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Beitragstitel Motorized intramedullary bone transport nail – reconstruction of large diaphyseal bone defects after tumor resection
Beitragscode P61
Autoren
  1. Farah Selman Universitätsklinik Balgrist Vortragender
  2. Daniel Müller Universitätsklinik Balgrist
  3. Thomas Dreher Universitäts-Kinderspital Zürich, Zürich
Präsentationsform Poster
Themengebiete
  • A07 - Spezialgebiet 3 | Tumore
Abstract Introduction
The technique using bone transport and distraction osteogenesis after tumor resections fell into oblivion, as methods for bone transport used to be very complicated and often needed external fixation techniques. The lack of patient comfort, pin-tract infections and a significantly delayed adjuvant therapy led to little acceptance of this approach. Strictly intramedullary implants can avoid all the mentioned problems. This case report describes the utilization of a Precice Bone Transport Nail for intramedullary distraction osteogenesis after tumor resection at the tibia.

Methods
A 15-year-old female patient was diagnosed with an adamantinoma localized in the tibia diaphysis. After the complete en-bloc resection of the tumor, a bone defect of 9 cm length was present. During the surgery the proximal and distal part of the residual tibia were stabilized with a temporary external fixation in order to keep the correct rotation and length. A Precise Bone Transport Nail was implanted. Distally, another osteotomy was performed to create the transport segment and the nail was then fixed. The transport segment was fixed to the distraction unit of the nail. The distraction process was initiated 8 days after the surgery, at a rate of 0.25 mm twice a day. The patient was provided an external magnet controller for home use along with detailed instructions. Full weight-bearing was allowed. For the first 6 weeks crutches were used for longer distances. Regular follow up examinations were done to monitor transport and callus formation. About 6 months postoperative, the patient underwent the necessary screw exchange of the transport unit because of the large defect and the product design.

Results
At 1-year follow-up, the patient was fully weight-bearing without pain. There was significant healing at the bone distraction site, and no evidence of local recurrence of the tumor. The nail was removed 2 years postoperatively. The hardware removal surgery was more demanding due to the long time the nail stayed implanted and a resulting osseous integration. No further revision surgery was needed. A complete reconstruction of 9 cm bone defect could be achieved.

Conclusion
The use of motorized intramedullary nails for distraction osteogenesis after tumor resection is a safe and reliable technique for the biologic reconstruction of intercalary defects in selected cases. It allows full weight-bearing during the transport phase which is very comfortable.