Biological treatment options for management of malignant and aggressive tumors of the proximal tibia in paediatric age group

Abstract

Background: Musculoskeletal tumors in the pediatric age group pose a great challenge in their management. Historically, amputation was usually the only available treatment modality but with advances in medical and surgical oncology, limb saving procedures are in vogue now. Here, we attempt surgical excision and biological reconstruction of the residual defect with fibular grafts in two pediatric patients. Case report 1: 6 year old girl was brought with pain and gradually increasing swelling over her right knee following a trivial trauma. Physical examination confirmed the swelling to be bony in consistency with grossly restricted movements at the joint. She was clinico-radiologically diagnosed as distal femur intramedullary osteosarcoma. Thorough surgical resection with free vascularized fibular bone graft placed within the intramedullary canal sufficiently distal to the physis was done. The follow up was uneventful. Case report 2: 16 year old girl presented with pain and persistent swelling over her left knee following a trivial trauma. Clinically, she had a tender, bony hard swelling over proximal tibial metaphyseal region. She was diagnosed as Campanacci 3 giant cell tumor. She was managed by limb saving surgical excision with free vascularized fibular graft from the contralateral side and repair of the extensor mechanism using the residual tibia. We could achieve satisfactory clinical and radiological graft uptake. Conclusion: As the current trend suggests, non-ablative procedures offer a great alternative to such locally aggressive benign or malignant tumors.