Epiphysis preserving resection of malignant proximal tibial tumours

The purpose of the study was to evaluate the treatment of five patients with proximal tibial epiphysis preserving resection for malignant tumours of the tibia.

Three patients suffered from Ewing sarcoma, two had osteosarcoma. The proximal level of the resection was in the line of the growth plate in four patients, and 2 cm below of the growth plate in one patient. The distal resection level was in the diaphysis, depending on the tumour border. The resected part of the tibia was substituted by both the ipsilateral and contralateral fibulas. The two fibulas were proximally built into the epiphysis, the contralateral, freely transplanted fibula was placed distally into the tibial diaphysis. The leg was fixed in an Ilizarov frame.

The follow-up period was 4.9 years on average (range, 3.5–8 years). Neither local recurrence nor metastasis was noticed in patients with tibia tumour resection during the observation time. Proper fixation of the transplanted fibula with all of the patients, both proximal to the tibia epiphysis and distal to diaphysis, was experienced. The range of motion of the knee was 122° on the average. Two patients can walk without support and three can walk with an orthosis fully weight bearing. The limb shortening of the affected side was 2.6 cm on average (range,1.5–4.5 cm). In three patients the transplanted opposite side fibula has broken. In one patient, chronic osteomyelitis developed at the distal part of the transplanted fibula.

The difficulties of intercalary segment supplementation were present to a greater extent because of the small size of proximal epiphysis, but the preserved knee joint can produce better function for the patient in this limb-saving surgery.