O1293 LIMB SALVAGE FOR AGGRESSIVE AND MALIGNANT BONE TUMOUR OF THE PROXIMAL EXTREMITIES

Abstract

Aims: In patients who have malignant bone tumour (MBT) of the proximal extremities, it is often possible to carry out resection which salvage the limb. Reconstruction, however, remains a problem because none of the procedures which are available adequately compensates for the functional loss after amputation. Material and Methods:Between 1985 and 2001, 45 patients (p) with MBT or aggressive BT of the proximal extremities were reviewed. All (p) have pathologic confirmation. Among them 7 were osteosarcoma, 6 chondrosarcoma, 2 fibrosarcoma, 1 Ewing’s sarcoma, 1 plasmocitoma, 4 bone metastases and 24 giant cell tumour. Radiographs, CT, MRI, scan with Tc 99 m were useful for treatment decision. We used for reconstruction non vascularised fibular autografts in 29p, a free vascularised fubular grafts in 4 p.tibia grafts in 2 p. Ticoff-Limberg procedures in 1 p.resection of the proximal radius in 1 p.endoprosthesis of the proximal humerus in 4 p.and MMA cement and Rush-Pin in 4 p. The functional results were graded according to the rating system of the MSTS. The mean duration of follow-up was 64 months (12–201 m). Results:Our results were satisfactory with regard to pain, emotional acceptance and manual dextterity.29 p.were still alive at the time of the latest follow-up.2 p.died from other disease.14 p. died from the disease. Function and lifting ability were unsatisfactory in 4 p.(8,9%). Radiographs schow:2 p.(4,4%) with delayed union,4 p.(8,9%) had colaps or fracture of the head of the fibula,2 p. had local recurence. Conclusion: different methods of reconstruction of the proximal extremities after resection of the MBT are effective in selected cases.