ArticleStrategies in trauma and limb reconstruction
Staged Reconstruction of Distal Femoral Osteosarcoma in a 10-year-old Girl using a Hybrid Endoprosthesis-Motorised Lengthening Nail Construct: A Case Report.
Article in Strategies in trauma and limb reconstruction. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Reconstruction of tumour defects in skeletally immature patients poses a particular challenge due to the resection of growing physes and resulting limb-length discrepancies. Expandable prostheses allow outpatient lengthening with fewer surgical revisions, but the limb is lengthened within the prosthesis rather than native bone. Case description: A 10-year-old girl with no medical history presented with distal right thigh pain and swelling. Imaging and biopsy confirmed osteosarcoma. She underwent wide local excision and initial endoprosthetic reconstruction, followed by a planned staged exchange to a hybrid endoprosthesis (BioXpand), in which the usual prosthetic stem is replaced by a motorised intramedullary nail (Fitbone), allowing limb lengthening via distraction osteogenesis. The patient began non-invasive lengthening on postoperative day five (approximately 0.96 mm/day), with the rate adjusted weekly based on clinical and radiological parameters. After 12 weeks, 6 cm of length was achieved, and consolidation took a further 6 weeks before full weight-bearing. Finally, the reconstruction was converted into a definitive static prosthesis once the final limb length was achieved. At the latest follow-up, the patient attends school and participates in sports, reports no pain, and is skeletally mature, with a 1-centimetre leg-length difference. Conclusion: This case demonstrates the feasibility of a staged approach to the reconstruction of paediatric osteosarcoma by combining the principles of endoprosthetic reconstruction with distraction osteogenesis. A staged strategy enabled oncologic clearance, growth accommodation, and functional preservation. Clinical significance: Staged BioXpand reconstruction offers a 'bioexpandable' alternative to expandable endoprostheses by restoring length through distraction osteogenesis rather than metal extension. A modular sequence (primary reconstruction, hybrid nail exchange for outpatient lengthening, then definitive static conversion) can equalise limb length while generating bone stock, supporting future revisions.
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