Preservation of the Epiphysis and Growth Plate in the Surgical Management of Femoral Osteosarcoma in a Skeletally Immature Patient by Intercalary Resection and Biological Reconstruction: A Case Report

Osteosarcoma arises most frequently in the metaphysis around the knee and its management by limb salvage surgery in skeletally immature pediatric patients is extremely challenging. Common reconstructive methods such as endoprosthetic or biological reconstruction are not fully capable of dealing with...

Full description

Saved in:
Bibliographic Details
Published inCase reports in oncology Vol. 12; no. 2; pp. 513 - 522
Main Authors Yoda, Yuhei, Yamaguchi, Sayaka Iwai, Hirozane, Toru, Asano, Naofumi, Seki, Atsuhito, Morioka, Hideo, Nakayama, Robert, Nakamura, Masaya, Matsumoto, Morio
Format Journal Article
LanguageEnglish
Published Basel, Switzerland S. Karger AG 01.05.2019
Karger Publishers
Subjects
Online AccessGet full text

Cover

Loading…
Abstract Osteosarcoma arises most frequently in the metaphysis around the knee and its management by limb salvage surgery in skeletally immature pediatric patients is extremely challenging. Common reconstructive methods such as endoprosthetic or biological reconstruction are not fully capable of dealing with durability-related and growth-related problems and their functional outcomes are not as good as those seen in adult cases. A definitive limb salvaging procedure in children that outperforms amputation or rotationplasty has not yet been established. Herein, we report a case of stage IV osteosarcoma in the femur of a 7-year-old boy that was safely managed with intercalary resection preserving the distal femoral growth plate and epiphysis, followed by biological reconstruction using a frozen tumor-devitalized autograft. Good response to preoperative chemotherapy and the diaphyseal location of the tumor enabled us to perform a tumor resection that spared the growth plate and preserved the native knee joint structure. Plate fixation over the growth plate was terminated by removing the locking screws in the epiphysis after 44 months, which restored growth capacity to some extent. At 50 months postoperatively, no recurrence or progression of the disease was observed. The patient uses an extension shoe and reports having little discomfort in his daily life despite having a restricted range of motion and limb length discrepancy. In conclusion, limb salvage with biological reconstruction in skeletally immature patients can provide an acceptable functional outcome, including minimized limb length discrepancy, if critical damage to the growth plate and articular components can be avoided.
AbstractList Osteosarcoma arises most frequently in the metaphysis around the knee and its management by limb salvage surgery in skeletally immature pediatric patients is extremely challenging. Common reconstructive methods such as endoprosthetic or biological reconstruction are not fully capable of dealing with durability-related and growth-related problems and their functional outcomes are not as good as those seen in adult cases. A definitive limb salvaging procedure in children that outperforms amputation or rotationplasty has not yet been established. Herein, we report a case of stage IV osteosarcoma in the femur of a 7-year-old boy that was safely managed with intercalary resection preserving the distal femoral growth plate and epiphysis, followed by biological reconstruction using a frozen tumor-devitalized autograft. Good response to preoperative chemotherapy and the diaphyseal location of the tumor enabled us to perform a tumor resection that spared the growth plate and preserved the native knee joint structure. Plate fixation over the growth plate was terminated by removing the locking screws in the epiphysis after 44 months, which restored growth capacity to some extent. At 50 months postoperatively, no recurrence or progression of the disease was observed. The patient uses an extension shoe and reports having little discomfort in his daily life despite having a restricted range of motion and limb length discrepancy. In conclusion, limb salvage with biological reconstruction in skeletally immature patients can provide an acceptable functional outcome, including minimized limb length discrepancy, if critical damage to the growth plate and articular components can be avoided.
Author Hirozane, Toru
Seki, Atsuhito
Yoda, Yuhei
Nakamura, Masaya
Nakayama, Robert
Matsumoto, Morio
Asano, Naofumi
Morioka, Hideo
Yamaguchi, Sayaka Iwai
AuthorAffiliation b Department of Orthopaedic Surgery, National Center for Child Health and Development, Tokyo, Japan
a Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
c Department of Orthopedic Surgery, Tokyo Medical Center, Tokyo, Japan
AuthorAffiliation_xml – name: b Department of Orthopaedic Surgery, National Center for Child Health and Development, Tokyo, Japan
– name: c Department of Orthopedic Surgery, Tokyo Medical Center, Tokyo, Japan
– name: a Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
Author_xml – sequence: 1
  givenname: Yuhei
  surname: Yoda
  fullname: Yoda, Yuhei
– sequence: 2
  givenname: Sayaka Iwai
  surname: Yamaguchi
  fullname: Yamaguchi, Sayaka Iwai
  email: saya_iwai@a6.keio.jp
– sequence: 3
  givenname: Toru
  surname: Hirozane
  fullname: Hirozane, Toru
– sequence: 4
  givenname: Naofumi
  surname: Asano
  fullname: Asano, Naofumi
– sequence: 5
  givenname: Atsuhito
  surname: Seki
  fullname: Seki, Atsuhito
– sequence: 6
  givenname: Hideo
  surname: Morioka
  fullname: Morioka, Hideo
– sequence: 7
  givenname: Robert
  surname: Nakayama
  fullname: Nakayama, Robert
– sequence: 8
  givenname: Masaya
  surname: Nakamura
  fullname: Nakamura, Masaya
– sequence: 9
  givenname: Morio
  surname: Matsumoto
  fullname: Matsumoto, Morio
BackLink https://www.ncbi.nlm.nih.gov/pubmed/31427945$$D View this record in MEDLINE/PubMed
BookMark eNptkk1v1DAQhiNURNuFA3eELHHisGBvYifmgFRWbVmpaFdbOFsTZ7ybbRIH2ynqP-Rn4f1gaSUutjXzzPuOR3OenHS2wyR5zegHxrj8SCnllOUsfZacMSEmY8FzfvLofZqce7-hVEgu-IvkNGXZJJcZP0t-Lxx6dPcQatsRa0hYI7ns63794GtPoKvItbO_wposGghI6m5H3A5uVWtoyDfoYIUtdmFbfIWtdTE69wGtB6dtC9sSILd32GCApnkgs7aFMDgki2i6LSxjrAvooh64B7KMDeldO1v3L7Vt7N5ridp2Prhhl_1ELsgUPMZwb114mTw30Hh8dbhHyY-ry-_Tr-Ob-fVsenEz1oIVYSyNYKjTshIpS3WWG855LhjLM2p0qY1khvF4ImpJUciiAC5MJcuJkZhSSEfJbK9bWdio3tVt7FlZqNUuYN1KgQu1blAV0oBJGWeiqDKZ8rKoJiljwAyVBcT3KPm81-qHssVKx2HE6T0RfZrp6rVa2XslhBR5kUWBdwcBZ38O6IPa2MF18f9qktIIsDwvIvV-T2lnvXdojg6Mqu0CqeMCRfbt45aO5N-N-Wd5B26F7ghMl_O9hOorE6k3_6UOLn8A5PTbMg
CitedBy_id crossref_primary_10_1097_BPO_0000000000001878
crossref_primary_10_1002_adhm_202200471
crossref_primary_10_1007_s00590_021_03149_z
Cites_doi 10.1007/s11999-017-5356-z
10.1200/JCO.2013.54.7844
10.5435/JAAOS-D-15-00619
10.1007/s11999-014-4028-5
10.1302/0301-620X.87B2.15325
10.1302/0301-620X.96B4.32629
10.1093/annonc/mdq589
10.1097/00003086-199301000-00035
10.1007/s11999.0000000000000055
10.1186/s12891-018-2109-4
10.1007/s00264-017-3499-x
10.2106/JBJS.RVW.16.00026
10.1200/JCO.1999.17.4.1164
10.2106/00004623-200412000-00015
ContentType Journal Article
Copyright 2019 The Author(s). Published by S. Karger AG, Basel
Copyright © 2019 by S. Karger AG, Basel 2019
Copyright_xml – notice: 2019 The Author(s). Published by S. Karger AG, Basel
– notice: Copyright © 2019 by S. Karger AG, Basel 2019
DBID M--
NPM
AAYXX
CITATION
3V.
7X7
7XB
8FI
8FJ
8FK
ABUWG
AFKRA
BENPR
CCPQU
FYUFA
GHDGH
K9.
M0S
PQEST
PQQKQ
PQUKI
PRINS
5PM
DOA
DOI 10.1159/000501713
DatabaseName Karger Open Access Journals
PubMed
CrossRef
ProQuest Central (Corporate)
Health & Medical Collection
ProQuest Central (purchase pre-March 2016)
Hospital Premium Collection
Hospital Premium Collection (Alumni Edition)
ProQuest Central (Alumni) (purchase pre-March 2016)
ProQuest Central (Alumni)
ProQuest Central
ProQuest Central
ProQuest One Community College
Health Research Premium Collection
Health Research Premium Collection (Alumni)
ProQuest Health & Medical Complete (Alumni)
Health & Medical Collection (Alumni Edition)
ProQuest One Academic Eastern Edition (DO NOT USE)
ProQuest One Academic
ProQuest One Academic UKI Edition
ProQuest Central China
PubMed Central (Full Participant titles)
DOAJ Directory of Open Access Journals
DatabaseTitle PubMed
CrossRef
ProQuest One Academic Eastern Edition
ProQuest Health & Medical Complete (Alumni)
ProQuest Central (Alumni Edition)
ProQuest One Community College
ProQuest Hospital Collection
Health Research Premium Collection (Alumni)
ProQuest Central China
ProQuest Hospital Collection (Alumni)
ProQuest Central
ProQuest Health & Medical Complete
Health Research Premium Collection
ProQuest One Academic UKI Edition
Health and Medicine Complete (Alumni Edition)
ProQuest One Academic
ProQuest Central (Alumni)
DatabaseTitleList

CrossRef

PubMed
ProQuest One Academic Eastern Edition
Database_xml – sequence: 1
  dbid: DOA
  name: Directory of Open Access Journals
  url: https://www.doaj.org/
  sourceTypes: Open Website
– sequence: 2
  dbid: NPM
  name: PubMed
  url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
  sourceTypes: Index Database
– sequence: 3
  dbid: M--
  name: Karger Open Access Journals
  url: https://www.karger.com/OpenAccess
  sourceTypes:
    Enrichment Source
    Publisher
– sequence: 4
  dbid: 7X7
  name: ProQuest Health and Medical
  url: https://search.proquest.com/healthcomplete
  sourceTypes: Aggregation Database
DeliveryMethod fulltext_linktorsrc
Discipline Medicine
EISSN 1662-6575
EndPage 522
ExternalDocumentID oai_doaj_org_article_89faf315168d4935b8d2311a1f098ad2
10_1159_000501713
31427945
501713
Genre Case Reports
GroupedDBID ---
0~B
29B
3O.
3V.
53G
5GY
5VS
6J9
7X7
8FI
8FJ
ABDBF
ABPAZ
ABUWG
ACGFS
ADBBV
AEGXH
AEYAO
AFKRA
AHMBA
ALIPV
ALMA_UNASSIGNED_HOLDINGS
AOIJS
AZPMC
BAWUL
BCNDV
BENPR
BPHCQ
BVXVI
CAG
CCPQU
CYUIP
DIK
E0A
E3Z
EBS
EJD
F5P
FB.
FYUFA
GROUPED_DOAJ
GX1
HMCUK
HYE
IAO
IHR
KQ8
M--
M48
M~E
O1H
O5R
O5S
OK1
PQQKQ
PROAC
RKO
RNS
RPM
TR2
UKHRP
4.4
ADRAZ
C1A
COF
IPNFZ
ITC
NPM
RIG
AAYXX
CITATION
7XB
8FK
K9.
PQEST
PQUKI
PRINS
5PM
ID FETCH-LOGICAL-c618t-9f61ec3bd6313c47f5557611740fcbcf91f15f91eec90e6988a56fd9b2f9e30a3
IEDL.DBID RPM
ISSN 1662-6575
IngestDate Tue Oct 22 15:16:09 EDT 2024
Tue Sep 17 21:34:56 EDT 2024
Wed Nov 20 04:41:25 EST 2024
Fri Dec 06 04:38:08 EST 2024
Sat Sep 28 08:34:53 EDT 2024
Thu Sep 05 19:48:32 EDT 2024
Thu Aug 29 12:04:23 EDT 2024
IsDoiOpenAccess true
IsOpenAccess true
IsPeerReviewed true
IsScholarly true
Issue 2
Keywords Biological reconstruction
Limb salvage
Childhood osteosarcoma
Frozen tumor-devitalized autograft
Language English
License This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC). Usage and distribution for commercial purposes requires written permission.
https://creativecommons.org/licenses/by-nc/4.0
This article is licensed under the Creative Commons Attribution-NonCommercial-4.0 International License (CC BY-NC) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes requires written permission.
LinkModel DirectLink
MergedId FETCHMERGED-LOGICAL-c618t-9f61ec3bd6313c47f5557611740fcbcf91f15f91eec90e6988a56fd9b2f9e30a3
OpenAccessLink https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6696784/
PMID 31427945
PQID 2308431778
PQPubID 2047992
PageCount 10
ParticipantIDs doaj_primary_oai_doaj_org_article_89faf315168d4935b8d2311a1f098ad2
crossref_primary_10_1159_000501713
proquest_journals_2308431778
pubmed_primary_31427945
karger_primary_501713
pubmedcentral_primary_oai_pubmedcentral_nih_gov_6696784
PublicationCentury 2000
PublicationDate 2019-05-01
PublicationDateYYYYMMDD 2019-05-01
PublicationDate_xml – month: 05
  year: 2019
  text: 2019-05-01
  day: 01
PublicationDecade 2010
PublicationPlace Basel, Switzerland
PublicationPlace_xml – name: Basel, Switzerland
– name: Switzerland
– name: Basel
– name: Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH-4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.ch
PublicationTitle Case reports in oncology
PublicationTitleAlternate Case Rep Oncol
PublicationYear 2019
Publisher S. Karger AG
Karger Publishers
Publisher_xml – name: S. Karger AG
– name: Karger Publishers
References Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993Jan;286(286):241–6. 10.1097/00003086-199301000-0003584253520009-921X
Fletcher C, Bridge J, Hogendoorn P, Mertens F. WHO Classification of tumours of soft tissue and bone. 4th ed.Lyon: IARC Press; 2013.
Higuchi T, Yamamoto N, Nishida H, Hayashi K, Takeuchi A, Kimura H, et al.. Knee joint preservation surgery in osteosarcoma using tumour-bearing bone treated with liquid nitrogen. Int Orthop. 2017Oct;41(10):2189–97. 10.1007/s00264-017-3499-x285735130341-2695
Levin AS, Arkader A, Morris CD. Reconstruction following tumor resections in skeletally immature patients. J Am Acad Orthop Surg. 2017Mar;25(3):204–13. 10.5435/JAAOS-D-15-00619281959841067-151X
Morris CD, Wustrack RL, Levin AS. Limb-salvage options in growing children with malignant bone tumors of the lower extremity: a critical analysis review. JBJS Rev. 2017Jul;5(7):e7. 10.2106/JBJS.RVW.16.00026287427152329-9185
Tsuchiya H, Wan SL, Sakayama K, Yamamoto N, Nishida H, Tomita K. Reconstruction using an autograft containing tumour treated by liquid nitrogen. J Bone Joint Surg Br. 2005Feb;87(2):218–25. 10.1302/0301-620X.87B2.15325157367470301-620X
Bielack SS, Kempf-Bielack B, Heise U, Schwenzer D, Winkler K; Cooperative German-Austrian-Swiss Osteosarcoma Study Group. Combined modality treatment for osteosarcoma occurring as a second malignant disease. J Clin Oncol. 1999Apr;17(4):1164–74. 10.1200/JCO.1999.17.4.1164105611750732-183X
Takeuchi A, Yamamoto N, Hayashi K, Matsubara H, Kimura H, Miwa S, et al.. Growth of epiphysis after epiphyseal-preservation surgery for childhood osteosarcoma around the knee joint. BMC Musculoskelet Disord. 2018Jun;19(1):185. 10.1186/s12891-018-2109-4298750141471-2474
Igarashi K, Yamamoto N, Shirai T, Hayashi K, Nishida H, Kimura H, et al.. The long-term outcome following the use of frozen autograft treated with liquid nitrogen in the management of bone and soft-tissue sarcomas. Bone Joint J. 2014Apr;96-B(4):555–61. 10.1302/0301-620X.96B4.32629246926272049-4394
Aponte-Tinao LA, Albergo JI, Ayerza MA, Muscolo DL, Ing FM, Farfalli GL. What are the complications of allograft reconstructions for sarcoma resection in children younger than 10 years at long-term followup. Clin Orthop Relat Res. 2018Mar;476(3):548–55. 10.1007/s11999.0000000000000055295296390009-921X
Wong J, Morton L, Tucker M, Abramson D, Seddon J, Sampson J, et al.. Risk of subsequent malignant neoplasms in long-term hereditary retinoblastoma survivors after chemotherapy and radiotherapy.2014 Oct;32(29):3284-3290. 10.1200/JCO.2013.54.7844
Muscolo DL, Ayerza MA, Aponte-Tinao LA, Ranalletta M. Partial epiphyseal preservation and intercalary allograft reconstruction in high-grade metaphyseal osteosarcoma of the knee. J Bone Joint Surg Am. 2004Dec;86(12):2686–93. 10.2106/00004623-200412000-00015155908540021-9355
Li J, Wang Z, Ji C, Chen G, Liu D, Zhu H. What are the oncologic and functional outcomes after joint salvage resections for juxtaarticular osteosarcoma about the knee. Clin Orthop Relat Res. 2017Aug;475(8):2095–104. 10.1007/s11999-017-5356-z284250550009-921X
Aponte-Tinao L, Ayerza MA, Muscolo DL, Farfalli GL. Survival, recurrence, and function after epiphyseal preservation and allograft reconstruction in osteosarcoma of the knee. Clin Orthop Relat Res. 2015May;473(5):1789–96. 10.1007/s11999-014-4028-5253522620009-921X
Andreou D, Bielack SS, Carrle D, Kevric M, Kotz R, Winkelmann W, et al.. The influence of tumor- and treatment-related factors on the development of local recurrence in osteosarcoma after adequate surgery. An analysis of 1355 patients treated on neoadjuvant Cooperative Osteosarcoma Study Group protocols. Ann Oncol. 2011May;22(5):1228–35. 10.1093/annonc/mdq589210303810923-7534
ref13
ref12
ref14
ref11
ref10
ref2
ref1
ref8
ref7
ref9
ref4
ref3
ref6
ref5
References_xml – ident: ref9
  doi: 10.1007/s11999-017-5356-z
– ident: ref14
  doi: 10.1200/JCO.2013.54.7844
– ident: ref2
  doi: 10.5435/JAAOS-D-15-00619
– ident: ref8
  doi: 10.1007/s11999-014-4028-5
– ident: ref6
  doi: 10.1302/0301-620X.87B2.15325
– ident: ref12
  doi: 10.1302/0301-620X.96B4.32629
– ident: ref10
  doi: 10.1093/annonc/mdq589
– ident: ref7
  doi: 10.1097/00003086-199301000-00035
– ident: ref4
  doi: 10.1007/s11999.0000000000000055
– ident: ref5
  doi: 10.1186/s12891-018-2109-4
– ident: ref11
  doi: 10.1007/s00264-017-3499-x
– ident: ref3
  doi: 10.2106/JBJS.RVW.16.00026
– ident: ref13
  doi: 10.1200/JCO.1999.17.4.1164
– ident: ref1
  doi: 10.2106/00004623-200412000-00015
SSID ssj0069565
Score 2.1709442
Snippet Osteosarcoma arises most frequently in the metaphysis around the knee and its management by limb salvage surgery in skeletally immature pediatric patients is...
SourceID doaj
pubmedcentral
proquest
crossref
pubmed
karger
SourceType Open Website
Open Access Repository
Aggregation Database
Index Database
Enrichment Source
Publisher
StartPage 513
SubjectTerms Biological reconstruction
Bone cancer
Case Report
Case reports
Chemotherapy
Childhood osteosarcoma
Childrens health
Frozen tumor-devitalized autograft
Knee
Limb salvage
Medical imaging
Medical prognosis
Metastasis
Nitrogen
Patients
Pediatrics
Sarcoma
Surgery
Tumors
X-rays
SummonAdditionalLinks – databaseName: DOAJ Directory of Open Access Journals
  dbid: DOA
  link: http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwrV3Pb9MwFLbQDogL4seAwkBPiGtEHMeOvduoVgbS2MSYtFvkOH5atTWt2nLYf7g_i2c76dYJiQuXHuzYSfte3vu-5PV7jH2qsJCoS5kJl_usrHKXaVfFloAFVo0SGIW0j3-oo_Py-4W8uNfqK9SEJXng9MN91gYtCspLSrelEbLRLUESbjnmRts2Rd-8GMhUisGKUL_sdYQoX8fOdUEYRmxlnyjST5nnKtRcL_8GMR9WSt5LPZNn7GmPGeEgXetz9sh3L9jj4_6t-Et2G-oohoerMEcgUAeHi2l8arEC27Xwldj2-hJOrwlawrSLR5z9XsawB3clMGHxJNTe0ugJ2X--ovtgPrNhiYWzK8pRBNavb-DbbBYVQeE06bJCQ2PBRrSfXd5AKOiL_5iIZ08NL-O5At29E63dhwMYUx6FxAN22fnk8Nf4KOs7NGROcb3ODCrunWhaJbhwZYVSEn_hxHJydI1Dw5FL-vTemdwro7WVClvTFGi8yK14xXa6eeffMJCm8CJ0n-EoiaKWOmxqjVbcScydH7GPg-XqRRLiqCOBkabemHfEvgSbbg4I2tlxgDyq7j2q_pdHjdhu8ojNNsPmew_Gxz9P0lS9aJGmB_-p-ziwqong6QDRKj1ir5MrbVYLXhYUDeWIVVtOtnX12zPd9DIqgCtlCGSUb__H133HnhAINKmIc4_tkAf49wS01s2HeE_9AVq7KFc
  priority: 102
  providerName: Directory of Open Access Journals
– databaseName: Karger Open Access Journals
  dbid: M--
  link: http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwdV1Lb9QwEB5BkapeEI8CgYIsxDVSHMeOza2suhSk0opSqbfIcWy6ajdZ7S6H_kN-FmM7SUkFlxz8lmbs-cYZfwPwoXQ5d7LgKTOZTYsyM6k0ZUgJmLuyFswFIu2Tb-L4ovh6yS_7-w7_Fubaxz8HatSRWwANbkg955ld2EN4lHsONR-kl6bDmSsQ5fOeN2jSfA92GS1yVDo-MTyBnx-NTpzuX-jyfpDkX1Zn_gQe93CRHEb5PoUHtn0Guyf9D_Hn8NuHUAz3qqRzBPEcOVotwoXFhui2IZ_R0d5ekbMbRJVk0YYW57_W4cQjd9EvvvPch91i6SmKvtvgFuiW2nfR5PwazRPi9Jtb8mW5DGSg5CxSspIay7x4cDy9viU-li88lgizx1yXYS7v6d7x1X4kh2SGJpREF2AfLuZHP2bHaZ-cITWCym2qnKDWsLoRjDJTlI5zdF0oOjiZM7VxijrK8WutUZkVSkrNhWtUnTtlWabZC9hpu9a-AsJVbplPPEMdR--0kH5QraSghrvM2ATeD5KrVpGDowq-C1fVKOkEPnmZjg08bXYo6NY_q34XVlI57RiCHCGbQjFeywbxLdXUZUrqJk9gP2rEOMww-MG98tn301hVrRqH1YP-VP0RsKnQt5MenZUygZdRlcbeg04mUE6UbLL6aU27uArk30IoxBfF6_-s9A3sIaRTMSTzAHZQqPYtwqZt_S7smD9qihT7
  priority: 102
  providerName: Karger AG
– databaseName: Health & Medical Collection
  dbid: 7X7
  link: http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwfV1Lb9QwELagSIhLxaPQQKksxDUijmPH7gWVVbcFqbSiVNpb5Dh2u2o3WXa3h_5DfhbjR7JshbjkYMd2pBnPfGNPvkHoY2lzZkXBUqozkxZlplOhS18SMLdlzan1RNqn3_nJZfFtwibxwG0Z0yp7m-gNddNpd0b-CaCycM6uFJ_nv1JXNcrdrsYSGo_RE5KDKwd9LidDwMUB-7PIJgRe29evc_QwdMMHeap-8D83LvN68S-g-TBf8i8HNH6OtiNyxIdB1C_QI9O-RE9P4934K_TbZVP0R6y4sxigHT6aT_3ZxRKrtsHHEHOvrvH5LQBMPG39Gxd3C2_88DoRxg0euwxcaD0DLeiWsBu6mXJDFL64AU8FkP32Hn-dzTwvKD4P7Ky4hjYnKZhPLe6xS-vz_0341UPZS7-WC3rX1LUH-BCPwJviEA3soMvx0c_RSRrrNKSaE7FKpeXEaFo3nBKqi9IyBlEMgVgns7rWVhJLGDyN0TIzXAqhGLeNrHMrDc0UfY222q41uwgzmRvqatAQyyBQLYSbVEnBiWY20yZBH3rJVfNAx1H5MIbJahBvgr44mQ4vOAZt39Atrqq4ISshrbIU8A4XTSEpq0UDUJcoYjMpVJMnaCdoxDBNP_neg_bRj7PQVc0bC929_lTRGiyrte4m6E1QpWE0JUUONpElqNxQso2v3-xpp9eeB5xzCVCjePv_Jd-hZwDyZEjS3ENbIFvzHoDUqt73u-UPLl4gfQ
  priority: 102
  providerName: ProQuest
– databaseName: Scholars Portal Journals: Open Access
  dbid: M48
  link: http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwdV3fb9MwELbGkKa9oAEDAgNZiNegOI4dGwlNo1oZSGUTo9LeIsext2ptUtIirf_h_izOzo-RabzkwY4vVXyX-77k6x1CH1IbMysSFlIdmTBJIx0KnfqWgLFNc06tL6Q9-cFPpsn3C3axhboem-0NXD1I7Vw_qWk9_3jze3MIAf_ZBzyTvi-dK_tCH6HHMSREp-yaJP3HBA4UwCkZCeexU3qwtsDQYOku2qEkicE72SBD-UL-kJ2unS67fgiG3ldT_pOexnvoSYsr8VHjCE_RlimfoZ1J--X8Obp1WovuBSyuLAbgh4-XM_9mY4VVWeCvwMjXV_hsDvATz0p_xvmf2j8a8Z1Mxi0eO30ujJ6Cj1QriJVqodwShc-vIY_BvZxv8LfFwlcNxWdN7Vacw5jbR7Cn6g12oj__rwp_9aYppr-Wo8R3hW0_4SM8glyLG66wj6bj41-jk7Dt4hBqTsQ6lJYTo2lecEqoTlLLGHAcAkwosjrXVhJLGByN0TIyXAqhGLeFzGMrDY0UfYG2y6o0rxBmMjbUdaghlgGNTYQzqqTgRDMbaROg993OZcumWEfmSQ6TWb_TAfri9rQ_wdXX9gNVfZm14ZoJaZWlgIa4KBJJWS4KAMJEERtJoYo4QPuNR_RmOuMH98ZHP0-bqWxZWJju_CfrXD0DEigcjEtFgF42rtSv7nwyQOnAyQa_fjhTzq58lXDOJQCR5PV_bb5Bu4D-ZKPePEDbsK3mLSCsdf7Ox89fUaQjWw
  priority: 102
  providerName: Scholars Portal
Title Preservation of the Epiphysis and Growth Plate in the Surgical Management of Femoral Osteosarcoma in a Skeletally Immature Patient by Intercalary Resection and Biological Reconstruction: A Case Report
URI https://karger.com/doi/10.1159/000501713
https://www.ncbi.nlm.nih.gov/pubmed/31427945
https://www.proquest.com/docview/2308431778
https://pubmed.ncbi.nlm.nih.gov/PMC6696784
https://doaj.org/article/89faf315168d4935b8d2311a1f098ad2
Volume 12
hasFullText 1
inHoldings 1
isFullTextHit
isPrint
link http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV3Pb9MwFLa2ISEuiB8DAqOyENescRw7NretahlI3aqNSb1FjmOzak1atd1h_-H-LJ7tpKMTJy4-2LFj6b3n9z3n5XsIfc1tyqzIWEx1YuIsT3QsdO5LAqY2Lzm1nkh7fM7PrrOfUzbdQ6z7F8Yn7etydtzM6-NmduNzK5e17nd5Yv3JeMC5hDM26--jfXC_XYgejl8OgJ-1FELgqn3ROscJ4wrmUJKloH9sxwd5qn7wP7cu83r1L6D5NF_yLwc0eoVetsgRn4QdvkZ7pnmDno_bb-Nv0YPLpuiuWPHCYoB2eLic-buLNVZNhb9DzL25wZM5AEw8a_wTV3crf_jhx0QYN3nkMnCh9wK0YLEGa1jUyk1R-OoWPBVA9vk9_lHXnhcUTwI7Ky6hz0kK1lOre-zS-vx_E_7toeylf5cLeh-pa7_hEzwAb4pDNHCIrkfDX4OzuK3TEGtOxCaWlhOjaVlxSqjOcssYRDEEYp3E6lJbSSxh0BqjZWK4FEIxbitZplYamij6Dh00i8Z8QJjJ1FBXg4ZYBoFqJtyiSgpONLOJNhH60kmuWAY6jsKHMUwWW0lH6NTJdPuAY9D2HYvV76LVo0JIqywFvMNFlUnKSlEB1CWK2EQKVaUROgwasV2mW_zoSf_g8iIMFcvKwnCnP0V7GqwLCPOEA2q5iND7oErb2Z1ORijfUbKd3e-OgFl4HvDWDD7-98xP6AXgPxnyN4_QAYjdfAaMtSl7YFnTvIeenQ7PJ5c9f1MB7TiOXZuJnre5P5Y6LrA
link.rule.ids 230,314,727,780,784,864,885,2102,2221,12056,21388,24318,27635,27924,27925,31719,33744,43310,43805,53791,53793,73745,74302
linkProvider National Library of Medicine
linkToHtml http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwfV3db9MwELegk4AXxMeAjgEW4jUijmPH5gVtVUsHa1ftQ9pb5Dg2q7YmXVse9h_yZ3F2nJZOiJc82LEd6c53v7Mvv0PoU2YTZkXKIqpjE6VZrCOhM18SMLFZwan1RNqjMR9epN8v2WU4cFuGtMrWJnpDXdbanZF_BqgsnLPLxNf5beSqRrnb1VBC4yHacczprIN2DvvjyWlrizmgfxb4hMBv-wp2jiCGbnkhT9YPHuja5V4v_gU172dM_uWCBs_Q04Ad8UEj7OfogaleoEejcDv-Ev12-RTtISuuLQZwh_vzqT-9WGJVlfgbRN2rKzy5AYiJp5V_4-zXwps_vEmFcYMHLgcXWk9AD-ol7Id6ptwQhc-uwVcBaL-5w0ezmWcGxZOGnxUX0OZkBfOpxR12iX3-zwm_elP40q_lwt4Nee0XfIB74E9xEw_sootB_7w3jEKlhkhzIlaRtJwYTYuSU0J1mlnGII4hEO3EVhfaSmIJg6cxWsaGSyEU47aURWKlobGir1CnqivzBmEmE0NdFRpiGYSqqXCTKik40czG2nTRx1Zy-bwh5Mh9IMNkvhZvFx06ma5fcBzavqFe_MzDlsyFtMpSQDxclKmkrBAlgF2iiI2lUGXSRbuNRqynaSffv9feOz1puvJ5aaG71Z882INlvtHeLnrdqNJ6NCVpAlaRdVG2pWRbX7_dU02vPBM45xLARrr3_yU_oMfD89Fxfnw0_vEWPQHIJ5uUzX3UATmbdwCrVsX7sHf-AL6UJNM
linkToPdf http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwfV3fb9MwELagkyZeED8GBAZYiNdocRw79l7QVlo2YF21MWlvkePYrNqadG152H_In8XZcVo6IV7yYMd2pDvffWd_uUPoY25TZkXGYqoTE2d5omOhc18SMLV5yan1ibRPRvzoIvt6yS4D_2kRaJWdTfSGumq0OyPfA6gsnLPLxZ4NtIjx5-Gn2W3sKki5m9ZQTuMh2gKvmKQ9tHU4GI3POrvMIRJgIbcQ-HBfzc4li6EbHskn7gdvdO142PN_wc777Mm_3NHwCXoccCQ-aAX_FD0w9TO0fRJuyp-j345b0R244sZiAHp4MJv4k4wFVnWFv0AEvrzC4xuAm3hS-zfOf829KcRrWowbPHR8XGg9BZ1oFrA3mqlyQxQ-vwa_BQD-5g4fT6c-Syget7lacQltTm4wn5rfYUfy839R-NXbIph-LRcCrxPZ7uMD3AffitvYYAddDAc_-kdxqNoQa07EMpaWE6NpWXFKqM5yyxjENAQin8TqUltJLGHwNEbLxHAphGLcVrJMrTQ0UfQF6tVNbV4hzGRqqKtIQyyDsDUTblIlBSea2USbCH3oJFfM2uQchQ9qmCxW4o3QoZPp6gWXT9s3NPOfRdiehZBWWQroh4sqk5SVogLgSxSxiRSqSiO002rEappu8t177f2z07armFUWujv9KYJtWBRrTY7Qy1aVVqMpyVKwkCxC-YaSbXz9Zk89ufJZwTmXADyy1_9f8j3ahm1TfD8efXuDHgH6ky17cxf1QMzmLSCsZfkubJ0_PdcpAA
openUrl ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Preservation+of+the+Epiphysis+and+Growth+Plate+in+the+Surgical+Management+of+Femoral+Osteosarcoma+in+a+Skeletally+Immature+Patient+by+Intercalary+Resection+and+Biological+Reconstruction%3A+A+Case+Report&rft.jtitle=Case+reports+in+oncology&rft.au=Yoda%2C+Yuhei&rft.au=Yamaguchi%2C+Sayaka+Iwai&rft.au=Hirozane%2C+Toru&rft.au=Asano%2C+Naofumi&rft.date=2019-05-01&rft.issn=1662-6575&rft.eissn=1662-6575&rft.volume=12&rft.issue=2&rft.spage=513&rft_id=info:doi/10.1159%2F000501713&rft_id=info%3Apmid%2F31427945&rft.externalDocID=31427945
thumbnail_l http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=1662-6575&client=summon
thumbnail_m http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=1662-6575&client=summon
thumbnail_s http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=1662-6575&client=summon