Gathen M, Norris G, Kay S, Giannoudis PV. Recalcitrant distal humeral non-union following previous Leiomyosarcoma excision treated with retainment of a radiated non-angiogenic segment augmented with 20 cm free fibula composite graft: A case report. World J Orthop 2019; 10(4): 212-218 [PMID: 31041163 DOI: 10.5312/wjo.v10.i4.212]
Corresponding Author of This Article
Peter V Giannoudis, BSc, MBBS MD, FACS, FRCS(Eng), Professor, Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Great George Street, Leeds LS1 3EX, United Kingdom. pgiannoudi@aol.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Apr 18, 2019; 10(4): 212-218 Published online Apr 18, 2019. doi: 10.5312/wjo.v10.i4.212
Recalcitrant distal humeral non-union following previous Leiomyosarcoma excision treated with retainment of a radiated non-angiogenic segment augmented with 20 cm free fibula composite graft: A case report
Martin Gathen, Grayson Norris, Simon Kay, Peter V Giannoudis
Martin Gathen, Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Bonn 53129, Germany
Grayson Norris, Peter V Giannoudis, Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds LS3 3EX, United Kingdom
Simon Kay, Plastic and Reconstructive Surgery, School of Medicine, University of Leeds, Leeds LS3 3EX, United Kingdom
Author contributions: Gathen M reviewed the literature and drafted the manuscript. Giannoudis PV and Kay S were the patient’s surgeons, reviewed the literature and contributed to manuscript drafting; they were also responsible for the revision of the manuscript for important intellectual content; Norris G reviewed the literature and contributed to manuscript drafting; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report.
Conflict-of-interest statement: All Authors declare no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist and the manuscript was prepared and revised according the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Peter V Giannoudis, BSc, MBBS MD, FACS, FRCS(Eng), Professor, Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Great George Street, Leeds LS1 3EX, United Kingdom. pgiannoudi@aol.com
Telephone: +44-113-3922750 Fax: +44-113-3923290
Received: December 14, 2018 Peer-review started: December 14, 2018 First decision: January 11, 2019 Revised: February 27, 2019 Accepted: March 12, 2019 Article in press: March 12, 2019 Published online: April 18, 2019 Processing time: 125 Days and 5.2 Hours
Abstract
BACKGROUND
Leiomyosacromas in the Extremities are rare malignant smooth muscle tumors. Adjuvant radiation therapy, in combination with wide surgical excision allows the best chance of treatment. During the follow up pathological fractures are common complications that can be accompanied by Implant failure and defect situations that are most challenging in their management.
CASE SUMMARY
We present a case of a 52-year-old female suffering from a pathological fracture of the humeral shaft 10 yr after resection of a Leiomyosarcoma and postoperative radiotherapy. She developed implant failure after retrograde nailing and another failure after revision to double plate fixation. In a two-stage revision, the implants were removed and the huge segmental defect created after debridement was bridged by a compound osteosynthesis with nancy nails and bone cement for formation of the induced membrane. Due to the previous radiotherapy treatment, 20 cm of the humeral shaft were declared devascularized but were left in situ as a scaffold. In the second stage, a vascularized fibula graft was used in combination with a double plate fixation and autologous spongiosa grafts for final reconstruction.
CONCLUSION
This combinatory treatment approach led to a successful clinical outcome and can be considered in similar challenging cases.
Core tip: We present an innovative treatment alternative for segmental bone defects after pathological fracture, tumor resection and radiation of the humerus. A combination of Induced membrane, vascularized fibula graft and double plate fixation was used to bridge a segmental bone defect. Devascularized bone stock was left in situ as a scaffold and not resected as usual. The treatment approach led to a successful clinical outcome and can be considered in similar complex cases.
