Foot growth disorder after surgery of lower limb malignant bone tumor in a pediatric series

Bakground: Child malignant bone tumors often develop near growth cartilage. The gold standard surgery consists in large segmental resection. This resection often requires the sacrifice of growth cartilage, leading to inequality of limb length. Prothesis are used for reconstruction when the epiphysis is resected, otherwise different strategies of osteosyntheses and grafts may be an option.

Hypothesis: The aim of the study was to analyze the foot size inequality after surgery of lower limb malignant bone tumor in patients with growth residual.

Patients and methods: A retrospective study analyzed the data of 60 patients followed in an oncology pediatric center, between January 2008 and December 2018, for surgically treated malignant bone tumor. All surgeries were realized between January 1992 and December 2013. The primary outcome was the foot size inequality at the last consultation. Categorical variables were described by frequencies and percentages, and compared with Student tests. Continuous variables were described by median and interquartile range, the linear relationship between the foot size inequality and the explanatory variables were analyzed with Pearson tests.

Results: A foot size inequality of 1.15 cm [-0.5-3] was measured, a statistically significant difference (p < 0.0001). Younger children had a greater difference, as the patients with a greater final leg inequality. The children who required several surgeries because of mechanical issues also had a higher foot length difference.

Discussion: The foot length inequality after bone tumor surgery of the lower limb in children with residual growth potential is a reality not enough described.

Level of evidence: IV.