PMC7641670_01
Pre- and postoperative X-ray of the unplanned fixation of the pathological fracture femur.
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Follow-up radiographic imaging revealed proper bony and implant alignments (Figure 1).
Three months after bony fixation, a bone mass was developed.
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Few months later, she experienced a progressive enlarged mass prominent at the medial aspect of the left knee with severe night pain that brought her to visit her physician again (Figure 2).
MRI scans of the bone mass that developed 3 months after operation.
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T1-weighted, hyperintense SI on T2-weighted, and STIR sequence along with radiating heterogenous enhancement (Figure 3). The patient was then referred to King Chulalongkorn Memorial Hospital with a diagnosis of a progressive enlarging tumor at the left distal femur.
Intraoperative steps of the surgery began by outlining the areas that will be incised.
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The posterior cuts were then joined by a single vertical posterior incision (Figure 4).
Popliteal artery was identified and protected (a). Tumor was removed leaving behind the continuity of uncontaminated neurovascular bundle (b). The specimen was sent for pathological study (c). The distal leg was rotated and reattached to the proximal thigh (d).
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Femoral vessels, sciatic nerve, and common peroneal nerve were identified and protected (Figure 5(a)). Temporary Kirschner wire fixations were inserted above the femur and below the tibia to propose the resection level as guidance for the orientation (Figures 5(b) and 5(c)). The distal limb was externally rotated to 180 degrees and reattached to the femur while preventing vascular kinging during the turn (Figure 5(d)).
Postoperative X-rays of the surgical site.
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Postoperative imaging yielded satisfactory results, and the wound healed uneventfully (Figure 6).
Clinical functional outcome at the 3-month follow-up visit; she could move her new knee without limitation.
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Her new knee could move as expected, and she was satisfied with the result of the treatment (Figure 7).