THE SURGICAL-TREATMENT AND OUTCOME OF PATHOLOGICAL FRACTURES IN LOCALIZED OSTEOSARCOMA

We reviewed the surgical treatment and oncological results of 40 patie nts with pathological fractures from localised osteosarcoma of the lon g bones to determine the outcome of limb salvage in their management, All had had adjuvant chemotherapy, There were 24 males and 14 females with a median age at diagnosis of 18 years (2 to 46) and a median foll ow-up of 55 months (8 to 175). We performed limb salvage in 27 patient s and amputation in 13, The margins of resection were radical in five patients, wide in 26, marginal in six, wide but contaminated in two an d intralesional in one. Local recurrence developed in 19% of those tre ated by limb salvage and in none of those who had an amputation, The c umulative five-year survival of all the patients was 57% and in those treated by limb salvage or amputation it was 64% and 47%, respectively (p > 0.05). Limb-sparing surgery with adequate margins of excision ca n be achieved in many patients with pathological fractures from primar y osteosarcoma without compromising survival, but the risk of local re currence is significant.