Publication:

Functional outcome in reconstructions with fibula autograft in tumors of appendicular skeleton

Background Resection by a limb-sparing surgery and restoration of bone and soft tissues makes a successful limb salvage. Several reconstructive procedures that maintain limb length and provide acceptable cosmetic and functional results include endoprosthetic reconstruction, use of allografts and/or autografts like vascular or avascular fibula graft. The objective of the study was to assess and compare the preoperative and postoperative functional and radiological outcome in patients treated with wide resection of tumors of the appendicular skeleton followed by reconstruction with fibula graft.

Methods This retrospective and prospective comparative study was conducted in 17 patients in Amrita Institute of Medical Sciences, Kerala. The patients were followed up for a minimum of 9 months ranging to 65 months. Functional and radiological assessments were done. Wilcoxon signed ranks test was done to assess significant differences between preoperative and postoperative functional scores. The SPSS software was used to analyze the data collected.

Results There was statistical significance as well as improvement in the postoperative functional scores (p=0.004) when compared to the preoperative status. There was no significance (2 tailed test) in postoperative functional scores between vascular and avascular fibula graft (p=1.000).

Conclusions Fibula grafting after resection of appendicular tumors offers a wonderful technique in filling bony defects. It provides good functional outcome and better bony union. Even though the postoperative outcome is significant, there is no significant difference between vascularized and avascular fibula in terms of functional outcome, bony union and graft hypertrophy.