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Temporal hemiarthroplasty for distal femoral osteosarcoma in early childhood: a case report

BACKGROUND: Prosthetic reconstruction for distal femoral osteosarcoma is challenging for younger children. We herein report a successful case of limb-sparing surgery for a younger patient with distal femoral osteosarcoma requiring osteo-articular resection. CASE PRESENTATION: A 5-year-old girl with...

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Autores principales: Imanishi, Jungo, Tanabe, Masayuki, Kurihara, Taisei, Torigoe, Tomoaki, Kikkawa, Jun, Ohta, Atsuhiko, Watanabe, Atsuko, Tanaka, Ryuhei, Saita, Kazuo, Kadono, Yuho, Yazawa, Yasuo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7594408/
https://www.ncbi.nlm.nih.gov/pubmed/33115497
http://dx.doi.org/10.1186/s12957-020-02047-8
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author Imanishi, Jungo
Tanabe, Masayuki
Kurihara, Taisei
Torigoe, Tomoaki
Kikkawa, Jun
Ohta, Atsuhiko
Watanabe, Atsuko
Tanaka, Ryuhei
Saita, Kazuo
Kadono, Yuho
Yazawa, Yasuo
author_facet Imanishi, Jungo
Tanabe, Masayuki
Kurihara, Taisei
Torigoe, Tomoaki
Kikkawa, Jun
Ohta, Atsuhiko
Watanabe, Atsuko
Tanaka, Ryuhei
Saita, Kazuo
Kadono, Yuho
Yazawa, Yasuo
author_sort Imanishi, Jungo
collection PubMed
description BACKGROUND: Prosthetic reconstruction for distal femoral osteosarcoma is challenging for younger children. We herein report a successful case of limb-sparing surgery for a younger patient with distal femoral osteosarcoma requiring osteo-articular resection. CASE PRESENTATION: A 5-year-old girl with high-grade conventional osteosarcoma in the left distal femur underwent a series of surgeries. After three cycles of neoadjuvant chemotherapy, limb-salvage surgery was planned because femoral rotationplasty had been refused. At 6 years and 2 months old, distal femoral resection and temporary spacer insertion using a 7-mm-diameter intramedullary nail and molded polymethylmethacrylate was performed. At 7 years and 8 months old, secondary surgery was performed because the first spacer had been dislocated and the residual femur became atrophic. The distal end of the residual femur was removed by 1 cm, but the periosteum and induced membrane around polymethylmethacrylate was preserved. In order to stabilize the spacer against the tibia, a custom-made ceramic spacer with a smooth straight 8-mm-diameter stem was utilized. The bone-spacer junction was fixed with polymethylmethacrylate and then covered with the preserved periosteum and induced membrane. After surgery, the bone atrophy improved. At 9 years and 7 months old, the second spacer was removed because it had loosened, and the knee joint was reconstructed using a custom-made growing femoral prosthesis with a curved porous 8.5-mm-diameter stem. Cancellous bone tips from the proximal tibia were grafted around the bone-prosthesis junction underneath the induced membrane. At 10 years and 5 months old, the patient was able to walk unsupported and a radiograph showed further thickening of the cortex of the residual femur without any stress shielding. Although having 5 cm of limb length discrepancy, the patient and her mother were satisfied with the function. The MSTS score was 24 out of 30 points. Repeated limb length extensions are planned. CONCLUSIONS: This case report provides an example of limb-salvage surgery after distal femoral resection in a small child. The use of a temporary spacer utilizing partial cementation and preservation of the periosteum and induced membrane appears to afford a viable limb-salvage option after distal femoral resection for younger children. SUPPLEMENTARY INFORMATION: Supplementary information accompanies this paper at 10.1186/s12957-020-02047-8.
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spelling pubmed-75944082020-10-30 Temporal hemiarthroplasty for distal femoral osteosarcoma in early childhood: a case report Imanishi, Jungo Tanabe, Masayuki Kurihara, Taisei Torigoe, Tomoaki Kikkawa, Jun Ohta, Atsuhiko Watanabe, Atsuko Tanaka, Ryuhei Saita, Kazuo Kadono, Yuho Yazawa, Yasuo World J Surg Oncol Case Report BACKGROUND: Prosthetic reconstruction for distal femoral osteosarcoma is challenging for younger children. We herein report a successful case of limb-sparing surgery for a younger patient with distal femoral osteosarcoma requiring osteo-articular resection. CASE PRESENTATION: A 5-year-old girl with high-grade conventional osteosarcoma in the left distal femur underwent a series of surgeries. After three cycles of neoadjuvant chemotherapy, limb-salvage surgery was planned because femoral rotationplasty had been refused. At 6 years and 2 months old, distal femoral resection and temporary spacer insertion using a 7-mm-diameter intramedullary nail and molded polymethylmethacrylate was performed. At 7 years and 8 months old, secondary surgery was performed because the first spacer had been dislocated and the residual femur became atrophic. The distal end of the residual femur was removed by 1 cm, but the periosteum and induced membrane around polymethylmethacrylate was preserved. In order to stabilize the spacer against the tibia, a custom-made ceramic spacer with a smooth straight 8-mm-diameter stem was utilized. The bone-spacer junction was fixed with polymethylmethacrylate and then covered with the preserved periosteum and induced membrane. After surgery, the bone atrophy improved. At 9 years and 7 months old, the second spacer was removed because it had loosened, and the knee joint was reconstructed using a custom-made growing femoral prosthesis with a curved porous 8.5-mm-diameter stem. Cancellous bone tips from the proximal tibia were grafted around the bone-prosthesis junction underneath the induced membrane. At 10 years and 5 months old, the patient was able to walk unsupported and a radiograph showed further thickening of the cortex of the residual femur without any stress shielding. Although having 5 cm of limb length discrepancy, the patient and her mother were satisfied with the function. The MSTS score was 24 out of 30 points. Repeated limb length extensions are planned. CONCLUSIONS: This case report provides an example of limb-salvage surgery after distal femoral resection in a small child. The use of a temporary spacer utilizing partial cementation and preservation of the periosteum and induced membrane appears to afford a viable limb-salvage option after distal femoral resection for younger children. SUPPLEMENTARY INFORMATION: Supplementary information accompanies this paper at 10.1186/s12957-020-02047-8. BioMed Central 2020-10-28 /pmc/articles/PMC7594408/ /pubmed/33115497 http://dx.doi.org/10.1186/s12957-020-02047-8 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Report
Imanishi, Jungo
Tanabe, Masayuki
Kurihara, Taisei
Torigoe, Tomoaki
Kikkawa, Jun
Ohta, Atsuhiko
Watanabe, Atsuko
Tanaka, Ryuhei
Saita, Kazuo
Kadono, Yuho
Yazawa, Yasuo
Temporal hemiarthroplasty for distal femoral osteosarcoma in early childhood: a case report
title Temporal hemiarthroplasty for distal femoral osteosarcoma in early childhood: a case report
title_full Temporal hemiarthroplasty for distal femoral osteosarcoma in early childhood: a case report
title_fullStr Temporal hemiarthroplasty for distal femoral osteosarcoma in early childhood: a case report
title_full_unstemmed Temporal hemiarthroplasty for distal femoral osteosarcoma in early childhood: a case report
title_short Temporal hemiarthroplasty for distal femoral osteosarcoma in early childhood: a case report
title_sort temporal hemiarthroplasty for distal femoral osteosarcoma in early childhood: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7594408/
https://www.ncbi.nlm.nih.gov/pubmed/33115497
http://dx.doi.org/10.1186/s12957-020-02047-8
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