Pelvic ring reconstruction with tibial allograft, screws and rods following enneking type I and IV resection of primary bone tumors

Primary malignant bone tumors of the pelvis are quite rare and include Osteosarcoma, Ewing's sarcoma and Chondrosarcoma [1]. Their management is usually based on a combination of chemotherapy, surgery and radiotherapy, according to the tumor's histology, grade and stage, [[2], [3], [4]].

Surgery aims to obtain oncologically adequate local control through a wide excision that includes a layer of healthy tissue surrounding the tumor. Understandably, this surgery is associated with a consistent local morbidity and loss of function due to the structures involved by the tumor and those sacrificed to guarantee clear margins.

In 1978, Enneking and Dunham classified the internal hemipelvectomies into four types according to tumor localization, defining corresponding areas: Iliac (Type I); periacetabular (Type II); pubic (Type III); Sacrum (Type IV) and combined resections (Fig. 1) [2].

When the tumor is located in Area I, its extirpation can disrupt the pelvic ring. The advantage of reconstruction is often debated. Indeed, several authors sustain that non-reconstruction is the best choice to decrease operating time and complications and report similar functional outcomes [5,7].

Actually, in case of non-reconstruction, the homolateral hip is displaced proximally and rotates on the pubic symphysis, causing limb shortening. Scoliosis could also be a long-term consequence [7].

Instead, reconstruction preserves the length of the limb and the normal action of the residual muscles.

Theoretically, reconstruction can be achieved with an allograft, an autograft, or a prosthesis, consequently decreasing long-term sequelae [[8], [9], [10], [11]]. Indeed, the increase in patient survival requires much effort to guarantee sufficient function and quality of life after surgery.

The aim of this study was to evaluate the functional outcomes of pelvic ring restoration after Type I and IV pelvic resection through pedicle screw instrumentation and tibia allograft.

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