title: Van Nes rotationplasty as a treatment method for Ewing's sarcoma in a 14-month-old.
abstract: BACKGROUND
  In recent years, the rotationplasty procedure has become popular amongst tumour surgeons as an alternative to endoprosthetic replacement or amputation. There are very few documented cases of this technique in young patients with malignancy.
  
  
  METHODS
  We describe an extremely rare case of Ewing's sarcoma in a 14-month-old boy that involved the entire length of the left femur. At initial presentation, pulmonary metastatic spread had occurred and there was no neurovascular involvement. Complete response to neo-adjuvant chemotherapy was achieved prior to performing the definitive surgical procedure.
  
  
  CONCLUSIONS
  This case highlights the many reconstructive options and difficulties encountered in managing such extremely young patients with aggressive malignant disease. In this case, a complete femoral excision was necessary and various treatment options were explored. These included irradiation and re-implantation, endoprosthetic replacement and manufacturing a custom growing prosthesis. Taking future functional, psychological and social implications into consideration, we performed a total femoral excision and Van Nes rotationplasty of the tibia at our institute. Histological analysis of the tumour resection showed clear tumour margins and at 1 year clinical review, the patient demonstrates good functional outcome with no evidence of disease recurrence.
  
  
  CONCLUSIONS
  Van Nes rotationplasty is a viable reconstructive option in young patients with sarcoma of the femur. We believe this to be the youngest reported case of rotationplasty in current literature.
authors: Bone Tumour Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK. Electronic address: j_s_bhamra@hotmail.com.
authors: Jagmeet S
authors: JS
authors: Bhamra
authors: Hani B
authors: HB
authors: Abdul-Jabar
authors: David
authors: D
authors: McKenna
authors: Stephen
authors: S
authors: Ng Man Sun
authors: Elizabeth
authors: E
authors: Gillott
authors: Robin
authors: R
authors: Pollock
keywords: 14-Month-old; Ewing's sarcoma; Femur; Outcome; Treatment options; Van Ness rotationplasty
references: J Am Acad Orthop Surg. 2012 Oct;20(10):657-67
references: 23027695
references: Bone Joint J. 2013 Feb;95-B(2):192-8
references: 23365028
references: Orthopade. 2003 Nov;32(11):965-70
references: 14615846
references: Orthopedics. 2013 Jan;36(1):e126-31
references: 23276345
references: Clin Orthop Relat Res. 2006 Sep;450:25-7
references: 16951641
references: J Orthop Sci. 2012 Nov;17(6):775-81
references: 22878672
references: Sarcoma. 1997;1(1):39-45
references: 18521199
references: Clin Orthop Relat Res. 1991 Jan;(262):74-7
references: 1984934
references: Jpn J Clin Oncol. 2007 Feb;37(2):79-89
references: 17272319
references: J Bone Joint Surg Am. 1975 Dec;57(8):1039-46
references: 1201985
references: J Surg Oncol. 2000 Apr;73(4):192-7
references: 10797331
references: J Surg Oncol. 2012 Mar 15;105(4):331-6
references: 22311817