Reconstructive Challenges of Distal Tibia Bone Tumors: Extracorporeally Irradiated Autograft Combined with a Nonvascularized Autograft Fibula for Superior Reconstruction and Functional Outcomes When Compared to Ipsilateral Pedicled Fibula Transfer Alone

Figure 2

A 16-year-old male presented with a radiograph (a) and MRI (b) suggestive of a distal tibia osteosarcoma that was confirmed on a core needle biopsy. The distal tibia resection was performed with a bone margin of 2 cm and a soft tissue margin of healthy cover over the tumor (c). Procedure was performed through the anterolateral approach to allow tumor resection, fibula to be harvested, and adequate muscle cover over the lateral fixation after implantation (d). Following extracorporeal irradiation, the distal tibia tumor bone was prepared for reimplantation and the ipsilateral nonvascular fibula was inserted intramedullary spanning across both junctions (e). The construct was placed into the defect after the talus dome was prepared to achieve bony surface (f). After the fibula is confirmed to be across the proximal and distal junctions, a locking plate was used for fixation (g). Healed proximal osteotomy junction and fused ankle arthrodesis junctions with the fibula healing and incorporation seen on the latest follow-up radiograph (h).

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