[Limb salvage procedures in malignant bone tumors of the extremities, with special reference to the various...

The outcomes of 31 cases of limb salvage procedures for malignant bone tumors performed between 1974 and August 1988 were investigated. The age at operation ranged from 7 to 76. Thirteen cases were growing children under 15. The site of lesions were humerus in 6 cases, femur in 20, tibia in 3 and fibula in 2. Pathological diagnoses were osteosarcoma in 19, chondrosarcoma in 5 and others in 7. Reconstructive procedures were performed in 28 cases, consisting of endoprosthetic replacements in 18, vascularized fibula grafts in 6 and free autogenous bone grafts in 4. Two cases of osteosarcoma recurred, and amputations were performed. Six cases died of pulmonary metastases, while 22 cases (71%) are alive and free of disease. Functional results depended mainly on the size and site of resection rather than on the reconstructive procedures, and were generally good in the proximal femur and fibula, and poor in the distal femur and proximal tibia. Discrepancy in the length of lower limbs occurred in 8 cases of growing children; 5 of 6 vascularized fibula grafts showed thickening of the grafted bones, and one of them grew by 2.5 cm in length. Endoprosthetic replacements are adequate for hip and shoulder regions, and for low grade sarcoma which does not require chemotherapy or irradiation. Free autogenous bone grafts are good for narrow defect of bone, and cases of arthrodesis of joint. Vascularized fibula grafts are adequate for the upper limb, and lower limb of growing child.