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

Abstract

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.

Growth of epiphysis after epiphyseal-preservation surgery for childhood osteosarcoma around the knee joint

“…They preserved the epiphyseal plate with temporary screw fixation, and removed the screw after 14 weeks. Subsequently, the distal end of the plate had moved superior to the epiphysis accompanied by bone growth [ 7 ]. In the present study, one case showed the longitudinal growth of the epiphysis following removal of the screws from the epiphysis (Fig.…”

“…Recently, the advanced imaging [ 5 ], accurate tumor excision [ 6 ] and rigid fixation using a locking plate [ 7 ] have made it possible to perform the epiphyseal-preservation surgery for selected patients who responded to chemotherapy without tumor extension to the epiphysis [ 8 ]. This procedure is expected to preserve excellent limb function.…”

Effectiveness of electrical stimulation for postoperative pain in patients with osteosarcoma

“…[14,15] Though many patients choose surgery for their treatment, it also accompanies a lot of complications, such as postoperative pain (PPP), infection, and so on. [16,17]…”