International Journal of Surgery Case Reports最新文献

{"title":"Optimizing proximal fibula tumor resection: “The open door technique” for better surgical access and outcomes - A case series","authors":"Sadegh Saberi ,&nbsp;Hamed Naghizadeh ,&nbsp;Sepand Heydari ,&nbsp;Elham Poorghasem ,&nbsp;Mehdi Bayati ,&nbsp;Seyyed Saeed Khabiri","doi":"10.1016/j.ijscr.2025.111992","DOIUrl":"10.1016/j.ijscr.2025.111992","url":null,"abstract":"<div><h3>Objective</h3><div>Proximal fibula tumors pose significant surgical challenges due to their proximity to vital neurovascular structures, including the common peroneal nerve. Traditional resection techniques often require extensive tissue manipulation, which can lead to complications such as peroneal nerve injury and knee instability. This study introduces and evaluates the “open door technique,” designed to enhance surgical visualization and access, thereby reducing complications while achieving oncologic control.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of 31 patients who underwent proximal fibula tumor resection using the “open door technique” from 2015 to 2022. Patient demographics, tumor characteristics, and functional outcomes were documented. Preoperative imaging and a standardized surgical approach were employed, with follow-up assessments including the Musculoskeletal Tumor Society (MSTS) score and the Toronto Extremity Salvage Score (TESS). Descriptive statistics and comparative analyses were applied to evaluate surgical and functional outcomes.</div></div><div><h3>Results</h3><div>The “open door technique” achieved negative resection margins in 93.5 % of cases, with a recurrence rate of 6.5 % over a mean follow-up period of 36 months. Postoperative complications included permanent peroneal nerve injury in 12.9 % of patients and transient nerve injury in 9.7 %, both lower than rates typically associated with traditional techniques. Functional outcomes were favorable, with 87.1 % of patients achieving good to excellent MSTS and TESS scores, indicating practical neurovascular and ligamentous structure preservation.</div></div><div><h3>Conclusion</h3><div>The “open door technique” provides an effective, function-sparing approach for proximal fibula tumor resection, balancing oncologic control with reduced neurovascular complications and improved functional outcomes. These findings support its potential as a valuable addition to orthopedic oncology practices. Further studies are recommended to confirm its applicability across a broader patient population.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"136 ","pages":"Article 111992"},"PeriodicalIF":0.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ileosigmoid knot in pregnancy, incidentally discovered during caesarean section. A rare case report","authors":"Yahouza Boka Tounga ,&nbsp;Hamidou Soumana Diaouga ,&nbsp;Issifou Hama Sidi Mansour ,&nbsp;Kadi Ide ,&nbsp;Madi Nayama ,&nbsp;Rachid Sani","doi":"10.1016/j.ijscr.2025.111987","DOIUrl":"10.1016/j.ijscr.2025.111987","url":null,"abstract":"<div><h3>Introduction and importance</h3><div>The occurrence of intestinal obstruction during pregnancy is an unusual condition. Ileosigmoid knot is even rarer but it is associated with a poor prognosis.</div></div><div><h3>Case presentation</h3><div>We report a case of ileosigmoid knot in a 22-year-old patient who admitted to our department with third-trimester metrorrhagia in 36-week pregnancy. Ileosigmoid knot was incidentally discovered during a caesarean section indicated for retroplacental hematoma. Intraoperatively, necrosis of the ileum and the sigmoid colon was noted. After extraction of a healthy living male newborn, we performed resection of 30 cm of involved small bowel as well as resection of the necrotic sigmoid colon. We proceeded to do primary ileal anastomosis and a Hartmann's colostomy. The patient had a closure of colostomy after 30 days from the day of discharge, according to our department's protocol. The outcome was uneventful, with return to daily activities and a good maternal and perinatal prognosis.</div></div><div><h3>Discussion</h3><div>Through the analysis of this case report, we discuss the etiopathogenic, diagnostic, therapeutic and prognosis aspects of ileosigmoid knot in pregnancy.</div></div><div><h3>Conclusion</h3><div>Ileosigmoid knot in pregnancy is a life threatening condition needing multidisciplinary management. It may be associated with other obstetric emergencies such as retroplacental hematoma, which is a diagnostic pitfall. The diagnosis is often an incidentally discovery as evidenced by this case report.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"136 ","pages":"Article 111987"},"PeriodicalIF":0.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enterocutaneous fistula secondary to Richter's femoral hernia in an elderly patient: A diagnostic pitfall - A case report","authors":"Sabin Kumar Ghimire ,&nbsp;Rahul Jha ,&nbsp;Samrat Shrestha ,&nbsp;Rabin Kumar Ghimire ,&nbsp;Suresh Maharjan ,&nbsp;Niliza Shakya","doi":"10.1016/j.ijscr.2025.112002","DOIUrl":"10.1016/j.ijscr.2025.112002","url":null,"abstract":"<div><h3>Introduction</h3><div>Richter's femoral hernia is a rare form of abdominal wall hernia at the femoral canal. The development of an enterocutaneous fistula (ECF) in this setting is extremely rare and highlights a rare but serious complication resulting from delayed presentation. It underscores the importance of early recognition and timely surgical intervention in resource-limited countries to prevent morbidity and mortality.</div></div><div><h3>Case presentation</h3><div>A 90-year-old woman from a remote village presented with lower abdominal pain, bilious vomiting, and a right groin wound. Examination revealed bilious discharge from the wound. Imaging showed an incarcerated right Richter's femoral hernia. After stabilization, she underwent emergency laparotomy with resection and anastomosis of the perforated ileal segment, followed by primary repair of the femoral defect. The patient recovered well and showed no recurrence at the 3-month follow-up.</div></div><div><h3>Discussion</h3><div>The development of a groin wound with an ECF in this context of Richter's femoral hernia is extremely rare. Differentiating this condition from similar presentations such as ruptured inguinal abscess, suppurative inguinal lymphadenopathy, or inguinal necrotizing fasciitis is crucial for timely intervention. A high index of suspicion and the use of advanced imaging modalities are necessary to delineate the pathology. Structured multidisciplinary care and a tailored surgical approach can lead to successful outcomes.</div></div><div><h3>Conclusion</h3><div>Spontaneous perforation of a Richter's femoral hernia resulting in an enterocutaneous fistula is an extremely rare and serious complication in the elderly with delayed presentation. High clinical suspicion, early recognition, and prompt surgical intervention are crucial for improving outcomes.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"136 ","pages":"Article 112002"},"PeriodicalIF":0.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral tibial intercondylar eminence fractures in a pediatric patient: A rare case report","authors":"Sepand Heidari ,&nbsp;Erfan Khosravi ,&nbsp;Taghi Baghdadi ,&nbsp;Mohammad Mehdi Ebrahiminasab ,&nbsp;Pouya Tabatabaei Irani","doi":"10.1016/j.ijscr.2025.111996","DOIUrl":"10.1016/j.ijscr.2025.111996","url":null,"abstract":"<div><h3>Introduction and importance</h3><div>Tibial eminence fractures (TEFs) are uncommon injuries in children, resulting from avulsion at the anterior cruciate ligament (ACL) insertion. Bilateral involvement is exceedingly rare. Early recognition and proper classification are vital for successful treatment.</div></div><div><h3>Case presentation</h3><div>A 12-year-old male sustained bilateral TEFs after a bicycle-automobile collision. Radiographs and CT scans confirmed a Type I fracture on the right and Type II on the left. Closed reduction under fluoroscopy and hematoma drainage was performed, followed by immobilization in bilateral long leg casts. Radiological and clinical follow-up showed full healing and functional recovery.</div></div><div><h3>Clinical discussion</h3><div>TEFs commonly occur in young males due to sports or trauma. Management depends on the displacement and type of fracture. While surgery is often required for Type II fractures, this case highlights successful closed management of bilateral injuries. Long-term monitoring for instability is crucial.</div></div><div><h3>Conclusion</h3><div>This case illustrates successful closed reduction and casting in a rare bilateral pediatric TEF scenario, reinforcing the importance of individualized treatment planning.</div><div>This case demonstrates successful closed reduction and casting of a rare bilateral tibial eminence fracture in a 12-year-old male, with excellent clinical and radiographic outcomes.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"136 ","pages":"Article 111996"},"PeriodicalIF":0.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined endoscopic and laparoscopic approach to a giant hepatic hydatid cyst with biliary compression: A case report","authors":"Wail Alqatta","doi":"10.1016/j.ijscr.2025.112003","DOIUrl":"10.1016/j.ijscr.2025.112003","url":null,"abstract":"<div><h3>Introduction</h3><div>Hepatic hydatid disease caused by Echinococcus granulosus remains a significant health burden in endemic regions. Giant cysts may cause compression of adjacent structures, complicating both diagnosis and surgical management. Minimally invasive techniques combined with preoperative endoscopic intervention offer a safe and effective therapeutic option in selected cases.</div></div><div><h3>Case presentation</h3><div>This report describes a 45-year-old female from a rural area presenting with a two-year history of progressive epigastric pain, vomiting, anorexia, and weight loss. Physical examination revealed an epigastric mass and mild jaundice. Laboratory investigations showed elevated inflammatory markers (CRP 181 mg/L), elevated cholestatic enzymes (ALP 215 U/L, GGT 164 U/L), mild hyperbilirubinemia (total bilirubin: 2.1 mg/dL; direct bilirubin: 1.6 mg/dL) and a positive ELISA for <em>E. granulosus</em>. Abdominal CT revealed a well-demarcated, multilobulated cystic lesion measuring 20 × 12 × 12 cm, predominantly in the right hepatic lobe, extending into the left lobe and compressing the common bile duct (CBD), duodenum, pancreas, and lesser curvature of the stomach. ERCP demonstrated external compression of the CBD, and a plastic stent (10 Fr) was placed after balloon clearance of sludge. Albendazole (400 mg BID) was initiated preoperatively. Four days later, laparoscopic exploration confirmed a giant hydatid cyst occupying segments V-VIII and II-III. Laparoscopic endocystectomy with omentoplasty was performed without spillage. The postoperative course was uneventful, and the patient was discharged on postoperative day four. She remained asymptomatic at four months follow-up.</div></div><div><h3>Discussion</h3><div>This case highlights the role of combined endoscopic and laparoscopic intervention in managing large, compressive hepatic hydatid cysts. Preoperative biliary decompression reduces the risk of postoperative biliary fistula, while laparoscopic endocystectomy offers excellent outcomes in most patients, minimizing surgical trauma.</div></div><div><h3>Conclusion</h3><div>A combined endoscopic and laparoscopic approach can be safely and effectively applied in the management of giant hepatic hydatid cysts with biliary compression, providing favorable clinical outcomes and reduced perioperative morbidity.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"136 ","pages":"Article 112003"},"PeriodicalIF":0.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large colonic lipomas presenting as a rare cause of adult bowel obstruction and intussusception: A two-case surgical series","authors":"Yoseph Mulatu Habte ,&nbsp;Binyam Mulatu Habte ,&nbsp;Yabetse Alemayehu Kifle ,&nbsp;Esimael Musema Abdu ,&nbsp;Yusuf Mohammed Yusuf ,&nbsp;Shimelis Ayalew Yimer","doi":"10.1016/j.ijscr.2025.111988","DOIUrl":"10.1016/j.ijscr.2025.111988","url":null,"abstract":"<div><h3>Introduction and importance</h3><div>Colonic lipomas are uncommon benign tumors of mesenchymal origin that are typically asymptomatic but can lead to significant complications, including bowel obstruction or intussusception, when they grow large.</div></div><div><h3>Presentation of case</h3><div>We report two cases of symptomatic colonic lipomas presenting with features of intussusception and bowel obstruction. The first case involved a 70-year-old male with chronic abdominal pain, hematochezia, and obstructive symptoms, in whom colonoscopy and CT imaging revealed a large lipoma of the ascending colon causing ileocolic intussusception. The second case was a 36-year-old male presenting with acute lower abdominal pain, and imaging demonstrated a transverse colon lipoma with signs of partial obstruction and intussusception. Both patients underwent laparotomy with segmental colectomy and primary anastomosis. Histopathological examination confirmed benign submucosal lipomas. Postoperative courses were uneventful, with complete resolution of symptoms.</div></div><div><h3>Discussion</h3><div>Colonic lipomas are frequently asymptomatic but may lead to intussusception, with symptoms influenced by their size and location. The increased use of CT imaging has improved preoperative diagnosis. Management ranges from observation to endoscopic or surgical resection. However, selecting the optimal surgical approach remains challenging due to overlapping features with malignant lesions and the risk of complications in large or symptomatic cases.</div></div><div><h3>Conclusion</h3><div>Although uncommon, colonic lipomas should be considered in the differential diagnosis of adult intestinal obstruction. Imaging plays a key role, and surgical resection remains the definitive management for symptomatic cases.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"136 ","pages":"Article 111988"},"PeriodicalIF":0.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transvaginal approach for resection of a low rectal leiomyoma: A case report","authors":"Tu Trong Doan ,&nbsp;Duong The Pham ,&nbsp;Cuong Van Nguyen ,&nbsp;Thanh Tuan Tran ,&nbsp;Hai Van Nguyen","doi":"10.1016/j.ijscr.2025.111984","DOIUrl":"10.1016/j.ijscr.2025.111984","url":null,"abstract":"<div><h3>Introduction</h3><div>Rectal leiomyomas are rare benign lesions with an estimated incidence of 1 in 2000 rectal tumors. The treatment of choice for these tumors is complete resection. Transvaginal approach is an appropriate method for tumors located in the anterior wall of the rectum. We herein report a case of a 31-year-old female patient treated by transvaginal resection for a lower rectal leiomyoma and also mention a literature review regarding this topic.</div></div><div><h3>Case report</h3><div>A 31-year-old female patient was admitted to our hospital due to abdominal pain. She was diagnosed with a lower rectal leiomyoma and underwent transvaginal tumor resection. Postoperative course was stable and the patient was discharged after 5 days with no complications of vaginal fistula or sphincter dysfunction.</div></div><div><h3>Discussion</h3><div>Leiomyoma is a common benign tumor that can be found in many locations in the body, but rarely occurs in the rectum. Large leiomyomas of lower rectum would normally require transanal, intersphincteric, or transperineal resection. However, these approaches had risks related to sphincteric dysfunction and anastomosis leakage. Transvaginal resection is a minimally invasive approach that is an appropriate method for tumors located in the anterior wall of the rectum.</div></div><div><h3>Conclusion</h3><div>Transvaginal resection is a minimally invasive approach that may be considered for lower rectal submucosal tumors.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"136 ","pages":"Article 111984"},"PeriodicalIF":0.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145160014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment strategy for septic arthritis of the sternoclavicular joint with osteomyelitis, large abscesses, and mediastinitis: A case report","authors":"Ryo Maeda ,&nbsp;Ryusei Yamada ,&nbsp;Mayu Inomata ,&nbsp;Fumiaki Kawano","doi":"10.1016/j.ijscr.2025.111986","DOIUrl":"10.1016/j.ijscr.2025.111986","url":null,"abstract":"<div><h3>Introduction and importance</h3><div>Septic arthritis of the sternoclavicular joint (SASCJ) accounts for &lt;1 % of all joint infections. Owing to the limited literature on the disease, there is no consensus on the general treatment for SASCJ. Here, we report a case of SASCJ complicated by osteomyelitis, mediastinitis, infectious myositis, and cervical and chest wall abscesses that required radical sternoclavicular joint resection and reconstruction using the greater omental flap. In this report, we discuss the treatment strategy for advanced SASCJ cases.</div></div><div><h3>Case presentation</h3><div>A 65-year-old man was diagnosed with SASCJ relapse after the failure of antibiotic therapy alone, combined with osteomyelitis, mediastinitis, infectious myositis, and cervical and chest wall abscesses. A radical sternoclavicular joint resection was performed. After negative-pressure wound therapy, serial re-debridement was performed. The greater omental flap was transported into a deep, large residual space. The patient has been relapse-free for 1 year.</div></div><div><h3>Clinical discussion</h3><div>Radical resection of the entire sternoclavicular joint should be the preferred management strategy for patients with sternoclavicular joint infections, especially in cases of osteomyelitis. Although the pectoralis major flap is typically the first choice to cover the defect, we used the omental flap because the locoregional flaps were not large enough to reconstruct the defect.</div></div><div><h3>Conclusion</h3><div>The greater omental flap is an advantageous alternative when there is a need to provide coverage for large defects in cases of SASCJ.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"136 ","pages":"Article 111986"},"PeriodicalIF":0.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145160013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External carotid artery ligation in the management of carotid body tumors: A case report","authors":"Omaima Taie,&nbsp;Nourdine Lahlou,&nbsp;Zoulati Mohammed,&nbsp;Tarik Bakkali,&nbsp;Hassan Chtata","doi":"10.1016/j.ijscr.2025.111972","DOIUrl":"10.1016/j.ijscr.2025.111972","url":null,"abstract":"<div><h3>Introduction and importance</h3><div>Carotid body tumors (CBTs) are rare paragangliomas located at the bifurcation of the carotid artery. These tumors present significant clinical challenges due to their potential for local extension, high vascularity, and proximity to critical neurovascular structures. The <strong>rarity of complete resections requiring external carotid artery ligation (ECAL)</strong> underscores the clinical significance of this case, highlighting both the technical challenge and the functional outcome.</div></div><div><h3>Case presentation</h3><div>We report a case of a CBT in a middle-aged patient presenting with a progressively enlarging neck mass. Preoperative <strong>angio-CT</strong> revealed a 3.5 × 4.5 cm, highly vascularized tumor encasing the carotid bifurcation. Surgical resection was undertaken, during which the tumor was found <strong>to completely encase the external carotid artery, making dissection impossible without ligation.</strong> ECAL was therefore performed intraoperatively to allow safe mobilization of the tumor and ensure hemostasis.</div><div>The postoperative course was favorable, without major complications. The patient developed ipsilateral facial paresthesia, dysphonia, and aspiration episodes during the first postoperative month, likely related to intraoperative nerve manipulation or the ECAL. Aspiration resolved within the first month, while both dysphonia and facial paresthesia gradually improved and fully resolved by six months.</div></div><div><h3>Clinical discussion</h3><div>Surgical resection of cervical paragangliomas is challenging due to hypervascularity and proximity to cranial nerves. In our case, ECAL provided immediate hemostasis and clarified the ICA–tumor interface, enabling safe resection without compromising cerebral perfusion.</div></div><div><h3>Conclusion</h3><div>ECA ligation is a safe and effective adjunct in selected complex carotid body tumors, providing reliable vascular control with minimal neurological morbidity. <strong>This case supports its utility in complex, high-grade tumors.</strong></div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"136 ","pages":"Article 111972"},"PeriodicalIF":0.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distal femur osteosarcoma in an adolescent: Limb salvage with cryosurgery-recycled bone, hemi knee replacement, and ORIF—A case report","authors":"Bangkit Primayudha,&nbsp;Muhamad Naseh Sajadi Budi,&nbsp;Wilson Wijaya,&nbsp;Mohammad Syarif Mas'ud","doi":"10.1016/j.ijscr.2025.111957","DOIUrl":"10.1016/j.ijscr.2025.111957","url":null,"abstract":"<div><h3>Introduction</h3><div>This report presents a rare case of distal femoral osteosarcoma in an 11-year-old boy, managed through a hybrid limb-salvage approach combining cryosurgery-recycled bone, hemi knee arthroplasty, and internal fixation. The objective is to detail the surgical technique and assess short-term functional outcomes, particularly in adolescents with juxta-articular osteosarcoma.</div></div><div><h3>Presentation of case</h3><div>The patient presented with a three-month history of progressive right knee pain and swelling. Radiographs indicated classic osteosarcoma features, including a sunburst pattern and Codman's triangle. In the absence of biopsy and advanced imaging, diagnosis was made clinically and radiologically. Following 2 cycles of neoadjuvant chemotherapy, wide resection of the tumor was performed. The excised bone was treated with liquid nitrogen cryoablation and reimplanted as a recycled autograft. Knee joint reconstruction was completed using a cemented polyethylene hemiarthroplasty on the tibial side, with the femoral segment stabilized using a lateral locking plate. Postoperative recovery was smooth, with the patient achieving excellent functional outcomes within six months. No recurrence or metastasis was noted during follow-up.</div></div><div><h3>Discussion</h3><div>This case demonstrates the clinical feasibility of combining cryo-treated autograft and hemiarthroplasty for biologic limb reconstruction in pediatric patients. The technique preserves native anatomy, reduces donor site complications, and provides a cost-effective alternative to megaprostheses—making it particularly suitable for low-resource settings.</div></div><div><h3>Conclusion</h3><div>Cryosurgery-recycled autograft combined with hemi knee replacement and internal fixation is a promising limb-salvage strategy offering favorable oncological and functional outcomes in managing pediatric osteosarcoma.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"136 ","pages":"Article 111957"},"PeriodicalIF":0.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145160012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}