2 / 2017-03-14 14:53:58

Is Double-approach Surgery And Tenodesis Without Gastrocnemius Flap Better In Dealing With Proximal Fibular Osteosarcoma

Osteosarcoma,Proximal Fibula,Double-approach,Tenodesis,Gastrocnemius Flap

Background: It is challenging to resect proximal fibular osteosarcoma mostly involving the medial-posterior aspect. Also, reconstruction using gastrocnemius flap may result in significant lateral instability and possible abnormal knee movement. Meanwhile, post-operative gait was poor due to foot drop resulting from scarification of common peroneal nerve.
Questions: We asked 1)whether the double-approach surgery is more appropriate in dealing with proximal fibula osteosarcoma, especially when tumor involvement is mostly in medial-posterior aspect.2)Could one-stage tenodesis be an alternative to AFO when dealing with foot drop caused by scarification of common peroneal nerve.3) Could better gait be obtained using one-stage tenodesis without gastrocnemius flap.
Patients and Methods: Between 2011 and 2013, 5 patients of the proximal fibular osteosarcoma were handled with double-approach procedure. LCL and biceps tendon were reattached with the tibial metaphyseal combined with one-stage tenodesis of anterior tibial and toe extensor. The clinical outcome were evaluated including local tumor recurrence, complications, and functional outcomes.
Results: All the patients were followed a mean time of 47.2 months (range 42–52 months). There were no local recurrences. The Enneking functional results were classified as excellent (80%), good (20%) at the final follow-up.
Conclusions: In patients of proximal fibular osteosarcoma, double-approach procedure seemed to provide an easier and safer way for vessel and nerve protection and tumor en bloc resection. One-stage tenodesis without gastrocnemius flap is associated with good function.