Vascularized Fibular Graft With Femoral Head Epiphysis In Situ for Hip Reconstruction After Proximal Femoral Chondrosarcoma Resection in a Child

Introduction: The expansion of bone and joint reconstruction in pediatric sarcoma has reduced the use of ablative approaches. Due to the need to maintain growth potential and the finite life of metal implants, biological reconstruction has been traditionally preferred to endoprosthesis whenever possible, particularly in younger patients. Methods: This case report describes a novel surgical technique for proximal femoral reconstruction in a 10-year-old boy with chondrosarcoma of the right proximal femur. After surgical dislocation of the hip and wide excision of the tumor with preservation of the femoral epiphysis, the proximal femur was reconstructed with an autologous vascularised fibular graft, including the fibular head and proximal fibular physis, fixed to the residual femoral epiphysis proximally and diaphysis distally. Fibular diaphyseal struts were used to reconstruct the femoral neck and greater trochanter. The vascularized autologous graft was preferred over the allograft or acellular graft. The folded-over fibular struts were held together with screws, and the new femoral neck area was held to the femoral shaft with a combination of intramedullary press-fit and a medial calcar plate to buttress the construct. Results: At 1 year postoperatively, the patient continues to be disease-free (locally and systemically) and independently ambulant. Conclusion: This novel technique for proximal femoral reconstruction in pediatric sarcoma adds to the biological reconstructive options available to sarcoma surgeons. The focus is on maintaining bone growth at the femoral head while preserving native hip function.