A 19-year-old man with high-grade osteosarcoma of the distal femur has the popliteal neurovascular bundle free of tumor on MRI. He is planned for limb-salvage surgery with modular endoprosthetic reconstruction. A contraindication to limb salvage in osteosarcoma is:
- A Large soft tissue extension of tumor
- B Pathological fracture through the tumor ✓
- C Tumor in a skeletally immature patient under age 8 (limb length discrepancy concerns)
- D All of the above
Explanation
Pathological fracture through the tumor is a relative-to-absolute contraindication to limb salvage because hematoma from fracture contamination spreads tumor cells into the reactive zone and beyond, making it impossible to achieve a wide margin — amputation is often required to achieve local control. Large soft tissue extension alone is manageable if the neurovascular bundle is clear; pediatric age is addressed with expandable endoprostheses. Historically, contaminated tissue planes from fracture hematoma compromise the oncological result significantly, and most guidelines favor amputation in this scenario.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.