Bone transport nails for reconstruction of lower limb diaphyseal defects in patients with bone sarcomas: A case series

Purpose Bone transport nails (BTN) are increasingly being used for defect reconstruction in orthopedic surgery, including orthopedic oncology. Herein, we report on preliminary outcomes in three adult sarcoma patients undergoing bone defect reconstruction of the lower limbs with a BTN. Methods In this study three patients were retrospectively included; ID1 male, 18 years, Ewing's sarcoma of the right tibial diaphysis; ID2 female, 30 years, G2 periosteal osteosarcoma of the left femoral diaphysis; ID3 female, 28 years, epithelioid malignant peripheral nerve sheath tumor (MPNST) originating from the right proximal tibial metaphysis. All patients had been treated at a university hospital for primary sarcomas of the lower limbs and underwent defect reconstruction with a BTN (Precice (R) System, NuVasive GmbH, Globus Medical, Audubon, PA, USA). Results Bone defect lengths were 8.5 cm, 14.1 cm and 14.4 cm, respectively. Bone transport time amounted to 5.3 months, 9.1 months and 10.3 months, and time to bony consolidation to 9.1 months, 12.3 months and 14.7 months, respectively (in ID1 and ID3 partially). Patient ID1 required revision surgery for a wire breakage (used for two-level transport) and one screw avulsion. Patient ID2 developed a peri-implant infection that was successfully treated with prolonged antibiotics. In ID3, an occult intraoperative distal femoral fracture was initially treated conservatively. A consecutive varus/flexion deformity and residual ipsilateral limb length discrepancy was addressed via distal femoral osteotomy and retrograde femoral growing nail implantation. Conclusion The Precice (R) BTN can be used for reconstruction of diaphyseal long bone defects in patients with primary malignant tumors; however, candidate patients have to be thoroughly counselled regarding the prolonged immobilization and partial weight-bearing period associated with the lengthening procedure as well as risk for complications and revision surgery.