Orthopaedics & traumatology, surgery & research : OTSR 2017 06 21() pii S1877-0568(17)30175-5
The proximal femuris an uncommon site of osteosarcoma. The unusual manifestations at this site may lead to diagnostic and therapeutic mistakes. We therefore performed a retrospective studyto estimate the proportions of patients with imaging study findings and/or clinical manifestations typical for osteosarcoma and/or inappropriate treatment decisions.
Proximal femoral osteosarcoma often produces atypical clinical and radiological presentations.
MATERIAL AND METHODS
Consecutive patients who underwent surgery at our centre to treatproximal femoral osteosarcoma were included. For each patient, we collected the epidemiological characteristics, clinical symptoms, imaging study findings, treatment, and tumour outcome. Proportions were computed with their confidence intervals.
Twelvepatients had surgery for proximal femoral osteosarcomabetween 1986 and 2015. Imaging findings were typical in 1 (8%) patient; they consisted of ill-defined osteolysis in11/12(92%) patients, a periosteal reaction in1/12(8%) patient, soft tissue involvement in7/12(58%) patients, and immature osteoid matrix in 11/12(92%) patients. No patient had the typical combination of pain with a soft tissue swelling. Management was inappropriate in 2/12 (17%) patients, who did not undergo all the recommended imaging studies before surgery and were treated in another centre before the correct diagnosis was established. At last follow-up, 4 patients had died (after a mean of 7 years) and 8 were alive (after a mean of 4 years).
Proximal femoral osteosarcoma is uncommon and rarely produces the typical clinical and imaging study findings. The atypical presentation often results in diagnostic errors and inappropriate treatments. Ill-defined osteolysis on standard radiographsshould prompt computed tomography or magnetic resonance imaging of the proximal femur. Treatment in a specialised centre is imperative.
LEVEL OF EVIDENCE
IV, retrospective study.