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Physeal distraction for joint preservation in malignant metaphyseal bone tumors in children


Betz, M; Dumont, C E; Fuchs, B; Exner, G U (2012). Physeal distraction for joint preservation in malignant metaphyseal bone tumors in children. Clinical Orthopaedics and Related Research, 470(6):1749-1754.

Abstract

BACKGROUND:

Physeal distraction facilitates metaphyseal bone tumor resection in children and preserves the adjacent joint. The technique was first described by Cañadell. Tumor resection procedures allowing limb-sparing reconstruction have been used increasingly in recent years without compromising oncologic principles.
QUESTIONS/PURPOSES:

We report our results with Cañadell's technique by assessing tumor control, functional outcome, and complications.
METHODS:

Six consecutive children with primary malignant metaphyseal bone tumors underwent physeal distraction as a part of tumor resection. Tumor location was the distal femur in four patients, the proximal humerus in one patient, and the proximal tibia in one patient. The functional outcome was evaluated after a minimum of 18 months (median, 62 months; range, 18-136 months) using the Musculoskeletal Tumor Society (MSTS) score and the Toronto Extremity Salvage Score (TESS).
RESULTS:

At latest followup, five patients were alive and disease-free and one had died from metastatic disease. All tumor resections resulted in local control; there were no local recurrencies. The mean MSTS score was 79% (range, 53%-97%) and corresponding mean TESS was 83% (range, 71%-92%). In one case, postoperative infection required amputation of the proximal lower leg. All physeal distractions were successful except for one patient in whom distraction resulted in rupturing into the tumor. This situation was salvaged by transepiphyseal resection.
CONCLUSIONS:

We consider Cañadell's technique a useful tool in the armamentarium to treat children with malignant tumors that are in close proximity to an open physis.
LEVEL OF EVIDENCE:

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Abstract

BACKGROUND:

Physeal distraction facilitates metaphyseal bone tumor resection in children and preserves the adjacent joint. The technique was first described by Cañadell. Tumor resection procedures allowing limb-sparing reconstruction have been used increasingly in recent years without compromising oncologic principles.
QUESTIONS/PURPOSES:

We report our results with Cañadell's technique by assessing tumor control, functional outcome, and complications.
METHODS:

Six consecutive children with primary malignant metaphyseal bone tumors underwent physeal distraction as a part of tumor resection. Tumor location was the distal femur in four patients, the proximal humerus in one patient, and the proximal tibia in one patient. The functional outcome was evaluated after a minimum of 18 months (median, 62 months; range, 18-136 months) using the Musculoskeletal Tumor Society (MSTS) score and the Toronto Extremity Salvage Score (TESS).
RESULTS:

At latest followup, five patients were alive and disease-free and one had died from metastatic disease. All tumor resections resulted in local control; there were no local recurrencies. The mean MSTS score was 79% (range, 53%-97%) and corresponding mean TESS was 83% (range, 71%-92%). In one case, postoperative infection required amputation of the proximal lower leg. All physeal distractions were successful except for one patient in whom distraction resulted in rupturing into the tumor. This situation was salvaged by transepiphyseal resection.
CONCLUSIONS:

We consider Cañadell's technique a useful tool in the armamentarium to treat children with malignant tumors that are in close proximity to an open physis.
LEVEL OF EVIDENCE:

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Balgrist University Hospital, Swiss Spinal Cord Injury Center
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2012
Deposited On:21 Feb 2012 16:26
Last Modified:21 Sep 2018 07:22
Publisher:Springer
ISSN:0009-921X
Additional Information:The original publication is available at www.springerlink.com
OA Status:Green
Publisher DOI:https://doi.org/10.1007/s11999-011-2224-0
PubMed ID:22203330

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