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Palliative limb salvage using a retrograde nail-cement composite after intercalary resection of a distal femoral osteosarcoma: a case report

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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. [PUBLICATION ABSTRACT]

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									Journal of Orthopaedic Surgery ����������������




Palliative limb salvage using a retrograde nail-
cement composite after intercalary resection of
a distal femoral osteosarcoma: a case report
Piya Kiatisevi, Kiat Witoonchart, Narongchai Pattarabanjird, Phairat Thuvasethakul
Orthopaedic Oncology Unit, Institute of Orthopaedics, Lerdsin Hospital, Bangkok, Thailand




                                                              the patient could walk unassisted. At the 2-year
                                                              follow-up, his Musculoskeletal Tumor Society score
ABSTRACT                                                      was 83%. The patient died from lung metastases at 31
                                                              months. He had not experienced any complications
Malignant lower-limb metaphyseal and diaphyseal               with the reconstruction.
bone tumours that have not yet invaded the
epiphysis can usually be managed with limb-sparing            Key words: fracture fixation, intramedullary; limb salvage;
surgery. Reconstructions using intercalary allografts,        methylmethacrylate; osteosarcoma
autoclaved autografts, extracorporeally irradiated
autografts, vascularised autografts, and distraction
osteogenesis have all achieved favourable results.            INTRODUCTION
In patients with metastatic disease and a short
life expectancy, reconstruction with allografts or            The distal femoral metaphysis is the most common
autografts should be carefully considered because             site for primary malignant bone tumours in
a long recovery period is needed. An intercalary              children.1,2 For tumours close to, but not invading,
endoprosthesis provides immediate stability, a short          the epiphyseal area, part of the epiphysis should be
recovery period and a low implant failure rate.               salvaged to maximise knee function and minimise leg
Nonetheless, it may be expensive when there is                length discrepancy.3,4 Such limb-sparing procedures
inadequate space for stem insertion, necessitating a          include reconstruction with intercalary allografts,3,5,6
custom-made endoprosthesis. We present a 12-year-             autoclaved autografts,7 extracorporeally irradiated
old boy with stage-III osteosarcoma of the metaphysis         autografts,8 vascularised autografts,3,7,9 distraction
and diaphysis of the femur who underwent knee                 osteogenesis,10,11 and an intercalary endoprosthesis.12
joint salvage and reconstruction with a retrograde,           In patients with metastatic disease and a short
locked, intramedullary nail surrounded with                   life expectancy, reconstruction using allografts or
methylmethacrylate. At the one-month follow-up,               autografts should be carefully considered because


Address correspondence and reprint requests to: Dr Piya Kiatisevi, Orthopaedic Oncology Unit, Institute of Orthopaedics,
Lerdsin Hospital, 190 Silom Road, Bangrak, Bangkok, Thailand 10500. E-mail: piyamd@yahoo.com
384 P Kiatisevi et al.                                                                Journal of Orthopaedic Surgery


these require a long recovery period. An intercalary
endoprosthesis provides immediate stability with a
short recovery period and a low implant failure rate.
Nonetheless, these can be expensive when there is
inadequate space for stem insertion, necessitating a
custom-made endoprosthesis.12 We present a 12-year-

								
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