Abstract
Most children today with bone sarcomas undergo limb-sparing surgery. When treating children younger than 12 years of age, the result is significant limb length discrepancy (LLD). One of the solutions is the use of an expandable endoprosthesis. A retrospective analysis of 38 skeletally immature patients with bone sarcoma of the lower limb in whom different types of expandable endoprostheses were used from January 1988 to December 2005 were included. All patients were under the age of 14 years. There were 26 osteosarcoma and 12 Ewing's sarcomas. The data collected included the tumor characteristics, the surgical and other treatment modalities, complications and their treatment, and the final LLD and functional results. Fifty-five percent of the patients survived and had a mean follow-up of 113months. All survivors reached skeletal maturity at the time of last follow-up. Seventy-one percent of the survivors had satisfactory function and 29% had a poor result. There were three secondary amputations due to local recurrence. Complications were documented in 58% of patients; the most common was infection that was diagnosed 56 times (primary 16% and secondary 84%). A significant correlation was found between function and final LLD (greater than 5cm=inferior function), the number of complications, and the number of surgical procedures performed other than prosthesis elongation. The younger the patient was at definitive surgery, the shorter the time it took for the prosthesis to fail. In order to improve results, the number of operations must be reduced. This can be achieved by the use of novel non-invasive expandable endoprostheses or biological reconstruction.
Highlights
Bone sarcomas are rare malignancies which mainly affect children and young adults (5–25 years old)
Complications were documented in 58% of patients; the most common was infection that was diagnosed 56 times
A significant correlation was found between function and final limb length discrepancy (LLD), the number of complications, and the number of surgical procedures performed other than prosthesis elongation
Summary
Bone sarcomas are rare malignancies which mainly affect children and young adults (5–25 years old). The only treatment option was amputation surgery [1]. The past 30 years have witnessed many advances in various disciplines that contributed to the emergence of the. J Child Orthop (2010) 4:391–400 modern concept of limb-sparing surgery (LSS), the main one being effective systemic chemotherapy. 85% of the procedures for bone and soft tissue sarcomas are by LSS compared to 15% for amputation, and the overall 5-year survival is around 60% [1]. LSS in young children is challenging because of the expected future longitudinal and radial growth of the remaining limb, which leads to limb length discrepancy (LLD) that profoundly affects function [2,3,4]. Resection of the distal femur in children younger than 10 years of age leads to the loss of up to 1.6 cm every year, whereupon the LLD can reach 10–20 cm at the time of skeletal maturity [2, 3]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
