Ultra Short Osteotomy With Mortise-Tenon Diaphyseal Prosthesis Reconstruction for Forearm Metastases: A Retrospective...

Area of Science:

• Orthopedic oncology
• Surgical reconstruction
• Biomedical engineering

Background:

• Forearm diaphyseal metastases are rare and prone to pathological fracture due to torsional stress.
• Conventional intercalary prostheses often require long osteotomies, sacrificing valuable bone stock.
• Limited bone availability in the radius and ulna presents challenges for reconstruction.

Purpose of the Study:

• To evaluate the feasibility and short- to mid-term outcomes of a novel intercalary mortise-tenon diaphyseal prosthesis.
• To assess the efficacy of this prosthesis in enabling ultra-short osteotomies for forearm metastasis reconstruction.
• To determine the impact on pain, limb function, and oncologic outcomes.

Main Methods:

• Retrospective review of five consecutive patients with forearm diaphyseal metastases treated with en bloc resection and custom mortise-tenon prosthesis.
• Assessment of pain using the visual analogue scale (VAS) and limb function using the Musculoskeletal Tumor Society (MSTS) score.
• Recording of osteotomy length, perioperative data, complications, recurrence, and survival rates.

Main Results:

• Mean follow-up of 40.2 months with a mean osteotomy length of 3.6 cm, preserving bone stock.
• Significant reduction in mean VAS scores (0.4) and increase in mean MSTS scores (26.2) postoperatively.
• 100% and 80% survival rates at 12 and 24 months, respectively, with no local recurrence or implant failure.

Conclusions:

• Intercalary reconstruction with a mortise-tenon diaphyseal prosthesis is feasible for forearm diaphyseal metastases.
• The prosthesis facilitates ultra-short osteotomies, leading to substantial pain relief and functional recovery.
• Long-term durability and oncologic outcomes require further investigation in larger cohorts.