Surgical modalities in the treatment of bone sarcoma in children

Primary malignant bone tumours are rare but are one of the most common malignancies in adolescents. The optimum management of a child with a bone tumour is at a specialist treatment centre by a multidisciplinary team experienced in the diagnosis, chemotherapy and surgical management of these conditions. Most tumours are treated with chemotherapy followed by surgery. The surgical aim is to completely resect the tumour whilst ideally preserving the limb and maintaining function. The perfect limb salvage operation that restores normal function with no long term morbidity is rarely possible and most operations will restore function with potential long term complications. The variety of techniques possible for limb salvage includes the use of prostheses, allografts, reimplantation of sterilised bone or use of vascularised bone. Extendible prostheses are now common place and can maintain limb length following tumour resection even in the young child. Assessing outcomes is notoriously difficult but various measures are starting to allow comparisons of long term outcomes for this group of patients.