Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 16 , ISSUE 1 ( January-April, 2021 ) > List of Articles

CASE REPORT

Huge Intraosseous Tibial Haemangioma Managed with Embolisation, Excision and Fibular Ilizarov Reconstruction: A Case Report

Ken AD Barsales, Juanito Javier, Jolly J Catibog, Ariel Vergel de Dios, Edward HM Wang

Keywords : Case report, Embolisation, Haemangioma, Ilizarov, Limb salvage, Tibia

Citation Information :

DOI: 10.5005/jp-journals-10080-1518

License: CC BY-NC-SA 4.0

Published Online: 00-04-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aim: Our aim is to report the successful treatment of an intraosseous haemangioma of tibia with an atypical presentation through a multidisciplinary approach of preoperative embolisation, a subtotal resection of the tibia and subsequent reconstruction with the Ilizarov medial fibular translation technique. Background: En bloc excision is the treatment of choice for large tumours of the tibia. However, there is no single recommended method for the reconstruction of the resulting bony defect. Case: A 22-year-old female presented with a massive intraosseous haemangioma of the entire tibia. Sequential, multimodal treatment consisted of (1) preembolisation, (2) en bloc resection and (3) reconstruction of the extensive skeletal defect via the Ilizarov method of fibular medialisation. Radiologic union occurred at 6 months and graft hypertrophy at 22 months. At 45 months, the patient was fully weight-bearing without need for an assistive device. Conclusion: Resection and reconstruction of a large intraosseous haemangioma of the tibia can be treated successfully using a well-planned sequential management of embolisation, resection and Ilizarov fibular grafting. Significance: This report highlights the successful management of an unusually extensive and difficult tumour through appropriate and meticulous perioperative multidisciplinary planning, execution and follow-up.


PDF Share
  1. Cha JG, Yoo JH, Kim HK, et al. PET/CT and MRI of intra-osseous haemangioma of the tibia. Br J Radiol 2012;85:1012. DOI: 10.1259/bjr/35251836.
  2. Shetty V, Kushalappa KS, Jayaprakash Shetty B. Primary intraosseous cavernous hemangioma of the proximal tibia: a rare case report. J Clin Case Rep 2015;5:8. DOI: 10.4172/2165-7920.1000574.
  3. Kundu ZS, Gogna P, Gupta V, et al. Ankle fusion with centralisation of the fibula after distal tibia bone tumour resection. J Orthopaed Traumatol 2013;15(2):95–101. DOI: 10.1007/s10195-013-0279-2.
  4. Rougraff BT, Deters ML, Ivancevich S. Surface-based hemangioma of bone: three case studies and a review of the literature. Skeletal Radiol 1998;27(4):182–187. DOI: 10.1007/s002560050362.
  5. Meselhy MA, Singer MS, Halawa AM, et al. Gradual fibular transfer by ilizarov external fixator in post-traumatic and post-infection large tibial bone defects. Arch Orthopaed Trauma Surg 2018;138(5):653–660. DOI: 10.1007/s00402-018-2895-z.
  6. Weiner SD, Leeson MC. Hemangioma of the tibia. Orthopedics 1990;13:1397–1400. DOI: 10/3928/0147-7447-19901201-14.
  7. Weiss KS, Sabogal J, Carter JR. Intra-medullary hemangioma of the tibia and the value of magnetic resonance imaging in its detection. Orthopedics 1990;13:89. DOI: 10.3928/0147-7447-19900101-14.
  8. Dorfman HD, Steiner GC, Jaffe HL. Vascular tumors of bone. Hum Pathol 1971;2(3):349–376. DOI: 10.1016/s0046-8177(71)80004-7.
  9. Dolen UC, Moran SL. Long term functional outcomes of the capanna technique for pediatric limb salvage. Plast Reconstr Surg 2012;130(5):90–91. DOI: 10.1097/01.prs.0000421806.30326.41.
  10. Kask G, Pakarinen T-K, Parkkinen J, et al. Tibia adamantinoma resection and reconstruction with a custom-made total tibia endoprosthesis: a case report with 8-year follow-up. Case Rep Orthoped 2018;2018:3656913. DOI: 10.1155/2018/3656913.
  11. Zhao Z, Yan T, Guo W, et al. Surgical options and reconstruction strategies for primary bone tumors of distal tibia: a systematic review of complications and functional outcome. J Bone Oncol 2018;14:100209. DOI: 10.1016/j.jbo.2018.100209.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.