Pathologic fracture through a tumor in a weight bearing bone results in a hematoma and the traumatic dissemination of tumor extensively into the soft tissues. Except under unusual circumstances this local tumor contamination makes limbsalvage surgery difficult. Infection usually is the result of tumor ulceration through the skin, or it may be caused by wound infection at the biopsy site. It may negate attempts at local resection especially if prosthetic materials must be used in the limbsalvage effort. Also infection will markedly impair the ability of the oncologist to administer adequate preoperative or postoperative chemotherapy.
Skeletal immaturity is of great concern when irradiating or replacing the proximal tibia.
Eighty percent of this bone's growth is from the proximal epiphysis. If the tibia has not reached its full length, prosthetic replacement will result in leglength discrepancies. Contractures may be an additional problem that result from highdose radiation therapy in the young patient. Irradiation across the knee joint carries a high incidence of late contracture. In addition to the anatomic location of the tumor and the probable spread that has occurred prior to definitive therapy, the pathologic grade of the malignancy is extremely important in deciding the proper surgical procedures.