J Korean Orthop Assoc.  2008 Dec;43(6):813-817.

Reconstructive Arthrodesis using a Non-living Fibular Graft with an Attached Periosteal Sleeve for Osteosarcoma of the Distal Tibia: A Case Report

• Park JW
• Park JH
• Lee SH
• Jeong WK
• Park SY

Abstract

According to previous reports, ankle arthrodesis is regarded as the best reconstructive procedure after limb salvage surgery for osteosarcoma of the distal tibia. Of the many arthrodesis options, vascularized fibular graft (VFG) is widely accepted as the most successful method. However, reconstruction using VFG is not always possible, because VFG is a complicated surgical procedure and is associated with high rates of morbidity at donor sites. The authors devised a novel reconstructive surgical procedure that exploits the osteogenic potential of the periosteum. A 10-year-old female patient with osteosarcoma of the distal tibia underwent limb salvage surgery and the ipsilateral distal fibula and periosteal sleeve were transported to the defect for ankle arthrodesis. The transported fibula and periosteal new bone formation acted as a dual strut bone graft providing better stronger stability than fibula alone transfer. The authors believe the proposed procedure is an easier alternative to the surgically demanding VFG method.

Keyword

Distal tibia; Osteosarcoma; Arthrodesis; Vascularized fibular graft (VFG)

MeSH Terms

Animals
Ankle
Arthrodesis
Child
Durapatite
Female
Fibula
Humans
Limb Salvage
Osteogenesis
Osteosarcoma
Periosteum
Reconstructive Surgical Procedures
Tibia
Tissue Donors
Transplants
Durapatite

Figure

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  Fig. 1 Osteoblastic osteosarcoma in a 10-year-old girl. After preoperative chemotherapy, anteroposterior (A) and lateral (B) radiographs of the ankle joint are showing a sclerotic lesion of the distal tibia. T1 axial (C) and sagittal (D) MR imaging demonstrate a well-consolidated extraskeletal soft tissue mass in the distal tibia. These findings suggest that wide excision might be possible.

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  Fig. 2 Schematic diagram showing the proposed surgical technique. After tumor resection, a distal portion of the ipsilateral fibula is transported to the defect for ankle arthrodesis while maintaining its periosteal blood supply by attachment to the distal one-half of its periosteal sleeve.

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  Fig. 3 The authors hollowed out a groove on the dome of the talus and then the distal fibula of the transported segment was impacted into the groove. Two plates were applied at the proximal and distal junctions to stabilize the reconstruction at initial operation. New bone formation along the periosteal sleeve was detected at three months post-operatively (A), and a fracture of the transported fibula shaft developed at nine months post-operatively (B).

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  Fig. 4 Radiographs (A: tibia AP, B: tibia lateral, C: ankle AP, D: ankle lateral view) at two years postoperatively demonstrate that the transported fibula and periosteal new bone formation acted as a dual strut bone grafts providing better stability.

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