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

Figure 1 Magnetic resonance imaging examinations. A: T1WI of magnetic resonance imaging shows tumor does not involve the epiphysis; B: Epiphyseal distraction was performed to separate the epiphysis and diaphysis at a rate of 1 mm/d; C: The success of epiphysis separation was confirmed by plain x-ray 3 wk after distraction.

Figure 2 Free non-vascularized fibular graft was harvested and placed into the custom-made polymethyl methacrylate construct for reconstruction of 20 cm-long defect after tumor resection.

Figure 3 Direct view during the operation; for consideration of immediate stability, a locking compress plate was used medially for another inner support.

Figure 4 The plain x-ray examination shows that the 20 cm-long defect was successfully reconstructed by the hybrid complex, consisting of a custom-made polymethyl methacrylate construct and free non-vascularized fibular graft.

Figure 5 Bone union was achieved 6 mo after surgery in both proximal and distal, which was confirmed by CT. A: Cross-section of proximal union side; B: Cross-section of distal union side; C: Coronal section of proximal union side; D: Coronal section of distal union side.