title: Epiphyseal preservation and an intercalary vascularized fibular graft with hydroxyapatite composites. Reconstruction in metaphyseal osteosarcoma of the proximal tibia: a case report.
abstract: BACKGROUND DATA AND OBJECTIVES: We present here a case report of a patient with metaphyseal osteosarcoma with a preserved epiphysis and reconstructed by a vascularized fibular graft and hydroxyapatite composites.
  
  
  METHODS
  The case was a 14-year-old boy, who had osteosarcoma in the proximal tibia. After the diagnosis was confirmed by biopsy, the patient immediately received preoperative chemotherapy including high-dose Methotrexate, Cisplatin and Doxrubicin. Imagings after preoperative chemotherapy including MRI and contrasted enhanced CT confirmed no tumor penetration into the physis. Subsequently, we performed transepiphyseal resection of the proximal tibia to reserve the joint surface. The intercalary twin-barreled vascularized fibular graft was placed with hydroxyapatite composites. The patella tendon was reattached to the grafted fibular to biologically reconstruct the knee extensor mechanism. Postoperative chemotherapy was completed with the same regime as preoperative chemotherapy.
  
  
  RESULTS
  The bony union was completed at 10 months after the operation. The Enneking's functional evaluation score was 28 out of 30 points (93%). There was no evidence of local recurrence and no metastatic disease during the 42 months follow-up after initial diagnosis.
  
  
  CONCLUSIONS
  An accurate evaluation of MRI and CT can give a reliable assessment of intraphyseal penetration of metaphyseal osteosarcoma. In case of no involvement of the tumor in the physis, transepiphyseal osteotomy is the optimal procedure to preserve the joint surface and superior function of the joint, especially in the proximal tibia.
authors.affiliation: Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan. kahonoki@naramed-u.ac.jp
authors.forename: Kanya
authors.initials: K
authors.lastname: Honoki
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Kobata
authors.forename: Yoshizumi
authors.initials: Y
authors.lastname: Miyauchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yajima
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Fujii
authors.forename: Akira
authors.initials: A
authors.lastname: Kido
authors.forename: Koji
authors.initials: K
authors.lastname: Shigematu
authors.forename: Kenji
authors.initials: K
authors.lastname: Kawamura
authors.forename: Toru
authors.initials: T
authors.lastname: Morishita
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Mii
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Takakura
mesh_terms: D000293:Adolescent; D001859:Bone Neoplasms / Q000601:surgery*; D017886:Durapatite; D004838:Epiphyses; D005360:Fibula / Q000098:blood supply / Q000637:transplantation*; D006801:Humans; D008297:Male; D012516:Osteosarcoma / Q000601:surgery*; D010027:Osteotomy / Q000379:methods; D013977:Tibia; D014182:Transplantation, Autologous
chemical_list: D017886:Durapatite