Purpose
Primary malignant bone tumors of the hand are rare in children. Resection and reconstruction
of the digit are challenging and have been described in case reports. This retrospective
study describes the functional and oncologic outcomes of resection and reconstruction
using a nonvascularized fibular bone graft in a cohort of children.
Methods
A total of 5 children were included. The mean age at diagnosis was 7.6 years (range,
1.6–12 years). Histologic diagnosis showed Ewing sarcoma in 3 and osteosarcoma in
2 patients. Four tumors were located in the metacarpal bones of the fingers, and 1
was located in the thumb. Four patients were treated with chemotherapy. All the patients
were treated with wide resection and a cement spacer. This was followed by second
stage reconstruction using a nonvascularized fibular bone graft. In tumors of the
fingers, carpometacarpal joint fusion with a neighboring carpal bone was performed,
whereas a pseudoarthrosis was created between the graft and the base of the proximal
phalanx. In the thumb’s case, the opposite was done, with fusion at the metacarpophalangeal
joint and a pseudoarthrosis at the carpometacarpal joint.
Results
The mean follow-up duration was 5.5 years (range, 2–9 years). Surgical margins were
negative in all the patients. At their latest follow-up visit, none of the patients
developed systemic or local recurrence. Two complications required a revision surgery,
one due to graft subluxation and the other due to nonunion. At their final follow-up
examination, the mean total arc of movement was 80° (range, 60°–100°), and all the
patients were able to resume their grasping and writing capabilities.
Conclusions
The resection and reconstruction of primary malignant bone tumors of the metacarpals
using a nonvascularized fibular bone graft in children can preserve the cosmesis and
function of the digit without jeopardizing oncologic outcomes.
Type of study/level of evidence
Therapeutic V.
Key words
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Article info
Publication history
Published online: September 29, 2021
Accepted:
August 11,
2021
Received:
January 1,
2021
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
