Case report: reconstruction of a 16-cm diaphyseal defect after Ewing's resection in a child

Clin Orthop Relat Res. 2009 Feb;467(2):572-7. doi: 10.1007/s11999-008-0605-9. Epub 2008 Nov 14.


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.

Publication types

  • Case Reports

MeSH terms

  • Bone Transplantation
  • Chemotherapy, Adjuvant
  • Child
  • Femoral Neoplasms / diagnosis
  • Femoral Neoplasms / drug therapy
  • Femoral Neoplasms / surgery*
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Orthopedic Procedures / methods
  • Plastic Surgery Procedures / methods
  • Sarcoma, Ewing / drug therapy
  • Sarcoma, Ewing / surgery*
  • Transplantation, Autologous