Palliative limb salvage using a retrograde nail-cement composite after intercalary resection of a distal femoral osteosarcoma: a case report.
Malignant lower-limb metaphyseal and diaphyseal bone tumours that have not yet invaded the epiphysis can usually be managed with limb-sparing surgery. Reconstructions using intercalary allografts, autoclaved autografts, extracorporeally irradiated autografts, vascularised autografts, and distraction osteogenesis have all achieved favourable results. In patients with metastatic disease and a short life expectancy, reconstruction with allografts or autografts should be carefully considered because a long recovery period is needed. An intercalary endoprosthesis provides immediate stability, a short recovery period and a low implant failure rate. Nonetheless, it may be expensive when there is inadequate space for stem insertion, necessitating a custom-made endoprosthesis. We present a 12-year-old boy with stage-III osteosarcoma of the metaphysis and diaphysis of the femur who underwent knee joint salvage and reconstruction with a retrograde, locked, intramedullary nail surrounded with methylmethacrylate. At the one-month follow-up, the patient could walk unassisted. At the 2-year follow-up, his Musculoskeletal Tumor Society score was 83%. The patient died from lung metastases at 31 months. He had not experienced any complications with the reconstruction.
Kiatisevi
Piya
P
Orthopaedic Oncology Unit, Institute of Orthopaedics, Lerdsin Hospital, Bangkok, Thailand. piyamd@yahoo.com
Witoonchart
Kiat
K
Pattarabanjird
Narongchai
N
Thuvasethakul
Phairat
P
D001843:Bone Cements; D001858:Bone Nails; D002648:Child; D003952:Diagnostic Imaging; D017809:Fatal Outcome; D005266:Femoral Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007719:Knee Joint / Q000473:pathology / Q000601:surgery*; D007720:Knee Prosthesis; D023821:Limb Salvage; D008297:Male; D009367:Neoplasm Staging; D012516:Osteosarcoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D010166:Palliative Care
D001843:Bone Cements