# Preserved walking function without postoperative reconstruction for pelvic Ewing’s sarcoma: a case report

## TL;DR

A 14-year-old boy with pelvic Ewing’s sarcoma achieved stable walking after surgery without reconstruction, avoiding infection risks and preserving function.

## Contribution

Demonstrates successful functional preservation and reduced infection risk by avoiding pelvic reconstruction in a complex Ewing’s sarcoma case.

## Key findings

- The patient achieved a stable gait despite complete abductor muscle removal and no pelvic ring reconstruction.
- Avoiding reconstruction minimized postoperative infection risk and enabled early chemotherapy.
- This approach may offer benefits for similar pelvic Ewing’s sarcoma cases with metastases.

## Abstract

Ewing’s sarcoma is a primary bone tumor predominantly observed in children and adolescents, necessitating a multidisciplinary treatment approach. While localized cases have a 5-year survival rate of 60–70%, the prognosis is significantly worse in pelvic advanced cases with metastasis. Moreover, pelvic Ewing’s sarcoma has the unique problem of leading to high rates of postoperative infection.

We present the case of a Japanese 14-year-old boy with left iliac Ewing’s sarcoma and multiple metastases. At the initial visit, imaging revealed a large tumor in the left iliac bone with extraosseous extension and metastasis to multiple sites. Neoadjuvant chemotherapy resulted in significant tumor reduction. Surgical resection was performed without pelvic ring reconstruction to enable early postoperative chemotherapy and minimize postoperative infection risk. Despite complete abductor muscle removal, the patient achieved a stable gait postoperatively by centering the load axis.

Our case highlights the successful management of a left iliac Ewing’s sarcoma with multiple metastases, with a focus on functional preservation and infection risk reduction. Pelvic ring reconstruction was not performed to avoid postoperative complications, emphasizing the importance of early postoperative chemotherapy. The patient achieved a stable gait postoperatively, demonstrating the potential benefits of this approach in similar cases.