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Case Report: Reconstruction of a 16-cm Diaphyseal Defect after Ewing’s Resection in a Child

  • Case Report
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Clinical Orthopaedics and Related Research

Abstract

Numerous options exist for intercalary segmental reconstruction after bone tumor resection. We present the extension of a recently developed surgical two-stage technique that involves insertion of a cement spacer, induction of a membrane, and reconstruction of the defect with cancellous and cortical bone autograft in a 12-year-old child. The boy was referred to our center for treatment of a right femoral diaphyseal Ewing’s sarcoma. The first stage involved resection of the tumor and reconstruction with a locked intramedullary nail and a polymethylmethacrylate cement spacer. Seven months after the initial procedure during which adjuvant chemotherapy was given, the second-stage procedure was performed. The cement was removed and cancellous and cortical bone autograft was grafted in the membrane created around the cement spacer. Touchdown weightbearing was allowed immediately, partial weightbearing was resumed 6 weeks after the operation, and full weightbearing was allowed 4 months later. Successive plain radiographs showed rapid integration of the autograft to the host bone with bone union and cortical reconstitution. The principle of the induced membrane reconstruction seems applicable to intercalary segmental reconstruction after bone tumor resection in children.

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Acknowledgments

We thank Dr. Carl L. Stanitski, (Medical University of South Carolina Charleston, SC) for his wise and helpful comments.

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Authors and Affiliations

  1. Assistance Publique-Hôpitaux de Paris, Service de chirurgie orthopédique et traumatologique, Hôpital Cochin, 27, rue du Faubourg Saint-Jacques, 75679, Paris Cedex 14, France

    David Jean Biau MD

  2. Assistance Publique-Hôpitaux de Paris, Service de traumatologie et orthopédie infantile, Hôpital Necker, Paris, France

    Stéphanie Pannier MD & Christophe Glorion MD

  3. Assistance Publique-Hôpitaux de Paris, Service de traumatologie et orthopédie infantile, Hôpital Avicenne, Bobigny, France

    Alain Charles Masquelet MD

Authors
  1. David Jean Biau MD
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  2. Stéphanie Pannier MD
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  3. Alain Charles Masquelet MD
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  4. Christophe Glorion MD
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Corresponding author

Correspondence to David Jean Biau MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the reporting of this case report, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Biau, D.J., Pannier, S., Masquelet, A.C. et al. Case Report: Reconstruction of a 16-cm Diaphyseal Defect after Ewing’s Resection in a Child. Clin Orthop Relat Res 467, 572–577 (2009). https://doi.org/10.1007/s11999-008-0605-9

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  • DOI: https://doi.org/10.1007/s11999-008-0605-9

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