engleski

Reconstruction options after resection of Ewing sarcoma localized in the proximal three quarters of the femur in a 6-year-old girl - a case report

Limb salvage surgery has traditionally been a difficult problem in orthopaedic oncology, mostly in children: the majority of the bone tumors are diagnosed in the age when bone growth has not ended. With the development of modern chemotherapy the outlook for malignant tumors has greatly improved and encouraged surgeons to consider limb salvage in most cases. Now it is widely accepted as a treatment option for most malignant bone tumors of the extremities. Ewing sarcoma is the second most common primary malignant bone tumor in children and accounts for approximately 10% of all primary malignant bone tumors. More than 80% of Ewing sarcoma occurs in patients who are less than twenty years old, and are presented more frequently in the lower extremities and the pelvic girdle. The appropriate treatment to achieve local control after resection of Ewing sarcoma localized in the proximal part of the femur is still a subject of debate, and the long-term durability of proximal femoral reconstructions is not known. Currently, the two most popular options are proximal femoral replacement endoprostheses and allograft-prosthetic composite reconstructions. Lately, there have been reports on biological reconstruction after oncologic bone resections using a vascularized fibula flap, alone or in combination with a bone graft. Each of these methods has its short- and long-term advantages and disadvantages, and a surgeon should consider each patient individually. Chemo and radiotherapy also obstruct normal reconstruction, material fixation and bone growth, but are necessary for suppressing tumor reoccurrence. We present a 8-year follow-up case of a 6-year-old girl, in whom Ewing sarcoma was localized in the large part of the femur. After resection, only a quarter of the distal part of the femoral bone was preserved. We had three major problems in reconstruction procedures: reconstruction of the hip joint, still growing acetabular bones, and very small part of remnant femur.

Bone tumors; Ewing sarcoma; hip endoprosthesis; limb salvage surgery

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