ABSTRACT
Introduction: Osteosarcoma is a malignant tumor, the treatment of which is controversial between amputation and limb salvage surgery. Osteosarcoma occurring in a child is a challenge to manage due to the arrest of limb and the resultant limb length discrepancy. The management options for a child less than eight years of age are very limited. Case report: We present a case of a six year old child who was diagnosed to have osteosarcoma of proximal tibia. She was started on neoadjuvant chemotherapy, after which, she underwent wide resection and reconstruction with free vascularised fibular graft. The joint was fused using a locking compression plate and screws. The locking screws were inserted avoiding the distal femoral physis, enabling growth of the physis in future. Adjuvant chemotherapy was then given. Follow up radiographs showed Harris growth lines indicating growth to be occurring at the distal femoral physis. She was not found to have recurrence on last follow up four years after surgery. Conclusion: We found reconstruction using free fibular graft and arthrodesis using plate and screws, provided satisfactory results. An attempt can be made to preserve the distal femur physis.
ABSTRACT
Introduction: Aneurysmal bone cyst (ABC) is a rare, benign, and cystic lesion. The most common sites are the femur, tibia, humerus, and spine. It is more common in females and usually occurs during the second decade of life. Case Report: A 5-year-old female child had a trivial fall, following which she developed pain in her left hip. Radiographs revealed an expansile, lytic lesion in the metaphysis of the left proximal femur. Cortical breach was present resulting in a pathological fracture. Biopsy of the lesion showed blood filled cystic spaces confirming the diagnosis of ABC. We performed an extended curettage of the lesion, bone grafting, and angle blade plate fixation. The angle blade plate was removed 1 year after the surgery. Two years later, she complained of pain in the left hip. Radiographs showed a geographic lytic lesion surrounding the previously inserted bone graft. Magnetic resonance imaging revealed multiple blood fluid levels. We performed an extended curettage with high speed burr. We filled the cavity with bone substitute and stabilized the region using a proximal humerus internal locking system plate. The histopathological examination of intraoperative samples confirmed the diagnosis of recurrence of ABC. We found no further recurrence of the tumor after 3 years of follow-up. Conclusion: ABCs can present with pathological fractures and requires management of the cyst and stabilization of the bone. Recurrent ABCs can be managed by re-curettage of the lesion and prophylactic internal fixation. The curettage has to be extensive through a large cortical window and using a high speed burr.
