Intraepiphyseal resection of the proximal tibia and its impact on lower limb growth

From 1989 through 1996, 10 children affected by high grade bone tumors of t he proximal tibia underwent an intraepiphyseal intercalary resection, The r esidual epiphyseal bone segment measured less than 2 cm in thickness in all cases and reconstruction always was performed using the combination of a v ascularized fibular autograft and a massive bone allograft. The proximal ep iphyseal osteosynthesis was fixed by small fragment screws, The aim of this study was to report the growth pattern of the residual proximal tibial epi physis and to evaluate any possible lower limb discrepancy and/or deformity after the end of skeletal maturity, At current followup six patients were available for the final evaluation. Radiographic documentation included com puted tomography scan of both knees before surgery, a panoramic radiographi c view and a computed tomography scan of both lower limbs after the end of skeletal growth. The length of both femurs and tibias, the size of the tibi al plateau and of the opposite distal femur, and any possible deformity of femur or tibia were measured and compared with the preoperative data. No pa tient had a limb length discrepancy greater than 3.5 cm, In all cases the i psilateral femur had a valgus deformity of the hip develop, In two patients this deformity was associated with an elongation of the femur, partially c ompensating for the shortening of the tibia, The tibial plateau close to re construction grew less than the contralateral one (range 2%-8%) but maintai ned its normal relationship with the distal femur, None of these patients r eported any restriction in recreational activities, They could walk, run, a nd jump. Their functional result according the International Society of Lim b Salvage functional grading system was satisfactory in all cases.