Pathological fracture in osteosarcoma: is it always an indication for amputation?

The presence of a pathological fracture due to osteosarcoma (OS) has been considered a high risk factor for dissemination and an indication for immediate amputation. With current neoadjuvant chemotherapy regimens there is a trend towards limb salvage procedures in selected cases. The aim of this study is to assess the outcome of patients treated with amputation versus patients treated with limb salvage surgery focusing on local recurrence, mortality rates and metastatic dissemination.A retrospective study of patients with OS treated at our institution was performed. Fifteen patients with a mean age of 25.6 years (8 to 66) were identified with an average follow up of 7 years (2 to 29). Patients were treated either with amputation (8) or limb salvage procedure (6). One patient was not treated surgically.Four patients developed local recurrence (1 in the amputation group and 3 in the limb salvage group, treated with secondary amputation). Six patients developed pulmonary metastasis (4 in the amputation group and 2 in the limb salvage) and 3 patients died (all of them in the amputation group).1. A pathologic fracture in an OS is not always a contraindication for limb salvage because the oncologic results are acceptable. 2. In selected cases limb salvage has similar success rates to amputation.