Limb salvage surgery with cryotherapy in osteosarcoma of the femoral shaft: A case report.
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INTRODUCTION AND IMPORTANCE: Osteosarcoma is the most common primary malignant bone tumor, primarily affecting children and adolescents. Treatment is often challenging due to availability of modalities across hospitals. This study reports a case of osteosarcoma located in the midshaft of the femur. We aim to demonstrate that limb salvage can be achieved by the combination of cryosurgery and plate and screw fixation when mega prosthetic reconstruction is either unavailable or unaffordable for the patient. CASE PRESENTATION: A 14-year-old girl presented to the hospital with a complaint of a lump and persistent pain on the right thigh, particularly worsening at night. The symptoms had been present for five months prior to admission. On physical examination, a firm, immobile mass sized approximately 7 × 6 cm was palpated. The mass had a smooth surface and well-defined margins. Radiographic evaluation, including X-ray and magnetic resonance imaging (MRI), was suggestive of a primary bone tumor. A definitive diagnosis of osteosarcoma was established through histopathological examination. The patient underwent limb salvage surgery, which involved cryotherapy and reconstruction of the right midshaft femur using plate and screw fixation. CLINICAL DISCUSSION: In this case, the clinical and radiographic findings were suggestive of osteosarcoma. Although no large mass was grossly apparent, the presence of progressive pain served as a clinical red flag, prompting further investigation. In developing countries, cost and accessibility remain major challenges, mega prostheses for limb salvage surgery are often unaffordable for most patients and rarely available in other than tertiary orthopaedic centers. Therefore, limb salvage surgery using cryotherapy combined with double plate and screw fixation was selected as the treatment of choice, offering a practical and cost-effective solution. CONCLUSION: Limb salvage surgery using cryotherapy represents a viable and effective treatment option for osteosarcoma in resource-limited settings. It enables functional reconstruction and can achieve favorable outcomes in patients, making it a practical alternative where advanced prosthetics are not an option.