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Tubercle-Sparing Proximal Tibial Reconstruction in Patients with Primary and Metastatic Bone Disease: A Case Report
Mitchell S Fourman1, Duncan C Ramsey1, Erik T Newman1
1Orthopaedic Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston Massachusetts.
Case:
Two patients with cancer involving their proximal tibia required proximal tibial replacement (PTR). One had a soft-tissue sarcoma that involved her posterior cortex, and the other had extensive metaphyseal destruction from metastatic breast cancer. Their anterolateral cortex and tibial tubercle were uninvolved, permitting tubercle-sparing PTR. A plate was applied to the bone bridge in the latter patient in anticipation of radiotherapy. Both healed uneventfully and had minimal extensor lag 2 weeks postoperatively.
Conclusion:
Tubercle-sparing PTR preserves extensor mechanism function with minimal lag. It should be considered in patients with cancer when sparing the anterolateral cortex is oncologically safe.

