# Reconstruction of a High-Grade Osteosarcoma in the Proximal Tibia With Transphyseal Resection Using an Extracorporeal Irradiation and Vascularized Fibula Autograft: A Case Report

## TL;DR

A 13-year-old boy with high-grade osteosarcoma in the tibia was successfully treated using a novel combination of tumor removal, irradiation, and fibula grafting to preserve limb function.

## Contribution

The paper introduces a multidisciplinary limb-salvage strategy combining extracorporeal irradiation and vascularized fibula autograft for osteosarcoma in skeletally immature patients.

## Key findings

- Transphyseal resection with extracorporeal irradiation achieved clear tumor margins and allowed reimplantation of the sterilized tibial segment.
- A vascularized fibula autograft restored structural integrity and function in a skeletally immature patient.
- The approach minimized recurrence risk while preserving limb function in a complex osteosarcoma case.

## Abstract

This case report presents the treatment of a 13-year-old male patient diagnosed with high-grade osteosarcoma of the proximal tibia. Management involved a combination of transphyseal resection, extracorporeal irradiation, and reconstruction using a vascularized fibula autograft. The tumor was excised with clear margins, as confirmed intraoperatively through frozen section analysis. The resected tibial segment was sterilized using 50 Gy extracorporeal irradiation and subsequently reimplanted. To restore structural integrity and vascularization, a 14 cm pedicled fibula graft was harvested and inserted intramedullary, then stabilized with plates and screws. This multidisciplinary approach, involving orthopedic oncology and microsurgical reconstruction, demonstrates an innovative limb-salvage strategy that preserves function while minimizing the risk of recurrence. The case highlights the feasibility and potential advantages of combining extracorporeal irradiation with vascularized bone grafting in the management of complex osteosarcomas, particularly in skeletally immature patients.