PMC9826550_01
Pre-operative radiograph left femur.
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F1
X-ray of the left femur showed an osteosclerotic tumor in the medial aspect of the middle third of the left femur (Fig. 1).
Tumor cells producing osteoid and with chondroblastic areas. Pleomorphic spindle cells with eosinophilic cytoplasm and producing malignant osteoid (H and E, x40).
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F2
Areas of necrosis, deposition of thin, lace-like malignant osteoid, and chondroblastic differentiation were noted, features consistent with osteogenic sarcoma (Fig. 2).
Operative image and excised specimen of the femur.
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F3
A chevron osteotomy was made four fingerbreadths from the proximal and distal soft-tissue margin of the tumor, thus freeing the femoral diaphysis plus the encompassing tumor, from the rest of the left thigh tissues (Fig. 3).
Prepared femur autograft.
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F4
The femur autograft measured approximately 32 cm long (Fig. 4).
Immediate post-operative radiograph.
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F5
The femur autograft was replaced in the thigh, ensuring the chevron osteotomies fit well, and a locked intramedullary SIGN nail was placed (Fig. 5).
Radiograph of the left femur taken 1 year after surgery.
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F6
Radiographs done at 12 months post-operation demonstrated healing of the osteotomy sites with maintained implant position and the patient has normal lower limb function(Fig. 6, 7a, b).
(a) Knee range of motion-extension. (b) Knee range of motion- flexion.
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F7
Radiographs done at 12 months post-operation demonstrated healing of the osteotomy sites with maintained implant position and the patient has normal lower limb function(Fig. 6, 7a, b).