Gathen, M, Norris, G, Kay, S et al. (1 more author) (2019) 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 Journal of Orthopedics, 10 (4). pp. 212-218. ISSN 2218-5836
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.
Metadata
Item Type: | Article |
---|---|
Authors/Creators: |
|
Copyright, Publisher and Additional Information: | ©The Author(s) 2019. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) (https://creativecommons.org/licenses/by-nc/4.0/) |
Keywords: | Humerus; Fibular graft; Bone tumor; Osseous defect; Implant failure; Leiomyosarcoma; Case report |
Dates: |
|
Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Institute of Rheumatology & Musculoskeletal Medicine (LIRMM) (Leeds) > Orthopaedics (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 17 Feb 2020 11:40 |
Last Modified: | 17 Feb 2020 11:40 |
Status: | Published |
Publisher: | Baishideng Publishing Group Inc. |
Identification Number: | 10.5312/wjo.v10.i4.212 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:157167 |