title: The longitudinal split technique for narrow canal tibia in a case of distal femur replacement for osteosarcoma.
abstract: BACKGROUND
  There are currently no available prostheses that can be used for extremely small femurs or tibias of adult patients in countries where allograft is unavailable.
  
  
  METHODS
  We report the case of a 17-year-old girl requiring special limb salvage technique for distal femur reconstruction following resection of malignant tumor. This technique was needed because of a very narrow canal of the tibia. We split bilateral tibial cortices longitudinally with osteotomies to enlarge tibial canal enough to insert conventional endoprosthesis. After insertion of the implant, split tibia reduced with titanium cables and bands, and the split clefts were filled with cancellous bone. Fifteen months after the operation, proper fixation was achieved with bony fusion of bilateral split clefts and ambulation without assistance was achieved.
  
  
  CONCLUSIONS
  Any proper surgical procedure for our patient were reported previously. We developed a conventional non-expandable endoprosthesis for distal femur replacement using the double longitudinal split technique as a solution to this difficult problem.
  
  
  CONCLUSIONS
  Our longitudinal split technique should be applicable to adult patients with skeletal immaturity requiring resection of juxta-articular malignant tumors and in other situations complicated by the presence of a narrow canal.
authors.affiliation: Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, Japan. Electronic address: toruakiyama827@jichi.ac.jp.
authors.forename: Toru
authors.initials: T
authors.lastname: Akiyama
authors.affiliation: Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, Japan. Electronic address: panda714@hotmail.co.jp.
authors.forename: Shotaro
authors.initials: S
authors.lastname: Kanda
authors.affiliation: Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, Japan. Electronic address: saita-k@jichi.ac.jp.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Saita
keywords: Bone tumor; Distal femur replacement; Osteosarcoma; Surgical technique