Lower Limb Reconstruction using Tibial Strut Autograft after Resection of Primary Malignant Bone Tumors in Skeletally Immature Patients

Reconstruction of large bone defects in skeletally immature patients remains a surgical challenge.We report the long-term clinical outcomes of a novel surgical technique for lower limb reconstruction using the tibiaas a strut autograft following resection of primary malignant bone tumors in skeletally immature patients. We retrospectively reviewed the medical records of six patients diagnosed with lower limb primary bonesarcoma. All patients underwent tumor resection and reconstruction using tibial strut autograft. The radiological andclinical outcomes including complications at the recipient and donor sites were assessed. The mean age at presentation was ten years (range 6-15 years). Two cases had osteosarcoma andfour had Ewing sarcoma. The mean length of the resected tumor and tibial autografts were 20.83 and 19.33 cmrespectively. Union at both ends was achieved in five grafts while one graft achieved union only at the distal end.The mean time for union of the proximal and distal junctions was 4 and 8.8 months respectively. The mean follow-up period was 8.4 years (range 14 months–20 years). One patient developed a foot drop, and three patients underwentsubsequent joint arthrodesis (2 knees and 1 ankle). The mean musculoskeletal tumor society functional score was80.8%. Two patients had clinically significant leg-length discrepancy that needs further lengthening procedure.Four patients survived with no evidence of disease and two patients died due to their primary oncologic disease. Alldonor sites regenerated, with the earliest signs of new bone formation at (2-4) weeks post-operatively. Reconstruction using non-vascularized tibia strut autograft after resection of primary malignant lowerlimb bone tumors can be a viable alternative method for reconstructing large bone defects in the immature skeleton.Level of evidence: IV