Osteogenic Sarcoma : Amputation vs Limb preserving surgery

Young girl aged nine years , presented with tender lower end of right femur : 4 months duration. Swelling observed since 15 days . 

Clinical possibilities 

  1. Osteomyelitis 
  2. Osteogenic Sarcoma 

Preoperative Imaging

Heterogeneous mass arising from distal metaphysis of the right femur with a soft tissue component 

Preoperative needle biopsy 

High grade Osteogenic sarcoma  with a chondroblastic  differentiation . 


FDG avid sclerotic lesion involving distal meta diaphysis of the right femur with parosteal  reaction extending to the soft tissue with hypo dense area within the lesion 

Size 6.7 cm * 8.9cm * 12.3cm ( AP*T*CC ) SUV max 11.5

Joint space uninvolved 

No skip lesion 

Retroperitoneal nodes reactive 

No lung nodules

Preoperative Diagnosis 

No metastatic osteogenic sarcoma 


Preoperative CTRT


DePuy total femur replacement 


FWB + Knee ROM abduction pillow + Deroration boot for 6 weeks + sitting up till 60 degree 

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