4.P.19 TREATMENT OF LEGS DISCREPANCY WITH EXTERNAL FIXATORS IN YOUNG PATIENTS: LONG TERM OUTCOME AFTER BONE TUMOUR SURGERY

Abstract

Conservative treatment of neoplastic bone lesions in paediatric patients may require the sacrifice of growth cartilage with subsequent hypometria or axial deviation of the lower limb.

Segmental reconstructions can be made using acrylic cement and intramedullary nailing or allograft. In case of involvement of the joint, reconstruction can be performed with prosthesis or arthrodesis.

These reconstruction techniques can lead to a progressive deformity associated with shortening of the limb.

The resolution of legs discrepancy and axial defects in survived patients often requires more than one surgical procedure.

In our Institute, the patients affected by aforementioned defects, are treated with axial or circular external fixator at completed skeletal growth.

This paper refers complications and outcomes in five patients treated:

• 1st case. Male, 10 years: osteosarcoma of the distal femur healed with residual shortening of 8 centimeters.

  • – We proceeded with a double level lengthening (proximal femur and proximal tibia) using Ilizarov technique.

• 2nd case. Female, 8 years:distal femur osteosarcoma healed with a shortening of 6,5 centimeters.

  • – We used the Ilizarov apparatus to achieve an elongation of cm. 7 on soft tissues allowing the subsequent bone replacement with allograft of appropriate length.

• 3rd case. Female, 9 years: Ewing sarcoma of the femoral shaft. The correction of the legs discrepancy (8 centimeters) was performed using the Ilizarov apparatus with a proximal tibial corticotomy.

• 4th case. Female, 11 years: distal femur osteosarcoma healed with residual shortening of 8 centimeters.

  • – A gradual lengthening of soft tissues with recovery of the length leg allowed the insertion of a new allograft associated with vascularised fibula.

• 5th case. Male, 13 years: femoral fracture in fibrous dysplasia. Residual leg discrepancy of 5 centimeters treated with tibial lengthening by a proximal corticotomy and use of the Ilizarov apparatus.

The results obtained in our patients show that the use of the external fixator increases the quality of life in long-term survivors.