group. A reconstruction method using pasteurized bone has bio-mechanical and economical benefits. However, primary additional living fibular bone graft is a promising method.