The local treatment of pathological fracture in patients with a primary osteosarcoma remains controversial. In this paper we report the oncological outcome of the treatment of pathological fractures in 18 patients suffering from this disease. There were ten male and eight female patients, and the average age at diagnosis was 17 years. All patients received adjuvant chemotherapy. Wide resections were performed in 17, but in one there was 'contamination' of the margins of the excision. Skeletal reconstruction was performed with a locally designed and manufactured custom 'mega' prosthesis. The average follow-up was 33 months (range: 12-93 months), and 14 patients were alive on completion of the study. Local recurrence appeared in two patients, while three developed pulmonary metastases.Résumé Le traitement local des patients ayant une fracture pathologique due à un ostéosarcome primaire reste sujet à controverse. Nous avons fait une étude sur le résultat oncologique de la chirurgie conservatrice chez 18 patients d'un âge moyen de 17 ans lors du diagnostic ayant des fractures pathologiques d'ostéosarcome. Tous les patients avaient subi d'une chimiothérapie adjuvante. Les marges de résection étaient larges chez 17 patients et contaminées chez un patient. La reconstruction squelettique a été accomplie avec des prothèses faites sur mesures conçues et fabriquées localement. Le suivi moyen a duré 33 mois (entre 12 et 93 mois). Quatorze patients étaient vivants à la fin de cette étude. La récidive locale s'est manifestée chez deux patients alors que trois patients ont été atteints de métastase pulmonaire.
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