Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2019; 7(21): 3632-3638
Published online Nov 6, 2019. doi: 10.12998/wjcc.v7.i21.3632
Epiphyseal distraction and hybrid reconstruction using polymethyl methacrylate construct combined with free non-vascularized fibular graft in pediatric patients with osteosarcoma around knee: A case report
Yin-Hua Liang, Hong-Bo He, Can Zhang, Yu-Peng Liu, Jun Wan
Yin-Hua Liang, Department of Operation, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
Hong-Bo He, Can Zhang, Yu-Peng Liu, Jun Wan, Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
Author contributions: Liang YH and Wan J analyzed and interpreted the patient data and was a major contributor in writing the manuscript; Zhang C and Liu YP collected the data; Wan J, He HB and Zhang C made the plan preoperatively and performed the operation together; Wan J was in charge of the study design.
Supported by National Natural Science Foundation of China, No. 81301671
Informed consent statement: Clinical information of this study was obtained by chart reviews and with the approval of the Committee on Clinical Investigation of Xiangya Hospital, Central South University.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jun Wan, MD, PhD, Academic Fellow, Assistant Professor, Doctor, Department of Orthopedics, Xiangya Hospital, Central South University, Xiangya Road No. 87, Changsha 410008, Hunan Province, China. wanjun@csu.edu.cn
Telephone: +86-731-89753706 Fax: +86-731-89753706
Received: May 2, 2019
Peer-review started: May 3, 2019
First decision: September 9, 2019
Revised: September 27, 2019
Accepted: October 5, 2019
Article in press: October 5, 2019
Published online: November 6, 2019
Processing time: 191 Days and 20.5 Hours
Abstract
BACKGROUND

In children with osteosarcoma around the knee joint without epiphysis involvement, joint-sparing surgery seems to be an ideal way to retain knee joint function. However, there are two points of debate with regard to the technique: How to accurately achieve a safe surgical margin, and how to achieve intercalary reconstruction of the massive bone defect following resection of the tumor.

CASE SUMMARY

We present the case of an 8-year-old girl with osteosarcoma of the distal femur without involvement of the epiphysis. Epiphyseal distraction was applied to separate the epiphysis and metaphysis, and this provided a safe surgical margin. The massive bone defect was reconstructed with a custom-made antibiotic-loaded polymethyl methacrylate (PMMA) construct combined with a free non-vascularized fibular graft. Six months after surgery, bone union between the autograft and host bone was confirmed in both the proximal and distal femur by computer tomography (CT) examination. Moreover, considerable callus formation was found around the PMMA construct. After 28 mo of follow-up, there was no sign of recurrence or metastasis. The patient could walk without any aid and carry out her daily life activities satisfactorily.

CONCLUSION

In cases of osteosarcoma without epiphysis involvement, epiphyseal distraction can be easily applied to obtain a safe margin. Hybrid reconstruction with an antibiotic-loaded PMMA construct combined with a free non-vascularized fibular graft has the advantages of being easy to manufacture, less time-consuming to place, and less likely to get infected, while also ensuring bone union. Our case provides an alternative technique for biological reconstruction after joint-sparing surgery in patients with osteosarcoma around the knee without epiphyseal involvement.

Keywords: Epiphyseal distraction; Custom-made polymethyl methacrylate construct; Non-vascularized fibular graft; Osteosarcoma; Case report

Core tip: Epiphyseal distraction can be applied to obtain a safe margin in the osteosarcoma patient without epiphysis involvement. Hybrid reconstruction with an antibiotic-loaded polymethyl methacrylate construct combined with a free non-vascularized fibular graft has advantages such as easy manufacturing, less time-consuming, lower chances of infection, and better bone union.