[Distal tibial reconstruction and ankle arthrodesis in osteosarcoma (salvage technique). A case presentation].
Treatment of bone sarcomas is aimed in healing and secondarily rescuing the limb. With the use of chemotherapy, radiation therapy, new prostheses and availability of graft, now most tumors can be resected, reducing functional deficit.


OBJECTIVE
To present a surgical option in management of osteosarcoma of distal tibia.


METHODS
Fifteen year-old man, starting in April 2003 with a mass in the left ankle area. June 2003 pulsatile progressive pain started, increased with activity, decreased with rest. November 2003 the physical exam: limping by left lower limb, with a tumor in the posteromedial ankle surface (3 x 2 cm), hard, not movable, regular edges, painful on palpation, Radiographic observations (November 2003), showed blastic oval stone image (4 x 3.5 cm) with expanded posterior and medial cortices with periosteal reaction. The initial biopsy report (chondroblastoma) was not consistent with the diagnostical assumption. So resection was performed 10 cm wide, placing a methylmethacrylate spacer. The final histological report was positive to osteogenic sarcoma. The patient received 11 sessions of chemotherapy. The reconstruction of the distal tibia and arthrodesis with autologous graft from the fibula, heterologous graft and stabilization with transcalcaneal nail, was done in March 2005.


RESULTS
Successful evolution without tumor activity with graft integration to arthrodesis and plantigrade gait.
Castro
José Antonio Enríquez
JA
Hospital General de México. drenriquezja@hotmail.com
Hernández
Mercedes
M
Sierra
Alejandro Cedillo
AC
Méndez
Josefina Molina
JM
Macías C
Carlos Roberto
CR
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001174:Arthrodesis / Q000379:methods*; D001706:Biopsy; D001858:Bone Nails; D001859:Bone Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D002804:Chondroblastoma / Q000175:diagnosis; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003951:Diagnostic Errors; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005360:Fibula / Q000637:transplantation; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D016268:Internal Fixators; D008297:Male; D012516:Osteosarcoma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D011859:Radiography; D013977:Tibia / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014182:Transplantation, Autologous
D005047:Etoposide; D004317:Doxorubicin; D002945:Cisplatin; D007069:Ifosfamide