Volume 11, Issue 4 (11-2024)
JROS 2024, 11(4): 213-220 |
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Sami S A, Kargar K, Shams R, Zareie B, Hamidzadehkhiavi A, Beheshti Fard S. Pediatric Tumor Resection and Recon-struction: Outcomes of Osteoarticular Allograft Fix-ation With Stabilized Dynamized Nailing Technique. JROS 2024; 11 (4) :213-220
URL: http://jros.iums.ac.ir/article-1-2290-en.html
URL: http://jros.iums.ac.ir/article-1-2290-en.html
Sam Aliliu Sami1 
, Khalil Kargar1 , Roshanak Shams1 , Bushra Zareie1 , Amin Hamidzadehkhiavi2 , Shahabaldin Beheshti Fard3
, Khalil Kargar1 , Roshanak Shams1 , Bushra Zareie1 , Amin Hamidzadehkhiavi2 , Shahabaldin Beheshti Fard3
1- Department of Orthopedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
2- Department of Orthopedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. & Department of Orthopedic Surgery, School of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran.
3- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
2- Department of Orthopedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. & Department of Orthopedic Surgery, School of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran.
3- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
Abstract: (25 Views)
Background: Reconstructing large bone defects after lower limb tumor resection remains a challenge in pediatric orthopedics. While osteoarticular allografts offer a biological solution, achieving stable fixation and union is crucial to minimize complications such as fractures and nonunions.
Objectives: We aimed to explore a novel, stabilized, dynamized nailing technique (SDNT) to enhance outcomes in pediatric patients undergoing tumor resection and reconstruction.
Methods: Between 2014 and 2024, 40 pediatric patients (Mean±SD age: 11.85±2.93 years) with malignant bone tumors (70.73% osteosarcoma, 24.39% Ewing sarcoma, 2.44% chondrosarcoma) underwent wide resection (≥2 cm margins) and reconstruction with fresh frozen osteoarticular allografts (FFOA) soaked in gentamicin. Fixation was achieved using SDNT, a modified intramedullary nailing (IMN) approach designed to promote union through controlled dynamization. Patients were followed for a Mean±SD of 33.68±20.58 months, with outcomes including union time, complications, and survival assessed via clinical and radiographic evaluations.
Results: The Mean±SD union time was 9.71±3.05 months. Complications occurred in 48.88% of patients, with delayed union (24.39%), infection (14.64%), and drop foot (4.88%) being the most common. Notably, no fractures occurred except for nail bending (2.44%). Survival was 70.73%, with a 29.27% mortality rate and 17.07% disease relapse. Metastasis affected 29.27% of patients, primarily in the lungs (26.83%).
Conclusion: SDNT with osteoarticular allografts offers a promising approach for pediatric lower limb tumor reconstruction, achieving a low fracture rate and effective bone union despite a high overall complication rate. These findings suggest SDNT may improve mechanical stability compared to traditional fixation methods, warranting further investigation.
Objectives: We aimed to explore a novel, stabilized, dynamized nailing technique (SDNT) to enhance outcomes in pediatric patients undergoing tumor resection and reconstruction.
Methods: Between 2014 and 2024, 40 pediatric patients (Mean±SD age: 11.85±2.93 years) with malignant bone tumors (70.73% osteosarcoma, 24.39% Ewing sarcoma, 2.44% chondrosarcoma) underwent wide resection (≥2 cm margins) and reconstruction with fresh frozen osteoarticular allografts (FFOA) soaked in gentamicin. Fixation was achieved using SDNT, a modified intramedullary nailing (IMN) approach designed to promote union through controlled dynamization. Patients were followed for a Mean±SD of 33.68±20.58 months, with outcomes including union time, complications, and survival assessed via clinical and radiographic evaluations.
Results: The Mean±SD union time was 9.71±3.05 months. Complications occurred in 48.88% of patients, with delayed union (24.39%), infection (14.64%), and drop foot (4.88%) being the most common. Notably, no fractures occurred except for nail bending (2.44%). Survival was 70.73%, with a 29.27% mortality rate and 17.07% disease relapse. Metastasis affected 29.27% of patients, primarily in the lungs (26.83%).
Conclusion: SDNT with osteoarticular allografts offers a promising approach for pediatric lower limb tumor reconstruction, achieving a low fracture rate and effective bone union despite a high overall complication rate. These findings suggest SDNT may improve mechanical stability compared to traditional fixation methods, warranting further investigation.
Keywords: Pediatric bone tumors, Osteoarticular allograft, Stabilized dynamized nailing, Intramedullary nailing (IMN), Lower limb reconstruction, Tumor resection, Osteosarcoma, Ewing sarcoma, Bone union, Fresh frozen allograft, Gentamicin-soaked allograft
Type of Study: Research Article |
Subject:
Tumor surgery
Received: 2025/08/26 | Accepted: 2025/09/27 | Published: 2024/11/20
Received: 2025/08/26 | Accepted: 2025/09/27 | Published: 2024/11/20
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