Suspecting a bone tumor, an MRI scan was taken. Subsequently, the boy underwent open biopsy (of 6 cm of length) with curettage. After this procedure the patient was not able to walk with that leg due to the pain. The tumor was diagnosed as osteosarcoma.

At this point, the boy was brought to our center to receive treatment. After evaluation of the case (Fig. 11.2), we decided that limb salvage was possible by means of the Cañadell technique and posterior reconstruction. The patient started chemotherapy and received three sessions of intra-arterial chemotherapy. We placed the external fixator and distraction was carried out at a rate of 1 mm per day.

After between 7 and 10 days of distraction or if the patient reports pain, we typically request an X-ray to confirm rupture through the growth plate. In this case, the X-ray revealed that separation had occurred through the biopsy tract (Fig. 11.3).

The external fixation was removed and intra-epiphyseal osteotomy undertaken. We were able to preserve the proximal tibiae epiphysis and the knee joint. We reconstructed with an intercalary allograft with an intramedullary nail (Fig. 11.4 and 11.5).

Postoperatively, the patient recovered in a normal way. He continued with chemotherapy treatment. The excised tumor had 100 % necrosis. The patient started walking with crutches and then with full weight-bearing and demonstrated complete range of motion of the knee.

Nine months after completion of chemotherapy (one and a half years after surgery) the patient reported a pain in the contralateral knee (Fig. 11.6). This turned out to be a single bone metastasis without lung affectation. We decided to treat the metastasis as if it were a primary tumor. Intra-venous and intra-arterial chemotherapy was initiated. As the tumor was in contact with all of the physis, we performed intra-epiphyseal osteotomy rather than the Cañadell technique. Then we proceeded with reconstruction (Fig. 11.7)