title: Ewing sarcoma of the acetabulum in children: a "growth plate-based" surgical strategy.
abstract: BACKGROUND
  Surgical strategy for Ewing sarcoma (ES) of the pelvis relies on Enneking classification. In adults, in case the acetabulum is involved, excision of the entire acetabulum is needed and often leads to loss of function. In children, the surgeon may adopt a strategy, such as in metaphyseal tumors of long bones where an unaffected growth plate allows a transepiphyseal resection, therefore sparing the joint.
  
  
  METHODS
  We present a "triradiate cartilage strategy" for the excision of ES of the pubic component of the acetabulum, which allows a wide resection while preserving most of the socket. The approach is ilioinguinal. Osteotomies of the iliopubic and ischio pubicrami are performed, followed by hip arthrotomy and anterior dislocation. Transacetabular resection is achieved using osteotomes, under image intensifier guidance, with no further reconstruction. Cases are presented for 2 boys aged 6.5 and 9.5 years, treated with chemotherapy and transacetabular resection.
  
  
  RESULTS
  Resections were all rated R0. Patient #1 remained asymptomatic, including during sport activities, and had normal hip range of motion at 12-year follow-up. Radiograph demonstrated mild protrusio acetabuli. Patient #2 had no complain at 3-year follow-up with normal hip range of motion, although he presented with an equinus gait. Radiographs demonstrated a well-covered femoral head without medial shift.
  
  
  CONCLUSIONS
  A "growth plate-based" surgical strategy can be adapted to malignant pelvic tumors in skeletally immature children. This technique leaves intact the ilio ischiatic component of the triradiate cartilage, which, according to Ponseti, contributes the most to the growth of the acetabulum. Joint sparing improves the functional result and decreases the risk of complication.
  
  
  METHODS
  IV.
authors.affiliation: Service de Chirurgie Orthopédique et Traumatologique, Hôpital des Enfants, Toulouse, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Sales de Gauzy
authors.forename: Valérie
authors.initials: V
authors.lastname: Lafontan
authors.forename: Monica
authors.initials: M
authors.lastname: Urseï
authors.forename: Franck
authors.initials: F
authors.lastname: Accadbled
mesh_terms: D000077:Acetabulum / Q000000981:diagnostic imaging / Q000601:surgery*; D000293:Adolescent; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D006132:Growth Plate / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000379:methods*; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods; D012512:Sarcoma, Ewing / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome