Type 1 pelvic resection for chondrosarcoma

Case contributed by Dr Matt A. Morgan

Presentation

Patient presents with right hip pain.

Patient Data

Age: 50-60Y
Gender: Male
X-ray

Initial radiograph

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 a chondrosarcoma

X-ray

Type 1 pelvic resection

Resection of most of the right iliac wing.

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 ipislateral 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 orthopaedic 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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Case information

rID: 37758
Case created: 22nd Jun 2015
Last edited: 8th Sep 2015
Inclusion in quiz mode: Excluded

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