Intermittent internal fixation with a locking plate to preserve epiphyseal growth function during limb-salvage surgery in a child with osteosarcoma of the distal femur: a case report
| Autor: | Yan-xi Chen, Jiong Mei, Guangyao Jia, Ming Ni, Xiao-Zhong Zhu |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Male
limb shortening medicine.medical_specialty medicine.medical_treatment epiphysis Article External fixation Fracture Fixation Internal Fracture fixation Bone plate medicine Internal fixation Humans Femur Growth Plate Child epiphyseal preservation Bone growth Salvage Therapy Osteosarcoma business.industry Femoral Neoplasms limb salvage General Medicine Bone cement Surgery Radiography medicine.anatomical_structure Epiphysis business Bone Plates Systematic Review and Meta-Analysis |
| Zdroj: | Medicine |
| ISSN: | 1536-5964 |
| Popis: | Limb shortening is a problem associated with surgery for osteosarcoma of the lower extremity in adolescents, as the tumors frequently occur near the epiphysis. Herein we report the use of a less invasive stabilization system (LISS) and an intermittent fixation method to preserve the growth function of epiphysis in an 11-year-old patient with an osteosarcoma of the distal femur. The 11-year-old male presented with left knee enlargement and pain for 2 weeks, and magnetic resonance imaging (MRI) and biopsy were consistent with osteosarcoma of the left distal femur. After preoperative chemotherapy, en bloc tumor resection was performed with margins based on MRI findings preserving the epiphyseal growth plate, the tumor cavity was filled with inactivated bone and bone cement, and a LISS was used to stabilize the femur. Aggressive postoperative chemotherapy was given. Approximately 105 weeks after surgery radiography showed that the distal end of the plate had moved superior to the epiphysis along with bone growth. Locking screws were placed in the distal part of the LISS plate to stabilize the re-implanted bone, and external fixation was not needed. The patient was able to walk with the crutches 1 week postoperatively, and bear weight on the extremity 6 weeks postoperatively. At 6 years after surgery, the patient's height had increased 52 cm, shortening of the affected limb was only 1 cm, and the circumference of the affected limb was 2 cm smaller than that of the contralateral limb. There was no significant discomfort in the affected limb, and there was no gait abnormality. The patient could jump and run, and could participate in sports including basketball and badminton to the same degree as his peers. In summary, the novel method of bone reconstruction and fixation provided good results in a child with an osteosarcoma of the distal femur. This fixation method preserves the osteogenic function of the epiphysis and restored bone integrity simultaneously, and provides good functional recovery. |
| Databáze: | OpenAIRE |
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