[The Surgical Treatment and Outcome of Nonmetastatic Osteosarcoma of the Extremity with Pathologic Fractures]

Objective: To demonstrate the influence of pathologic fracture and the form of surgical therapy on the survival rate and the prognosis of the patients with osteosarcoma.

Methods: From 1992 to 2001 retrospective analysis was done for 22 patients with pathological fracture out of 189 patients with primary extremity osteosarcoma. The 22 patients presented as primary extremity osteosarcoma with pathologic fracture without prior treatment. They were 7 females and 15 males and their age ranged from 8 to 36 years old. Most of diseases located in humerus and femurs. Limb salvage underwent in 12 patients (allograft 2, bone cement spacer 4, local resection 1, prosthesis 4 and rotation-plasty 1) and amputation in 10. All these patients had pre and post operative chemotherapy. The 22 patients followed 8 to 146 months after surgery, and the average was 54.7 months. The minimum follow-up for survive patient was 36 months.

Results: The 54.5% patients had limb-salvage surgery and 45.5% had amputation, and the limb salvage was lower than non-fracture patients (71.9%), but without significance (P = 0.096). Nine patients developed lung metastases and died in 8 to 26 months postoperatively. The five-year estimated survival rate was 53.4%. The recurrent rates were 16.7% and 10.0% in limb salvages and amputation respectively. The lung metastases rates were 25% and 60% in limb salvages and amputation respectively.

Conclusion: The performance of a limb-salvage procedure in carefully selected patients with pathologic fracture does not significantly increase the risk of local recurrence or death.