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Trifocal Bone Transport and Motorized Intramedullary Nail to Restore Massive Limb Length Inequality After Excision of Osteosarcoma of the Femur

This case appears in the HSS publication Grand Rounds from HSS - Management of Complex Cases, Summer 2013 - Volume 4, Issue 2, Case 3

Case 3, presented by S. Robert Rozbruch, MD describes a 35-year-old male who previously underwent resection of osteosarcoma from the right femur 5 years before presenting at HSS. Tumor treatment was successful and the patient was cured of cancer; however, reconstructions first with ipsilateral free fibula and then with allograft both failed. The patient presented to us with a 21cm bone defect in the right femur that was stabilized with an intramedullary (IM) rod and bone cement after treatment of an infection. He additionally had 4cm of leg length discrepancy (LLD). In total, this represented 25cm of bone loss (Figure 1). The recommendation given to him from other surgeons was hip disarticulation amputation. Limb salvage surgery was presented by us as an alternative option. The proposed plan included a trifocal bone transport over an IM nail using cable/pulley technique for the femur defect. Subsequent tibial lengthening was planned using a fully implantable motorized IM nail. At 2 year follow-up after successful treatment the patient has no pain, normal hip and ankle range of motion (ROM), and knee ROM of 0-120 degrees. He walks without a limp and without assistance. 

Read full case details in Volume 4, Issue 2 of Grand Rounds - Complex Cases.

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