Bone healing and functional outcomes of utilizing contralateral free vascularized fibular graft following en bloc resection of adamantinoma and osteofibrous dysplasia-like adamantinoma.

Abstract

Adamantinomas and osteofibrous dysplasia-like (OFD-like) adamantinomas are rare tibial bone tumors with variable presentations, making diagnosis and management challenging. While en bloc resection with wide margins is generally preferred, the optimal method for reconstruction remains debated. This study assesses clinical and functional outcomes following tibial reconstruction using an intercalary free vascularized fibular graft harvested from the contralateral limb. A retrospective single-center review included patients treated between 1998 and 2020 for tibial adamantinoma or OFD-like lesions, with at least 2 years of follow-up. Diagnosis was confirmed histologically. All patients underwent en bloc resection and reconstruction using an intercalary free vascularized fibular graft. Outcomes included bone healing and graft remodeling (De Boer and Wood coefficient), functional results (Musculoskeletal Tumor Society score), complications, and oncologic status. Ten patients (mean age: 12.6 years) were included, five with adamantinoma and five with OFD-like variants. All achieved bone union at a mean of 11.5 months; one required revision for nonunion. Graft remodeling averaged 94% at 2 years. The mean Musculoskeletal Tumor Society score at last follow-up (9.3 years) was 28. Reported complications included four graft fractures, one deep infection, and one transient peroneal nerve palsy. Two patients developed metastases; the remaining eight remained disease-free at a mean follow-up of 112 months. The contralateral free vascularized fibular graft provides effective tibial reconstruction after adamantinoma resection, yielding good oncologic control, bone consolidation, and functional outcomes. However, complications persist and warrant careful surgical planning and extended follow-up. Level IV, retrospective case series.