Sarcoma / 2013 / Article / Fig 3

Clinical Study

Bilateral Fibular Graft: Biological Reconstruction after Resection of Primary Malignant Bone Tumors of the Lower Limb

Figure 3

(Patient no. 8) (a) 12-year-old boy with Ewing’s sarcoma of the right femur diaphysis. Radiograph showing the reconstructive result with a bilateral free fibular graft and lateral plate fixation for a defect of 16,5 cm. (b) 15 months after tumor resection plate failure occurred at the distal interphase between fibular graft and femur metaphysis showing an osseous nonunion. The patient had received his neoadjuvant and adjuvant chemotherapy according to EURO-E.W.I.N.G.-99-protocol including adjuvant radiotherapy. (c) The fracture was treated with replating and autogenous bone grafting. (d) 5 months later a second plate fracture occurred in the middle of the fibular grafts. The fibular grafts themselves showed two fractures on different levels. The bony structures show signs of demineralization and irregularities due to administered chemo- and radiotherapy. (e) Surgical revision resulting in double plate osteosynthesis and autogenous bone grafting. So far there have been no more complications until the last follow-up at 62 months.

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