Tibial Lengthening Over a Free Vascularized Fibular Autograft After Ewing’s Sarcoma Resection

Pediatric malignant osseous tumors, such as Ewing’s sarcoma, can involve all parts of the growing skeleton. Surgical treatment of these tumors often mandates the resection of large bony segments which may result in significant bone loss and lead to limb length discrepancy (LLD) and/or deformity. We present a case of an 18-year-old male who was diagnosed with Ewing’s sarcoma of the proximal left tibia.After the initial workup, the patient underwent tumor resection and reconstruction with a tibial allograft and an ipsilateral free vascularized fibular autograft. Given the proximity of the physis to the resection, the patient developed a residual LLD of 44 mm. A subsequent fracture of the proximal tibial metaphysis resulted in a varus deformity. Deformity assessment also indicated valgus of the distal femur which was corrected acutely. A monolateral multiaxial external fixator was installed for both lengthening of the tibia and correction of the angular deformity. The regenerate bone healed uneventfully. There was no significant residual deformity or LLD. Follow-up examination showed satisfactory functional outcome.