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Rotationplasty with Tibial Nerve Coaptation: A Case Report
Solange de Wouters1,2, Alexander Thomas Schade1,3, Ali Etemad-Rezaie1
1Division of Orthopaedics, Hospital for Sick Children and University of Toronto, Ontario, Canada.
JBJS Case Connector
|February 28, 2023
Summary
Rotationplasty with tibial nerve repair is a viable limb-sparing option for adolescent osteosarcoma. This surgical technique allows for functional recovery, preserving sensation and muscle strength in the affected limb.
Area of Science:
- Orthopedic Oncology
- Pediatric Surgery
- Neurosurgery
Background:
- Osteosarcoma is a common bone cancer in adolescents.
- Distal femoral osteosarcoma can involve critical neurovascular structures, such as the tibial nerve.
- Surgical management often involves limb-sparing techniques or amputation.
Observation:
- A 14-year-old male presented with distal femoral osteosarcoma encasing the tibial nerve.
- The patient underwent rotationplasty with resection and end-to-end repair (coaptation) of the tibial nerve.
- Postoperative assessment at 1 year revealed restored sensation and functional muscle contraction.
Findings:
- Successful tibial nerve coaptation following resection in rotationplasty.
- Regained sensation in the plantar foot and gastro-soleus muscle strength (MRC 4+/5).
- Functional extension of the reconstructed knee was achieved.
Implications:
- Tibial nerve resection is not a contraindication for rotationplasty in adolescent patients.
- Nerve coaptation offers a functional alternative to endoprosthetic reconstruction or amputation.
- Rotationplasty with nerve repair can lead to excellent functional outcomes in limb salvage surgery for osteosarcoma.
