Type 1 pelvic resection for chondrosarcoma

Case contributed by Matt A. Morgan

Presentation

Right hip pain.

Patient Data

Age: 55 years
Gender: Male

Initial radiograph

x_ray

In the right iliac bone there is a subtle ill-defined calcification. On closer inspection the calcification has a chondroid pattern of rings and curls.

Further work up including MRI and biopsy revealed chondrosarcoma

Type 1 pelvic resection

x_ray

Complete type 1 (iliac) pelvic resection of most of the right iliac wing for chondrosarcoma. The humeral head allograft completes the pelvic ring.  

The defect is bridged by a humeral head allograft and attached to the pelvic ring through four cancellous screws. Additional surgical clips overlie the right mid pelvis.

Case Discussion

This patient underwent a type 1 pelvic resection for his chondrosarcoma.

Types 1-4 pelvic resections are an improvement on the older hemipelvectomy since they do not require resection of the ipsilateral lower limb. This, however, presents a biomechanical challenge as the incomplete pelvis is unstable and the line of force from the upper body to the lower limb is now directed around a weaker pubic ramus, which is torqued around the contralateral pelvis.

In order to give the pelvis some biomechanical strength, osseous allografts or arthroplasty hardware may be used to bridge the gap. In this case, a resected humeral head allograft completes the pelvic ring.

If the resection of the iliac wing is small/partial, some orthopedic surgeons may try to close the pelvis by wiring the two resection margins of the pelvis together and accepting a leg-length discrepancy.

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