Pathological fracture in osteosarcoma: is it always an indication for amputation?

Area of Science:

• Orthopedic Oncology
• Surgical Oncology
• Musculoskeletal Tumors

Background:

• Pathological fractures in osteosarcoma (OS) historically indicated amputation due to high dissemination risk.
• Neoadjuvant chemotherapy has shifted treatment paradigms, enabling limb salvage in select OS cases.
• This study evaluates outcomes comparing amputation and limb salvage for OS with pathological fractures.

Purpose of the Study:

• To compare local recurrence rates between amputation and limb salvage for osteosarcoma.
• To assess mortality rates in osteosarcoma patients treated with amputation versus limb salvage.
• To evaluate metastatic dissemination patterns in osteosarcoma patients undergoing different surgical interventions.

Main Methods:

• Retrospective analysis of 15 osteosarcoma patients with pathological fractures.
• Patients were treated with either amputation (8) or limb salvage (6); one received no surgery.
• Average follow-up was 7 years (range: 2-29 years).

Main Results:

• Local recurrence occurred in 4 patients (1 amputation, 3 limb salvage).
• Pulmonary metastasis developed in 6 patients (4 amputation, 2 limb salvage).
• Three deaths occurred, all within the amputation group.

Conclusions:

• Pathological fracture in osteosarcoma is not an absolute contraindication for limb salvage.
• Limb salvage surgery offers acceptable oncologic results in selected osteosarcoma patients.
• Limb salvage demonstrates comparable success rates to amputation in carefully selected cases.