Joint-sparing or physeal-sparing diaphyseal resections: the challenge of holding small fragments

Joint-sparing or physeal-sparing diaphyseal resections are technically challenging when only a small length of bone is available for implant purchase.

We describe a series of cases with the aim of generating some guidelines as to the choice of reconstruction method and the implant used.

We retrospectively reviewed 25 patients with diaphyseal resections in which the remaining epiphyseal or metaphyseal segment provided 3 cm or less of purchase. Reconstruction was performed with bone (allograft, extracorporeally radiated autograft, or vascularized fibula) in 19 cases or a custom diaphyseal implant (CDI) in six. The implants used for holding the bone construct varied from standard plates to custom plates. The presence of union, function, complications, and disease status at last followup was recorded.

Sixteen of the 25 patients are disease-free and alive with the original construct at a median followup of 34 months (range, 12-66 months). Implant-related complications such as plate breakage (four) and angulation (three) happened more frequently when weak plates such as reconstruction plates were used. Local recurrence with pulmonary metastases occurred in two cases. The two deep infections required an amputation or rotationplasty for control. Custom plates were successful in three of four patients.

Weak plates such as reconstruction plates are best avoided for these reconstructions. Custom plates allow secure fixation with technical ease. CDIs allow immediate weightbearing and ability to lengthen with predictable good functional short-term outcome.