ArticleJournal of bone oncology2026
Strategies for Pediatric Diaphyseal Bone Reconstruction of the Lower Limb After Oncologic Resection: A Multicenter Retrospective Analysis.
Article in Journal of bone oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Reconstruction of diaphyseal bone defects of the lower limb after oncologic resection in children remains a major challenge. Several biological techniques are used, including the induced membrane technique (IMT), vascularized fibular graft (VFG), and combined allograft with vascularized fibula graft (CAVFG), but comparative data in pediatric populations remain limited. Questions/purposes: We asked: (1) What are the consolidation outcomes after biological reconstruction of pediatric lower-limb diaphyseal defects? (2) Which factors are associated with time to bone union? (3) What are the complication and revision profiles of these reconstruction strategies? Methods: We conducted a national multicenter retrospective study including pediatric patients (<18 years) who underwent diaphyseal resection of the femur or tibia for malignant bone tumors or adamantinoma between 2004 and 2024. Patients were reconstructed using IMT, VFG, or CAVFG. The primary endpoint was radiographic consolidation at 1 year. Secondary outcomes included overall union rate, time to union, complications, and revision surgery. Time-to-event analyses were performed using Kaplan-Meier and Cox regression models. Results: A total of 133 patients were included (IMT 69, VFG 22, CAVFG 42). Overall bone union was achieved in 72.9% of patients, with no significant difference between reconstruction techniques (IMT 75.4%, VFG 81.8%, CAVFG 64.3%; Conclusion: Biological reconstruction of pediatric lower-limb diaphyseal defects allows limb salvage with acceptable union rates but prolonged healing and high complication rates. No technique demonstrated clear superiority, supporting an individualized reconstruction strategy based primarily on anatomical and mechanical considerations.
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