Mechanical failure of unsupported Huckstep intramedullary nail in malignant bone tumor reconstruction

Seventeen segmental resections of diaphyseal tumors and five knee resection arthrodeses were reconstructed using the Huckstep nail with intercalary bo ne grafts (fibula), cementation, and ceramic and titanium spacers. Although the bone defects were 0 to 25.5 cm in length (mean, 13.1 cm), all patients had relief of pain and were able to move alone with a wheelchair or a cane . Nail breakage occurred in four patients who had reconstruction surgery us ing a ceramic spacer (four patients without intercalary fibula graft and on e patient with intercalary fibula graft). The nail survival rate was signif icantly better in the patients with reinforcement by vascularized fibular g raft (100% at 5 years and 75% at 10 years; n = 8) than in the patients with out reinforcement by vascularized fibular graft (87.5% at 3 years and 0% at 5 years; n = 14). Huckstep nailing is a useful option for reconstruction o f large bone defects in diaphyseal tumors and knee resection arthrodesis. I t should be used in combination with a vascularized fibula graft to prevent mechanical failure and to achieve durability of limbs with defects from pr imary bone tumors. Huckstep nailing with nonbiologic augmentation is good f or palliative surgery for bone metastases in patients with a shorter expect ed survival rate.