Palliative Limb Salvage Using a Retrograde Nail-Cement Composite after Intercalary Resection of a Distal Femoral Osteosarcoma: A Case Report

• Published in: Journal of orthopaedic surgery (Hong Kong) Vol. 17; no. 3; pp. 383 - 387
• Main Authors: Kiatisevi, Piya, Witoonchart, Kiat, Pattarabanjird, Narongchai, Thuvasethakul, Phairat
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.12.2009; Sage Publications Ltd; SAGE Publishing
• Subjects: Bone Cements; Bone Nails; Child; Diagnostic Imaging; Fatal Outcome; Femoral Neoplasms - diagnosis; Femoral Neoplasms - pathology; Femoral Neoplasms - surgery; Humans; Knee; Knee Joint - pathology; Knee Joint - surgery; Knee Prosthesis; Limb Salvage; Male; Medical imaging; Neoplasm Staging; Osteosarcoma - diagnosis; Osteosarcoma - pathology; Osteosarcoma - surgery; Palliative Care; Patients; Surgery; Tissues; Tumors; Veins & arteries; limb salvage; methylmethacrylate; osteosarcoma; fracture fixation, intramedullary
• ISSN: 2309-4990; 1022-5536; 2309-4990
• DOI: 10.1177/230949900901700329

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.