title: Pathological fracture in osteosarcoma: is it always an indication for amputation?
abstract: BACKGROUND
  The presence of a pathological fracture due to osteosarcoma (OS) has been considered a high risk factor for dissemination and an indication for immediate amputation. With current neoadjuvant chemotherapy regimens there is a trend towards limb salvage procedures in selected cases. The aim of this study is to assess the outcome of patients treated with amputation versus patients treated with limb salvage surgery focusing on local recurrence, mortality rates and metastatic dissemination.
  
  
  METHODS
  A retrospective study of patients with OS treated at our institution was performed. Fifteen patients with a mean age of 25.6 years (8 to 66) were identified with an average follow up of 7 years (2 to 29). Patients were treated either with amputation (8) or limb salvage procedure (6). One patient was not treated surgically.
  
  
  RESULTS
  Four patients developed local recurrence (1 in the amputation group and 3 in the limb salvage group, treated with secondary amputation). Six patients developed pulmonary metastasis (4 in the amputation group and 2 in the limb salvage) and 3 patients died (all of them in the amputation group).
  
  
  CONCLUSIONS
  1. A pathologic fracture in an OS is not always a contraindication for limb salvage because the oncologic results are acceptable. 2. In selected cases limb salvage has similar success rates to amputation.
authors.affiliation: Department of Orthopaedic and Trauma Surgery. Hospital de Mataro (Consorci Sanitari del Maresme), Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Malagelada
authors.affiliation: Musculoskeletal Oncology Unit, Orthopaedic Surgery and Traumatology. Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Laura Trullols
authors.initials: LT
authors.lastname: Tarrago
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust. London, UK.
authors.forename: Saket
authors.initials: S
authors.lastname: Tibrewal
authors.affiliation: Musculoskeletal Oncology Unit, Orthopaedic Surgery and Traumatology. Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Ana Peiro
authors.initials: AP
authors.lastname: Ibanez
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust. London, UK.
authors.forename: Luckshmana
authors.initials: L
authors.lastname: Jeyaseelan
authors.affiliation: Musculoskeletal Oncology Unit, Orthopaedic Surgery and Traumatology. Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Isidre Gracia
authors.initials: IG
authors.lastname: Alegria
mesh_terms: D000328:Adult; D000671:Amputation, Surgical; D001859:Bone Neoplasms / Q000150:complications / Q000601:surgery*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000209:etiology*; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D012516:Osteosarcoma / Q000150:complications / Q000601:surgery*; D016879:Salvage Therapy / Q000379:methods; D055815:Young Adult