Radical change in osteosarcoma surgical plan due to COVID-19 pandemic

A 17-year-old man with osteosarcoma of the proximal humerus was planned for possible limb salvage surgery after standard neoadjuvant chemotherapy. However, during the surgical phase of treatment, the COVID-19 or SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) outbreak occurred changing the healthcare landscape due to uncertainty regarding the virus, risk of COVID-19 infection and complications, and implementation of an enhanced community quarantine restricting movement of people within cities. Instead of limb salvage surgery, the patient underwent a forequarter amputation. Exposure to the virus in a high-risk hospital setting was minimised with patient discharge after a short hospital stay and home convalescence monitored by video conferencing. Multidisciplinary sarcoma team meetings with family members and a sarcoma navigator nurse were crucial in managing expectations and deciding on appropriate treatment in the setting of a novel infectious disease causing a pandemic.

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Limb Salvage Surgery for Osteosarcoma of the Proximal Humerus: Outcome in 17 Dogs

Veterinary Surgery ◽

10.1111/j.1532-950x.1998.tb00150.x ◽

1998 ◽

Vol 27 (5) ◽

pp. 417-422 ◽

Cited By ~ 48

Author(s):

CHARLES A. KUNTZ ◽

TONIA L. ASSELIN ◽

WILLIAM S. DERNELL ◽

BARBARA E. POWERS ◽

RODNEY C. STRAW ◽

...

Keyword(s):

Limb Salvage ◽

Proximal Humerus ◽

Salvage Surgery ◽

Limb Salvage Surgery

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A Case Report of Limb Salvage Surgery with Scapular Flap for Osteosarcoma of Proximal Humerus.

Orthopedics & Traumatology ◽

10.5035/nishiseisai.52.738 ◽

2003 ◽

Vol 52 (4) ◽

pp. 738-741

Author(s):

Masakazu Murata ◽

Kenji Kumagai ◽

Masahiko Suzuki ◽

Sou Morooka ◽

Hiroyuki Shindo ◽

...

Keyword(s):

Case Report ◽

Limb Salvage ◽

Proximal Humerus ◽

Salvage Surgery ◽

Limb Salvage Surgery ◽

Scapular Flap

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Proximal Humerus Osteosarcoma: Limb Salvage Surgery Using Custom-made Shoulder Arthroplasty and Capsule Reconstruction with the Aortic Synthetic Graft

Journal of Orthopedics and Joint Surgery ◽

10.5005/jp-journals-10079-1042 ◽

2021 ◽

Vol 3 (2) ◽

pp. 87-90

Author(s):

J Balasubramaniam ◽

Sunder Lal Negi ◽

SV Akshay Kumar ◽

R Deivanayagam ◽

SA Rajkumar

Keyword(s):

Limb Salvage ◽

Shoulder Arthroplasty ◽

Proximal Humerus ◽

Salvage Surgery ◽

Limb Salvage Surgery ◽

Synthetic Graft ◽

Custom Made

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A Rare Case of Ewing’s-like Adamantinoma of Tibia Managed by Limb Salvage Surgery Using Long Segment Ilizarov Bone Transport: A Case Report and Review of Literature

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i05.2208 ◽

2021 ◽

Vol 11 (5) ◽

Author(s):

T K Jeejesh Kumar ◽

Puneeth K Pai ◽

Priyavrata Rajasubramanya

Keyword(s):

Case Report ◽

Limb Salvage ◽

Rare Case ◽

Salvage Surgery ◽

Treatment Protocol ◽

Bone Transport ◽

Molecular Techniques ◽

Limb Salvage Surgery ◽

Appropriate Treatment ◽

Ilizarov Bone Transport

Introduction: Adamantinoma is a rare low-grade malignant tumor in young adults. Recent advances in molecular techniques have shown different variants with discordance between genotype and phenotype. This poses a challenge in diagnosis and management. Ewing’s-like adamantinoma is one such variant. The appropriate treatment protocol for this dedifferentiated tumor remains to be established. Here, we present a rare case of Ewing’s-like Adamantinoma treated with limb salvage surgery using three step Ilizarov technique with good results. Case Report: A 38-year-old lady presented at our OPD complaining of recent onset pain and gradual increase in size over a long standing swelling in the right lower tibia. Radiologically was diagnosed as Ewing’s but was not responsive to chemotherapy. A Tru-Cut biopsy showed histological picture of dedifferentiated adamantinoma. Immunohistochemistry showed CD99 positivity. FISH revealed (11;22) translocation confirming Ewing’s-like adamantinoma. She was managed with wide excision followed by staged Ilizarov distraction-osteogenesis and bone transport to correct the 13 cm discrepancy in bone length. There have been no signs of recurrence on post-resection follow-up of 2 years. Patient attained full range of knee and ankle movements. Conclusion: The controversy as to what constitutes the difference between adamantinoma-like Ewing’s and Ewing’s-like adamantinoma persists despite technological advances. The appropriate treatment protocol remains to be established. Ilizarov three step techniques provide a feasible alternative to amputation while circumventing the difficulties of large bone reconstruction in the distal tibia. Keywords: Adamantinoma, Ewing’s-like, Ilizarov, bone transport, dedifferentiated, malignant bone tumor.

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3D-Printed Connector for Revision Limb Salvage Surgery in Long Bones Previously Using Customized Implants

Metals ◽

10.3390/met11050707 ◽

2021 ◽

Vol 11 (5) ◽

pp. 707

Author(s):

Jong-Woong Park ◽

Hyun-Guy Kang ◽

June-Hyuk Kim ◽

Han-Soo Kim

Keyword(s):

Limb Salvage ◽

Salvage Surgery ◽

Revisional Surgery ◽

Limb Salvage Surgery ◽

Musculoskeletal Tumor ◽

Musculoskeletal Tumor Society ◽

Proximal Ulna ◽

Custom Made ◽

Orthopedic Oncology ◽

3D Printed

In orthopedic oncology, revisional surgery due to mechanical failure or local recurrence is not uncommon following limb salvage surgery using an endoprosthesis. However, due to the lack of clinical experience in limb salvage surgery using 3D-printed custom-made implants, there have been no reports of revision limb salvage surgery using a 3D-printed implant. Herein, we present two cases of representative revision limb salvage surgeries that utilized another 3D-printed custom-made implant while retaining the previous 3D-printed custom-made implant. A 3D-printed connector implant was used to connect the previous 3D-printed implant to the proximal ulna of a 40-year-old man and to the femur of a 69-year-old woman. The connector bodies for the two junctions of the previous implant and the remaining host bone were designed for the most functional position or angle by twisting or tilting. Using the previous 3D-printed implant as a taper, the 3D-printed connector was used to encase the outside of the previous implant. The gap between the previous implant and the new one was subsequently filled with bone cement. For both the upper and lower extremities, the 3D-printed connector showed stable reconstruction and excellent functional outcomes (Musculoskeletal Tumor Society scores of 87% and 100%, respectively) in the short-term follow-up. To retain the previous 3D-printed implant during revision limb salvage surgery, an additional 3D-printed implant may be a feasible surgical option.

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Letter to the Editor: Surgical Technique: Unicondylar Osteoallograft Prosthesis Composite in Tumor Limb Salvage Surgery

Clinical Orthopaedics and Related Research ◽

10.1007/s11999-013-2972-0 ◽

2013 ◽

Vol 471 (6) ◽

pp. 2037-2038

Author(s):

Markus Nottrott ◽

Jendrik Hardes ◽

Georg Gosheger ◽

Arne Streitbürger

Keyword(s):

Surgical Technique ◽

Limb Salvage ◽

Salvage Surgery ◽

Limb Salvage Surgery ◽

Letter To The Editor

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Functional Outcome in Sarcomas Treated With Limb-Salvage Surgery or Amputation

Sarcoma ◽

10.1080/13577149878118 ◽

1998 ◽

Vol 2 (1) ◽

pp. 19-23 ◽

Cited By ~ 20

Author(s):

Rikke Johansen ◽

Ole S. Nielsen ◽

Johnny Keller

Keyword(s):

Functional Outcome ◽

Limb Salvage ◽

Salvage Surgery ◽

Univariate Analysis ◽

Soft Tissue Sarcomas ◽

Post Treatment ◽

Limb Salvage Surgery ◽

Functional Evaluation ◽

Functional Scores

Purpose.In all patients treated at the Centre for Bone and Soft Tissue Sarcomas of Aarhus the functional outcome is prospectively evaluated by use of the Enneking system for the functional evaluation after surgical treatment of tumours of the musculoskeletal system. This system has been accepted by the Musculoskeletal Tumour Society and the International Symposium on Limb Salvage.Patients/methods.In the present study the functional outcome after limb-salvage surgery (89 patients) and amputation (58 patients) was compared. In the limb-salvage group the treatment was surgery alone in 50% and surgery combined with either radiotherapy in 39% or chemotherapy in 11%. Inclusion criteria were: Deep seated extremity sarcomas, age >14 years, more than 1 year post-treatment follow-up time and alive at the end of the study. Median age was 49 years (range 14–88 years). Median tumour diameter was 8 cm (range 1–20 cm), median follow-up time was 4.8 years (range 1–11 years). Wilcoxon andχ2-tests were used for statistical analyses.Results.The two groups were comparable according to age, sex, size of tumour, type of tumour, location of tumour, as well as post-treatment follow-up time. The functional scores were significantly higher after limb-salvage surgery as compared to amputation, the median scores being 85 and 47, respectively (p<0.001). A similar difference was observed if the Enneking scores were subdivided into general health-related scores and extremity-related scores. No association was found between functional scores and the following factors by use of univariate analysis: size of tumour, radiation therapy, localization of tumour and surgical margin.Discussion.We conclude that this study indicates that limb-salvage surgery is associated with a better functional outcome than that observed after amputation. However, whether this also indicates a difference in quality of life needs further studies.

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