Akademik Veri Yönetim Sistemi
Journal of Orthopaedic Science, 2026 (SCI-Expanded, Scopus)
Background: Preoperative radiotherapy may impair bone healing and remodeling after wide resection and reconstruction using vascularized fibular grafts for bone tumors. This study evaluated whether preoperative radiotherapy affected union, nonunion, graft viability, and graft hypertrophy in these patients. Methods: We retrospectively reviewed data from 127 patients who underwent wide resection of a bone tumor and reconstruction with a vascularized fibular graft (2000–2023). Outcomes included time to initial and complete union, nonunion at 12 months, graft viability, graft hypertrophy at 3, 6, and 12 months, and the Musculoskeletal Tumor Society score. Patients were compared based on whether they received preoperative radiotherapy. Results: The mean age was 16.6 ± 11.3 years, and osteosarcoma and Ewing sarcoma were the most common diagnoses. The femur (48.8%) and tibia (34.6%) were the most affected sites. Thirty-one patients received preoperative radiotherapy, and nine received postoperative radiotherapy. The initial union time was 5.6 ± 2.1 months, and the complete union time was 11.3 ± 3.2 months. Nonunion at 12 months occurred in 20 patients (15.7%), and graft viability was preserved in 122 patients (96.1%). The mean hypertrophy increased from 16.1 ± 11.6% at 3 months to 29.8 ± 17.8% at 6 months and 46.2 ± 28.0% at 12 months. Patients who received preoperative radiotherapy demonstrated lower hypertrophy at 3 and 6 months (P = 0.013 and P = 0.005), with no statistically significant difference at 12 months. The mean Musculoskeletal Tumor Society score at final follow-up was 24.2 ± 5.4 (range, 2–30). Conclusion: Preoperative radiotherapy was associated with reduced graft hypertrophy at 3 and 6 months, with no statistically significant difference at 12 months, and did not adversely affect graft union or viability, supporting vascularized fibular graft reconstruction when radiotherapy is required for oncologic local control. Level of evidence: Level III, prognostic study.