Reconstruction of the pelvis after resection of malignant bone tumours in children and adolescents.
The predominant tumour of the pelvic region in children and adolescents is Ewing's sarcoma followed by osteosarcoma. Both tumours are treated by chemotherapy and the best chance of survival is offered by wide tumour resection. Compared to surgical treatment on the extremities, the resection and reconstruction of pelvic sarcomas remains challenging. Surgery of pelvic sarcomas shows higher rates of local recurrence and complications and a lower functional outcome than other localisations. Especially in children and adolescents the reconstruction methods have to focus additionally on the growing skeleton. According to the different types of pelvic resections and therefore the need of different reconstruction methods, the following article is based on Enneking's surgical classification of pelvic resections. Type I resections are best reconstructed with autografts implanted between the supracetabular osteotomy and the sacrum. Patients show the best functional results after this reconstruction. Periacetabular resections (type II) in small children do best with iliofemoral arthrodesis or pseudarthrosis; in larger adolescents the use of the pedestal Schoellner cup showed superior results over the prior saddle prosthesis. Type III resections are not reconstructed. Complete internal hemipelvectomy represents the most difficult situation, in children as well as in adults. High complication rates after allograft and endoprosthetic reconstruction have recently favoured the renaissance of a flail hip reconstruction or the hip transpositionplasty.
Dominkus
Martin
M
Medical University of Vienna, University Clinic of Orthopaedics, Waehringer Guertel 18-20, 1090 Vienna, Austria. martin.dominkus@meduniwien.ac.at
Darwish
Eslam
E
Funovics
Philipp
P
D000293:Adolescent; D001859:Bone Neoplasms / Q000601:surgery*; D002648:Child; D006801:Humans; D010384:Pelvic Bones / Q000601:surgery*; D019651:Plastic Surgery Procedures