Preservation of the Epiphysis and Growth Plate in the Surgical Management of Femoral Osteosarcoma in a Skeletally Immature Patient by Intercalary Resection and Biological Reconstruction: A Case Report

Osteosarcoma arises most frequently in the metaphysis around the knee and its management by limb salvage surgery in skeletally immature pediatric patients is extremely challenging. Common reconstructive methods such as endoprosthetic or biological reconstruction are not fully capable of dealing with durability-related and growth-related problems and their functional outcomes are not as good as those seen in adult cases. A definitive limb salvaging procedure in children that outperforms amputation or rotationplasty has not yet been established. Herein, we report a case of stage IV osteosarcoma in the femur of a 7-year-old boy that was safely managed with intercalary resection preserving the distal femoral growth plate and epiphysis, followed by biological reconstruction using a frozen tumor-devitalized autograft. Good response to preoperative chemotherapy and the diaphyseal location of the tumor enabled us to perform a tumor resection that spared the growth plate and preserved the native knee joint structure. Plate fixation over the growth plate was terminated by removing the locking screws in the epiphysis after 44 months, which restored growth capacity to some extent. At 50 months postoperatively, no recurrence or progression of the disease was observed. The patient uses an extension shoe and reports having little discomfort in his daily life despite having a restricted range of motion and limb length discrepancy. In conclusion, limb salvage with biological reconstruction in skeletally immature patients can provide an acceptable functional outcome, including minimized limb length discrepancy, if critical damage to the growth plate and articular components can be avoided.

Download Full-text

THE APPLICATION OF EXPANDABLE ENDOPROSTHETIC RECONSTRUCTION FOR LIMB SALVAGE SURGERY IN THE SKELETALLY IMMATURE PATIENTS

Biomedical Engineering Applications Basis and Communications ◽

10.4015/s1016237201000182 ◽

2001 ◽

Vol 13 (03) ◽

pp. 141-147 ◽

Cited By ~ 1

Author(s):

RONG-SEN YANG

Keyword(s):

Limb Salvage ◽

Salvage Surgery ◽

Limb Length Discrepancy ◽

Limb Length ◽

Limb Salvage Surgery ◽

Skeletally Immature ◽

Endoprosthetic Reconstruction ◽

Term Survival ◽

Length Discrepancy ◽

Primary Bone

The development of new image techniques enables the early detection of bone tumors in the extremities in the past two decades. In addition, new advance of adjuvant therapy improves the long-term survival of patients with primary bone malignancies. Since the primary bone malignancy frequently occurs at the metaphysis of long bones of pediatric patients in the first and second decade, many patients have to face the late problems of limb length discrepancy after the limb salvage operation. Since the inevitable limb length discrepancy will interfere the functional outcomes and cosmetic appearance, the reconstruction of limb defect after limb salvage remains a challenge. Several options of reconstruction are available for these patients, including resection arthrodesis, rotationplasty, osteochondral allograft reconstruction, and endoprosthetic reconstruction. All these methods are difficult to address the limb length discrepancy. The development of expandable endoprosthetic reconstruction makes limb-salvage surgery feasible in the skeletally immature and provides another choice of solution. This article presents the current status of custom-expandable endoprosthetic reconstruction in the skeletally immature patients after wide resection of primary bone malignancies in the extremity. The surgical options, complications and functional results will be emphasized. Basically these expandable endoprostheses can be classified according to the expansion design. Recent reports demonstrated that the results of expandable prosthesis in the growing children are rather acceptable. Some patients can regain the equal limb length after expansion of the prosthesis. However these patients have to take several expansion procedures for the equality of limb length during the growing period. A rather high complication rate of either endoprosthesis-related or disease-associated still needs to be settled in the near future. These include mechanical failure of the expansion mechanism, extensive metallosis, aseptic loosening, fatigue fracture, flexion contracture, local recurrence, delayed wound healing, fat embolism, local overgrowth of counterpart bone, nerve palsy, infection, and bone fracture. Some patients even require an amputation even after expandable endoprosthesis reconstruction because of difficult reconstruction or severe functional impairment. However, with regard to difficult rehabilitation for patients under 8 years, amputation or alternative options need to be considered. A comprehensive discussion with the parents and patient about the detailed treatment protocol is needed before performing reconstruction using expandable endoprosthesis.

Download Full-text

Is There a Reliable Method to Predict the Limb Length Discrepancy after Chemotherapy and Limb Salvage Surgery in Children with Osteosarcoma?

Chinese Medical Journal ◽

10.4103/0366-6999.187849 ◽

2016 ◽

Vol 129 (16) ◽

pp. 1912-1916 ◽

Cited By ~ 4

Author(s):

Yuan Li ◽

Feng Liao ◽

Hai-Rong Xu ◽

Xiao-Hui Niu

Keyword(s):

Limb Salvage ◽

Reliable Method ◽

Salvage Surgery ◽

Limb Length Discrepancy ◽

Limb Length ◽

Limb Salvage Surgery ◽

Length Discrepancy

Download Full-text

Intramedullary Bone Lengthening Following Preceding Hip Surgery—A Case Series

Journal of Clinical Medicine ◽

10.3390/jcm9124104 ◽

2020 ◽

Vol 9 (12) ◽

pp. 4104

Author(s):

Lukas Zak ◽

Thomas Manfred Tiefenboeck ◽

Gerald Eliot Wozasek

Keyword(s):

Hip Dysplasia ◽

Young Patients ◽

Limb Lengthening ◽

Limb Length Discrepancy ◽

Limb Length ◽

Hip Surgery ◽

Bone Lengthening ◽

Safe Procedure ◽

Length Discrepancy ◽

Healing Index

Limb length discrepancy (LLD) is a common problem after joint-preserving hip surgeries, hip dysplasia, and hip deformities. Limping, pain, sciatica, paresthesia, and hip instability are common clinical findings and may necessitate limb-lengthening procedures. The study included five patients (two female and three male, mean age of 28 years (20–49; SD: 12)) with symptomatic limb length discrepancy greater than 2.5 cm (mean: 3.6 cm) after total hip arthroplasty (THA), hip dysplasia, or post-traumatic hip surgery. They underwent either ipsi- or contralateral intramedullary limb-lengthening surgeries using the PRECICE™ telescopic nail. All patients achieved complete bone healing and correction of the pelvic obliquity after intramedullary lengthening. None of the patients had a loss of proximal or distal joint motion. The mean distraction-consolidation time (DCT) was 3.8 months, the distraction index (DI) 0.7 mm/day, the lengthening index (LI) 1.8 months/cm, the consolidation index (CI) 49.2 days/cm, the healing index (HI) 1.1 months/cm, and the modified healing index (HI*) 34 days/cm. Intramedullary limb lengthening after LLD in cases of hip dysplasia, hip deformity, and various kinds of hip surgery is a useful and safe procedure in young patients to achieve equal limb length. No functional impairment of the preceded hip surgery was seen.

Download Full-text

Epiphyseal Sparing and Reconstruction by Frozen Bone Autograft after Malignant Bone Tumor Resection in Children

Sarcoma ◽

10.1155/2015/892141 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

Ahmed Hamed Kassem Abdelaal ◽

Norio Yamamoto ◽

Katsuhiro Hayashi ◽

Akihiko Takeuchi ◽

Shinji Miwa ◽

...

Keyword(s):

Functional Outcome ◽

Limb Salvage ◽

Bone Tumor ◽

Treatment Options ◽

Tumor Resection ◽

Limb Salvage Surgery ◽

Leg Length ◽

Primary Bone Tumors ◽

Bone Tumor Resection ◽

Bone Autograft

Limb salvage surgery has become the standard treatment for malignant primary bone tumors in the extremities. Limb salvage represents a challenge in skeletally immature patients. Several treatment options are available for limb reconstruction after tumor resection in children. We report our results using the technique of epiphyseal sparing and reconstruction with frozen autograft bone in 18 children. The mean follow-up period for the all patients included in this study is 72 ± 26 m. Eight patients remained disease-free, seven patients lived with no evidence of disease, two were alive but with disease, and one patient died of the disease. Five- and ten-year rates of survival were 94.4%. Graft survival at 5 and 10 years was 94.4%. Functional outcome using the Enneking scale was excellent in 17 patients (94.4%) and poor in one patient (5.5%). Complications include 2 nonunions, 2 fractures, 2 deep infections, 1 soft tissue recurrence, and leg length discrepancy in 7 cases. This technique is a good reconstructive choice in a child with a nonosteolytic primary or secondary bone tumor, responsive to chemotherapy, without involvement of the articular cartilage. It is a straight forward, effective, and biological technique, which affords immediate mobilization of joints and possible cryoimmune effects, with excellent long term functional outcome and less complication.

Download Full-text