Application of External Fixators for Reconstruction in Bone Tumor Surgery
In this chapter, the authors introduce applications of external fixators to benign and malignant bone tumor surgery. In the section of benign bone tumor, the authors introduce the treatment of deformity correction and limb length discrepancy caused by Oll
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10
Hiroyuki Tsuchiya and Norio Yamamoto
Contents
10.1
10.1
Introduction ..............................................
177
10.2 10.2.1 10.2.2 10.2.3
Treatment of Benign Bone Tumors ........ Ollier’s Disease .......................................... Fibrous Dysplasia ...................................... Osteofibrous Dysplasia (Ossifying Fibroma)................................... Exostosis (Osteochondroma) .....................
177 178 178 179 182
Treatment of Malignant Bone Tumors.............................................
182
10.4.1 10.4.2 10.4.3 10.4.4
Reconstruction After Excision of Malignant Tumor ................. Selection of Patients................................... Technique of Distraction Osteogenesis...... Principles of Reconstruction ...................... Postoperative Care .....................................
183 183 183 183 188
10.5
Pitfalls and Common Errors ...................
188
References ...............................................................
188
10.2.4 10.3 10.4
Recently, distraction osteogenesis with an Ilizarov ring fixator or a Taylor spatial frame and callotasis with a unilateral fixator developed by de Bastiani have been widely adopted for the treatment of several orthopedic problems such as leg length discrepancy, deformity, nonunion, osteomyelitis, and congenital or acquired skeletal defects (De Bastiani et al. 1987; Ilizarov 1989a, b; Ilizarov and Green 1992). However, bone defects related to trauma, infection, or bone tumor have been treated with autografts, allografts, artificial bone substitutes, spacers, or prostheses. In cases of skeletal reconstruction, bone defects should ideally be repaired with living bone. Living bone that is provided by the distraction osteogenesis technique has the same strength and width as that of native bone. Moreover, the peripheral nerves, vessels, muscles, tendons, ligaments, and skin are also gradually lengthened in proportion with the lengthening of the bone. In this chapter, the authors introduce applications of external fixators to bone tumor surgery.
10.2 H. Tsuchiya (*) • N. Yamamoto Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Japan e-mail: [email protected]
Introduction
Treatment of Benign Bone Tumors
For the treatment of deformity correction and limb length discrepancy caused by benign tumors, external fixators are extremely useful. For leg length discrepancy, distraction osteogenesis, as
M. Kocaoğlu et al. (eds.), Advanced Techniques in Limb Reconstruction Surgery, DOI 10.1007/978-3-642-55026-3_10, © Springer Berlin Heidelberg 2015
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opposed to a contralateral shortening procedure, enables the preservation of body height and normalization of body proportions. Moreover, distraction osteogenesis avoids surgery on the unaffected limb and enables simultaneous correction of any associated deformity of the short limb. Closed osteotomy, acute correction, and internal fixation are conventionally used for d
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