Abstract
Purpose of the Study: To study the results of resection of giant cell tumour around the knee and limb salvage by distraction osteogenesis using Ilizarov construction over intramedullary nail.
Summary: The treatment of GCT has ranged from curettage and en-bloc resection. It has always been a challenge to reconstruct the resected gap especially across the joints. We have done juxta articular resection of the tumour followed by interlocking nailing across the resected gap as first stage. In the second stage simple Ilizarov construct was used for transportation of bone across the resected gap.
Results and Discussion: There were 6 male and 2 females. The mean age at presentation was 27 years. 3 lesions were in proximal tibia and 5 in the distal femur. The mean length of bone defect was 13.9 cm. With trifocal distraction the mean duration of Ilizarov external fixation was 90 days. We used colour doppler to asses the quality of regenerate during follow-ups. Mean duration of follow up was 44 months. A good quality of regenerate was seen at last follow up and all patients were fully weight bearing.
Allografts are an alternative to endoprosthetic reconstruction but high incidence of complications such as fracture, deformity and infection makes the outcome unpredictable. The treatment option of reconstructing the resected gap with endoprosthesis is limited in our Indian subcontinent set up because of limited resource and availibility. The advantage include, the method we used has given us best alternative which allowed us to fill the large resected gap without the need of massive bone grafts. The distraction from both sides of resected gap has reduced the transportation time and use of DCP plate across the docked bone has allowed us to remove the fixator earlier. The regenerate had sufficient biological strength and durability. The disadvantages include the long duration of external fixation and related problems such as pin tract infections and frustration of patients due to the long period of treatment.
Conclusion: Resection of tumour across the joint especially around the knee and recostruction by distraction osteogenesis using Ilizarov construct over the nail to fill the large gaps without using grafts is very encouraging.
The abstracts were prepared by Mrs Leslie O’Leary. Correspondence should be addressed to her at British Orthopaedic Association, 35–43 Lincoln’s Inn Fields, London WC2A 3PE or at l.oleary@boa.ac.uk
