Skip to main content

Limb Salvage in Children

  • Reference work entry
  • First Online:
European Surgical Orthopaedics and Traumatology

Abstract

In recent years, the treatment for children with bone tumours has advanced. These advances are largely due to chemotherapeutic developments, although the basis of good treatment remains highly specialized, experienced and multi-disciplinary teamwork. The corresponding increase in survival combined with the demanding functional requirements of these young patients challenge the surgeon with limb salvage and reconstruction procedures. Surgery is carried out in two steps. Firstly, en bloc resection and secondly reconstruction. The range of possibilities involving the available biological and non-biological materials is broad. The success of such surgery in conserving a limb hinges on thoughtful and creative pre-operative design and planning.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 649.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 949.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Abudu A, Grimer R, Tillman R, et al. The use of prostheses in skeletally immature patients. Orthop Clin North Am. 2006;37:75–84.

    Article  PubMed  Google Scholar 

  2. Bielack SS, Carrle D. State-of-the-art approach in selective curable tumors: bone sarcoma. Ann Oncol. 2008;19 Suppl 7:vii155–60.

    PubMed  Google Scholar 

  3. Brosjo O, Bauer HC. Diagnostic procedures and surgical treatment of bone sarcomas. Experience from the Scandinavian Sarcoma Group and Karolinska Hospital. Acta Orthop Scand Suppl. 2004;75:57–61.

    Article  CAS  PubMed  Google Scholar 

  4. Grimer RJ. Surgical options for children with osteosarcoma. Lancet Oncol. 2005;6:85–92.

    Article  PubMed  Google Scholar 

  5. Kotz R, Dominkus M, Zettl T, et al. Advances in bone tumour treatment in 30 years with respect to survival and limb salvage. A single institution experience. Int Orthop. 2002;26:197–202.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Lewis VO. Limb salvage in the skeletally immature patient. Curr Oncol Rep. 2005;7:285–92.

    Article  PubMed  Google Scholar 

  7. Mankin HJ, Gebhardt MC, Jennings LC, et al. Long-term results of allograft replacement in the management of bone tumors. Clin Orthop Relat Res. 1996;324:86–97.

    Article  PubMed  Google Scholar 

  8. Meyer JS, Nadel HR, Marina N, et al. Imaging guidelines for children with Ewing sarcoma and osteosarcoma: a report from the Children’s Oncology Group Bone Tumor Committee. Pediatr Blood Cancer. 2008;51:163–70.

    Article  PubMed  Google Scholar 

  9. Muscolo DL, Ayerza MA, ponte-Tinao L, et al. Intercalary femur and tibia segmental allografts provide an acceptable alternative in reconstructing tumor resections. Clin Orthop Relat Res. 2004;426:97–102.

    Article  PubMed  Google Scholar 

  10. Pakos EE, Nearchou AD, Grimer RJ, et al. Prognostic factors and outcomes for osteosarcoma: an international collaboration. Eur J Cancer. 2009;45:2367–75.

    Article  PubMed  Google Scholar 

  11. San-Julian M, Dolz R, Garcia-Barrecheguren E, et al. Limb salvage in bone sarcomas in patients younger than age 10: a 20-year experience. J Pediatr Orthop. 2003;23:753–62.

    Article  PubMed  Google Scholar 

  12. Wozniak W, Rychlowska M, Kuczabski M, et al. Evaluation of indications and the perspectives of limb salvage surgery in malignant bone tumours in children and youth. Med Wieku Rozwoj. 2000;4:85–93.

    CAS  PubMed  Google Scholar 

  13. Patino-Garcia A, Zalacain M, Folio C, et al. Profiling of chemonaive osteosarcoma and paired-normal cells identifies EBF2 as a mediator of osteoprotegerin inhibition to tumor necrosis factor-related apoptosis-inducing ligand-induced apoptosis. Clin Cancer Res. 2009;15:5082–91.

    Article  CAS  PubMed  Google Scholar 

  14. Patino-Garcia A, Zalacain M, Marrodan L, et al. Methotrexate in pediatric osteosarcoma: response and toxicity in relation to genetic polymorphisms and dihydrofolate reductase and reduced folate carrier 1 expression. J Pediatr. 2009;154:688–93.

    Article  CAS  PubMed  Google Scholar 

  15. Canadell J, San-Julian M. Pediatric bone sarcomas. Epiphysiolysis before excision, Heidelberg: Springer; 2009.

    Google Scholar 

  16. Mankin HJ. Advances in diagnosis and treatment of bone tumors. N Engl J Med. 1979;300:543–5.

    Article  CAS  PubMed  Google Scholar 

  17. Grimer RJ, Sneath RS. Diagnosing malignant bone tumours. J Bone Joint Surg Br. 1990;72:754–6.

    CAS  PubMed  Google Scholar 

  18. Grimer RJ, Carter SR, Spooner D, et al. Diagnosing musculoskeletal tumours. Sarcoma. 2001;5:89–94.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Frouge C, Vanel D, Coffre C, et al. The role of magnetic resonance imaging in the evaluation of Ewing sarcoma. A report of 27 cases. Skeletal Radiol. 1988;17:387–92.

    Article  CAS  PubMed  Google Scholar 

  20. Federman N, Bernthal N, Eilber FC, et al. The multidisciplinary management of osteosarcoma. Curr Treat Options Oncol. 2009;10:82–93.

    Article  PubMed  Google Scholar 

  21. Bacci G, Ferrari S, Longhi A, et al. Role of surgery in local treatment of Ewing’s sarcoma of the extremities in patients undergoing adjuvant and neoadjuvant chemotherapy. Oncol Rep. 2004;11:111–20.

    PubMed  Google Scholar 

  22. Krasin MJ, Rodriguez-Galindo C, Davidoff AM, et al. Efficacy of combined surgery and irradiation for localized Ewings sarcoma family of tumors. Pediatr Blood Cancer. 2004;43:229–36.

    Article  PubMed  Google Scholar 

  23. Bacci G, Longhi A, Briccoli A, et al. The role of surgical margins in treatment of Ewing’s sarcoma family tumors: experience of a single institution with 512 patients treated with adjuvant and neoadjuvant chemotherapy. Int J Radiat Oncol Biol Phys. 2006;65:766–72.

    Article  PubMed  Google Scholar 

  24. Eilber F, Giuliano A, Eckardt J, et al. Adjuvant chemotherapy for osteosarcoma: a randomized prospective trial. J Clin Oncol. 1987;5:21–6.

    CAS  PubMed  Google Scholar 

  25. Ferrari S, Smeland S, Mercuri M, et al. Neoadjuvant chemotherapy with high-dose Ifosfamide, high-dose methotrexate, cisplatin, and doxorubicin for patients with localized osteosarcoma of the extremity: a joint study by the Italian and Scandinavian Sarcoma Groups. J Clin Oncol. 2005;23:8845–52.

    Article  PubMed  Google Scholar 

  26. Tunn PU, Reichardt P. Chemotherapy for osteosarcoma without high-dose methotrexate: a 12-year follow-up on 53 patients. Onkologie. 2007;30:228–32.

    Article  CAS  PubMed  Google Scholar 

  27. Bielack SS, Kempf-Bielack B, Delling G, et al. Prognostic factors in high-grade osteosarcoma of the extremities or trunk: an analysis of 1,702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols. J Clin Oncol. 2002;20:776–90.

    Article  PubMed  Google Scholar 

  28. Kim MS, Cho WH, Song WS, et al. Time dependency of prognostic factors in patients with stage II osteosarcomas. Clin Orthop Relat Res. 2007;463:157–65.

    PubMed  Google Scholar 

  29. Provisor AJ, Ettinger LJ, Nachman JB, et al. Treatment of nonmetastatic osteosarcoma of the extremity with preoperative and postoperative chemotherapy: a report from the Children’s Cancer Group. J Clin Oncol. 1997;15:76–84.

    CAS  PubMed  Google Scholar 

  30. Delepine G, Delepine N. Limb salvage for high grade osteosarcoma. Considerations about margins. Chir Organ Mov. 1990;75:77–8.

    CAS  Google Scholar 

  31. Manfrini M, Gasbarrini A, Malaguti C, et al. Intraepiphyseal resection of the proximal tibia and its impact on lower limb growth. Clin Orthop Relat Res. 1999;358:111–9.

    PubMed  Google Scholar 

  32. Manfrini M, Innocenti M, Ceruso M, et al. Original biological reconstruction of the hip in a 4-year-old girl. Lancet. 2003;361:140–2.

    Article  PubMed  Google Scholar 

  33. Ortiz-Cruz E, Gebhardt MC, Jennings LC, et al. The results of transplantation of intercalary allografts after resection of tumors. A long-term follow-up study. J Bone Joint Surg Am. 1997;79:97–106.

    CAS  PubMed  Google Scholar 

  34. Capanna R, Campanacci DA, Belot N, et al. A new reconstructive technique for intercalary defects of long bones: the association of massive allograft with vascularized fibular autograft. Long-term results and comparison with alternative techniques. Orthop Clin North Am. 2007;38:51–60. vi.

    Article  PubMed  Google Scholar 

  35. Tillman RM, Grimer RJ, Carter SR, et al. Growing endoprostheses for primary malignant bone tumors. Semin Surg Oncol. 1997;13:41–8.

    Article  CAS  PubMed  Google Scholar 

  36. Grimer RJ, Belthur M, Carter SR, et al. Extendible replacements of the proximal tibia for bone tumours. J Bone Joint Surg Br. 2000;82:255–60.

    Article  CAS  PubMed  Google Scholar 

  37. Marulanda GA, Henderson ER, Palumbo BT, et al. Use of extendable prostheses: a limb-salvaging alternative for patients with malignant bone tumors. Expert Rev Med Devices. 2008;5:467–74.

    Article  PubMed  Google Scholar 

  38. Sewell MD, Spiegelberg BG, Hanna SA, et al. Non-invasive extendible endoprostheses for limb reconstruction in skeletally-mature patients. J Bone Joint Surg Br. 2009;91:1360–5.

    Article  CAS  PubMed  Google Scholar 

  39. Mastorakos DP, Disa JJ, Athanasian E, et al. Soft-tissue flap coverage maximizes limb salvage after allograft bone extremity reconstruction. Plast Reconstr Surg. 2002;109:1567–73.

    Article  PubMed  Google Scholar 

  40. San-Julian M, Duart J, de Rada PD, et al. Limb salvage in Ewing’s sarcoma of the distal lower extremity. Foot Ankle Int. 2008;29:22–8.

    Article  PubMed  Google Scholar 

  41. Unni KK, Dahlin DC. Grading of bone tumors. Semin Diagn Pathol. 1984;1:165–72.

    CAS  PubMed  Google Scholar 

  42. Mankin HJ, Hornicek FJ, Raskin KA. Infection in massive bone allografts. Clin Orthop Relat Res. 2005;432:210–6.

    Article  PubMed  Google Scholar 

  43. San-Julian M, Valenti A. Bone transplant. An Sist Sanit Navar. 2006;29 Suppl 2:125–36.

    PubMed  Google Scholar 

  44. Trampuz A, Zimmerli W. Prosthetic joint infections: update in diagnosis and treatment. Swiss Med Wkly. 2005;135:243–51.

    PubMed  Google Scholar 

  45. Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med. 2004;351:1645–54.

    Article  CAS  PubMed  Google Scholar 

  46. Gonzalez-Herranz P, Burgos-Flores J, Ocete-Guzman JG, et al. The management of limb-length discrepancies in children after treatment of osteosarcoma and Ewing’s sarcoma. J Pediatr Orthop. 1995;15:561–5.

    Article  CAS  PubMed  Google Scholar 

  47. San-Julian M, Canadell J. Fractures of allografts used in limb preserving operations. Int Orthop. 1998;22:32–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  48. Bae DS, Waters PM, Gebhardt MC. Results of free vascularized fibula grafting for allograft nonunion after limb salvage surgery for malignant bone tumors. J Pediatr Orthop. 2006;26:809–14.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mikel San-Julian .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 EFORT

About this entry

Cite this entry

San-Julian, M., Vázquez-García, B.L., Sierrasesúmaga, L. (2014). Limb Salvage in Children. In: Bentley, G. (eds) European Surgical Orthopaedics and Traumatology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-34746-7_179

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-34746-7_179

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-34745-0

  • Online ISBN: 978-3-642-34746-7

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics