Comparison of Fixation Techniques for Lower Extremity Rotationplasty

Area of Science:

• Orthopedic Surgery
• Pediatric Oncology
• Musculoskeletal Oncology

Background:

• Rotationplasty is a limb-sparing surgery for lower extremity tumors in young patients.
• The procedure utilizes the ankle as a functional knee joint for prosthetic use.
• Limited data exists comparing fixation methods for rotationplasty.

Purpose of the Study:

• To compare clinical outcomes between intramedullary nailing (IMN) and compression plating (CP) in pediatric rotationplasty.
• To evaluate fixation techniques in young patients undergoing rotationplasty for lower extremity tumors.

Main Methods:

• Retrospective review of 28 pediatric patients (mean age 10±4 years) undergoing rotationplasty.
• Tumor locations included femoral, tibial, and popliteal fossa.
• Fixation was achieved with either IMN (n=6) or CP (n=22).

Main Results:

• No difference in the mean time to union between IMN and CP groups (14±16 vs. 27±26 months).
• Fewer nonunion complications observed with IMN fixation.
• Postoperative fixation complications were significantly higher in the CP group (OR: 20, P <0.01), including fractures.

Conclusions:

• Rotationplasty is a viable limb salvage option for pediatric lower extremity tumors.
• Intramedullary nailing (IMN) fixation is associated with fewer fixation complications compared to compression plating (CP).
• IMN fixation should be considered for rotationplasty procedures when feasible.