Examination of clinical functional scores after reconstruction with vascularized fibula graft in patients with bone tumor

Various treatment methods have been presented from past to present for the treatment of bone segment losses. Surgeries such as trauma, osteomyelitis, congenital anomalies, skeletal system tumor resection, arthroplasty and spinal surgery may cause loss of bone segments. Most frequently preferred surgical techniques for reconstructive surgeries are; autogenous bone graft, bone allograft surgery, distraction osteogenesis and free-vascular bone grafting. Among these surgeries, free-vascular bone grafting is the most commonly used technique, as it provides the continuation of biology. In our study, we retrospectively investigated the relationship between the functional and quality of life outcomes and the healing time after reconstruction of segmental bone defects caused by tumors using free vascularized fibula grafts in Ankara University Faculty of Medicine Department of Orthopedics and Traumatology between 2005 and 2021. Clinical scores were analyzed using the visual analog scale (VAS), Musculoskeletal Tumor Society (MSTS) scale, and Short Form-36 (SF-36) quality of life scale. Of 47 patients, 21 were female and 26 were male, with a mean age of 31.3 (min:10-max:74). Eighteen and 29 patients were reconstructed with SDFG due to for upper and lower extremity tumors, respectively. Of the patients who were operated on the upper extremity, 11 had tumors in the humerus and 7 in the radius. In the lower extremity, 14 of the tumors were located in the femur and 15 in the tibia. The mean amount of defect measured during the operation was 13,73 cm (min: 6.07 max: 22.44). The mean follow-up period of the patients was 50 months (min:24- max:147), and 9 patients (19.15%) died during follow-up. When the imaging methods used during the follow-up of the patients, including direct radiographs and computed tomography used in some patients, were examined, it was observed that there was consolidation in the graft in 45 out of 47 patients, and the average consolidation time was 6.7 (min:2- max:14) months. When the pain and functions of the patients were examined, the mean VAS score of 47 patients was 3.57 (min:0 - max:10) and MSTS score was 21.12 (min:5- max:35). When the SF-36 questionnaires of the patients were examined, preoperative scores were lower in all patients compared to the postoperative period. Forty-five patients were divided into 2 groups; union duration shorter and longer than 6 months. The effects of patient gender, extremity difference, tumor location, amount of defect, preoperative and/or post-operative ChT and/or RT status, presence of distant metastases, development of postoperative complications, and duration of hospitalization on the duration of union were investigated. In the analysis of these parameters, it was observed that the duration of bone union in the upper extremity was earlier and the duration of bone union was prolonged in patients with postoperative complications (p=0.03, p=0.007, respectively). The effect of same parameters on MSTS scores was not statistically significant (table 6). We also examined the relationship between union time and age, VAS score and MSTS score. Since not all values are parametric, we compared groups with Spearman's rho test. It was observed that as the age of the patients decreased, consolidation occurred faster, and as the MSTS score increased, the VAS score was lower. At the end of 24 months, a negative correlation was observed between the consolidation time and the MSTS score of the patients, but it was not statistically significant. (table 5) (figure33,34). In our study, the scores of the SF-36 subheadings were higher in the postoperative period and this was statistically significant (table 3). Free-vascular fibula grafts are biological reconstruction methods that accelerate union. Although the mean duration of bone union is 6 months and 9-12 months in prolonged cases with this method, the functional scores of the patients at the end of two years are similar and both their mood and extremity functions are higher compared to the preoperative period.