Management of Pathological fractures of primary bone tumors by limb salvage

ABSTRACT

The aim of this study was to evaluate the oncologic outcome of patients with primary bone tumors complicated by a pathological fracture and treated by limb salvage. Thirty-one patients [17 males and 14 females] were included in this study, their age average was 17 years [range 6-61 years]. They all had primary bone tumors complicated by a pathological fracture. The diagnosis included osteosarcoma in 17 patients, Ewing's sarcoma in 10 patients, malignant fibrous histiocytoma in 3 patients and lymphoma in one patient. All patients received preoperative chemotherapy, during which the pathological fractures consolidated. The distal femur was affected in thirteen patients, the proximal femur in six patients, mid shaft femur in four patients, the proximal humerus in four patients, the proximal tibia in three patients and the fibula in one patient. Limb salvage was performed in all the patients. A wide resection margin was achieved in all patients. A reconstruction was done by a vascularized fibular graft in eight patients, by a modular prosthesis in six patients, by pedicled fibular graft in four patients, by a pedicled scapular crest graft in three patients and by an osteoarticular allograft in two patients. Rotationplasty was done in seven patients and no reconstruction was done for the patient who had fibular resection. The study concluded that pathological fractures of primary bone tumors should not be always considered as a contraindication for limb salvage as their oncological outcome is acceptable