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Harzem Ozger, Mustafa Sungur, Bugra Alpan, Alauddin Kochai, Levent Eralp Istanbul University Istanbul Faculty of Medicine Department of Orthopsedics and.

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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:

1 Harzem Ozger, Mustafa Sungur, Bugra Alpan, Alauddin Kochai, Levent Eralp Istanbul University Istanbul Faculty of Medicine Department of Orthopsedics and Traumatology

2 ? Amputation ? Amputation ? Rotationplasty ? Rotationplasty ? Megaprosthesis ? Megaprosthesis ? Biological reconstruction ? Biological reconstruction ? Massive allograft Massive allograft Recycled bone: Recycled bone: Autoclaving Autoclaving Irradiation Irradiation Pasteurization Pasteurization Cryopreservation Cryopreservation FVFG FVFG Composites Composites Massive allograft + Massive allograft +FVFG Recycled bone + Recycled bone +FVFG

3  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

4  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

5 WHY FROZEN HOT DOG?

6 - Availability - Anatomical congruence - Autogenous proteins, growth factors, cytokines - Almost no cost (only recycling cost) - No immune reaction? (cryoimmunological function?) Mechanical strength: Cryopreserved ≅ intact bone

7  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°) 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’

8  14 patients, treated between  8 male, 6 female  Mean age: 13.9 yrs (6-31)  Mean follow-up: 17.1 months (6-46)  9 osteosarcoma, 5 Ewing sarcoma  Tumor localization: - distal femur, 8 pts - proximal femur, 2 pts - femur diaphysis: 1 pt, - proximal tibia: 2 pts - tibia mid-diaphysis: 1 pt  10 yo male, OS  Distal femur  18 mo. follow- up  NED + 17 mo.

9  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 ( )  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.

10  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

11  8 yo. ♀, OSG  LN + FVFG  24 mo. follow-up  NED + 2 mo mo.+ 19 mo.+ 24 mo. + 7 mo.

12 + 5 mo+ 20 mo.  14 yo. ♀, ES  LN + FVFG  23 mo. follow-up  NED + 17 months

13  12 yo. ♂, OSG  LN + double FVFG  17 mo. follow-up  DOD + 0 mo.+ 3 mo.+ 13 mo.

14  11 ♀, ES  Healed pathological fx  LN + double FVFG  + 6 mo follow-up  NED

15 RR Bone scan at 3 mo. postop shows good uptake, FVFGs are alive. + 5 mo.

16  Cryopreserved recycled bone: - readily available - cheap - anatomically congruent - good mechanical strength BUT - DEAD bone - prolonged consolidation time

17  FVFG: - LIVING bone - rapid union BUT - poor mechanical strength

18  Combination (HOTDOG) - faster consolidation - greater mechanical strength

19


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