PMC8110409_01
Patient 1. (a) Magnetic resonance imaging showing adamantinoma of the distal tibia. (b) Radiograph showing wide tumor resection preserving the fibula, proximal tibial corticotomy, and implantation of a lengthening nail for bone segment transport. (c) Radiograph showing advanced bone segment transport after exchange to another lengthening nail.
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fig1
A wire cerclage was applied to fixate the intramedullary nail distally, as screw fixation was not possible due to the short length of the remaining bone segment (Figure 1).
Patient 1. (a) Radiograph showing complete consolidation of the entire tibia including the former callotasis site and the distal docking site with autologous bone grafting using a part of the distal fibular diaphysis as well as trauma nail and multiple screw osteosynthesis. (b) Bilateral long-standing radiograph showing correct alignment but persistent shortening of the reconstructed leg. (c) Clinical presentation showing persistent leg length discrepancy.
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fig2
Bone transport was thus stopped after having gained an additional distraction length of 50 mm (Figure 2).
Patient 1. (a) Radiograph showing complete consolidation of the proximal tibial callotasis site after exchange to another lengthening nail for distraction. (b) Bilateral long-standing radiograph showing correct alignment and equalization of leg lengths. (c) Clinical presentation showing equal leg lengths.
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fig3
Full consolidation of the bone regenerate was observed after 17 weeks (Figure 3).
PMC8110409_02
Patient 2. (a) Magnetic resonance imaging showing adamantinoma of the diaphyseal tibia. (b) Radiograph showing adamantinoma of the diaphyseal tibia. (c) Radiograph showing wide tumor resection preserving the fibula, proximal tibial corticotomy, and implantation of a lengthening nail for bone segment transport.
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fig4
A 14-year-old male patient presented with adamantinoma of the right diaphyseal tibia (Figure 4).
Patient 2. (a) Radiograph showing proceeded bone segment transport. (b-d) Clinical and fluoroscopic presentation of intraoperative retraction of the nail using the fast distractor tool with temporary K-wire transfixation of the transport segment. (e) Radiograph showing advanced bone segment transport.
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fig5
After distraction of 40 mm, revision surgery was performed to temporarily release the nail distally and retract the nail using the fast distractor tool (Fast Distractor, NuVasive, San Diego, CA, USA) to allow further distraction (Figure 5).
Patient 2. (a) Radiograph showing complete consolidation of the entire tibia including the former callotasis site and the distal docking site with autologous bone grafting harvested from the iliac crest as well as trauma nail and locking plate osteosynthesis. (b) Bilateral long-standing radiograph showing correct alignment and length of the reconstructed leg. (c) Clinical presentation showing equal leg lengths.
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fig6
After eight weeks, the docking site and the callotasis site showed sufficient osseous consolidation; thus, full weight-bearing was permitted (Figure 6).