Presentation on theme: "Harzem Ozger, Mustafa Sungur, Bugra Alpan, Alauddin Kochai, Levent Eralp Istanbul University Istanbul Faculty of Medicine Department of Orthopsedics and."— Presentation transcript:
Harzem Ozger, Mustafa Sungur, Bugra Alpan, Alauddin Kochai, Levent Eralp Istanbul University Istanbul Faculty of Medicine Department of Orthopsedics and Traumatology
6 yo male, ES Proximal 2/3 of femur 10 yrs follow-up NED Early postop. Xray. Mass. allograft fixed w/ IM nail +3 yrs Antiobiotic rod due to infection+3 yrs Antiobiotic rod due to infection +2 yrs Extracortical bone bridging but no union Allograft removed due to infectionAllograft removed due to infection Avascular Consolidation too late Expensive Immune response Infection Resorption Availability Socioreligious problems Anatomical incongruency Disadvantages Advantages Primary mechanical strength good
14 f, ES FVFG alone! + 7 yrs follow-up NED 4 yrs for full consolidation and full weight bearing – TOO LONG Advantages - Easily available - Vascular - Rapid healing Disadvantages - Primary mechanical strength insufficient
WHY FROZEN HOT DOG?
- Availability - Anatomical congruence - Autogenous proteins, growth factors, cytokines - Almost no cost (only recycling cost) - No immune reaction? (cryoimmunological function?) Mechanical strength: Cryopreserved ≅ intact bone
Technique 1. Tumor resection 2. Harvesting of FVFG 3. Soft tissue stripping 4. Preparation of medullary cavity 5. Preparation of cortical window for FVFG pedicle 6. Liquid Nitrogen treatment Nitrogen tank……………………20 min Room temperature (20°)………15 min Heated saline solution (30°).....10 min 7. Reimplantation + osteosynthesis 8. Insertion of FVFG inside prepared bone segment and anastomosis of pedicle 9. Grafting of osteotomy sites tumor resection soft tissue stripping LN treatment bone in the bun! …or ‘hot dog’
Recycled bone: cryopreservation for all patients FVFG: - 11 patients: contralateral single strut - 2 patients: bilateral fibula grafts harvested to bridge a defect longer than single fibula - 1 patient: ipsilateral single strut Mean bony defect: 17.2 cm (9.0-27.5) Mean fibular graft length: 18.9 cm (10-28) Plate: 13 pts; IM nail: 1 pt. 10 m, OS Proximal 2/3 femur 43 mo.follow-up NED + 5 mo.+ 27 mo.+30 mo.
Complete consolidation: 8 patients Mean time for consolidation: 13.4 months (9-19) 5 patients awaiting consolidation -mean follow-up: 7.6 months (6-12) No union in 1 pt (29 months follow-up; intramedullary nail) Complications: - implant failure: 3 pts - local recurrence: 1 pt. ( non responding to tx, synchron. multi-met) - deep infection: 1 pt (complete healing w/ antib., debr. + VAC) 19 female, OS Distal femur 10 male, ES Distal femur Full wt bearing and very good knee ROM at 15 mo. postop