Dr F.Ali Janjua

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13-year-old boy with localized Ewing sarcoma of the proximal radius.Baseline staging negative. MRI showed a large proxim...
24/12/2025

13-year-old boy with localized Ewing sarcoma of the proximal radius.

Baseline staging negative.

MRI showed a large proximal radial lesion with soft-tissue component near joint

Post-neoadjuvant MRI demonstrated good response with no vascular or joint invasion, supporting limb salvage.

We proceeded with a Wide local excision + Liquid nitrogen–treated autograft reconstruction

Managed to preserve neurovascular structures including PIN

Currently started on Adjuvant Chemotherapy and functonally improving after 3 weeks in back slab

In this function-critical upper-limb site, would you have approached differently?

Limb salvage in proximal humerus Ewing sarcomaA 24-year-old male presented with right proximal humerus Ewing’s sarcoma B...
15/12/2025

Limb salvage in proximal humerus Ewing sarcoma

A 24-year-old male presented with right proximal humerus Ewing’s sarcoma Baseline staging showed no pulmonary metastases and an intact neurovascular bundle with a normal glenoid.

He received neoadjuvant chemotherapy followed by reassessment imaging demonstrating a marked decrease, no skip lesion, NVB preserved, and CT thorax still negative.

Proceeded with a wide margin excision and reconstruction with proximal humerus replacement

8-year-old girl with localized Ewing sarcoma of the left proximal tibia –She initially underwent two open biopsies at di...
02/12/2025

8-year-old girl with localized Ewing sarcoma of the left proximal tibia –

She initially underwent two open biopsies at different centres, reported as chronic osteomyelitis.

When the second biopsy was reviewed at our institute in it was re-diagnosed as Ewing sarcoma.

Started on NACT . CT chest remained clear. Reassessment MRI of the leg showed interval response with reduction of the intramedullary extent and extra-osseous soft-tissue component, no skip lesions, no lymph nodes and no skin involvement – allowing us to aim for limb salvage instead of amputation.

She subsequently underwent:
Wide margin resection of the left proximal tibia with
Liquid nitrogen–treated recycled autograft with dual T-plates and a locking compression plate with intent to save her growth plate

Patellar tendon reattachment, gastrocnemius/soleus flap and full-thickness skin graft in collaboration with plastic surgery

Final histopathology showed no residual viable tumor in the resected segment and tumor-free marrow margins proximally and distally – an excellent local response to chemotherapy and surgery.

12-year-old girl with Ewing sarcoma of the 2nd metacarpal of the right hand.After neoadjuvant chemotherapy her MRI showe...
02/12/2025

12-year-old girl with Ewing sarcoma of the 2nd metacarpal of the right hand.

After neoadjuvant chemotherapy her MRI showed an excellent response with a clear neurovascular bundle and CT thorax confirmed no pulmonary metastases.

Wide local excision of the 2nd metacarpal, leaving only the distal subchondral head to preserve the MCP joint

Frozen sections from proximal and distal marrow margins – both negative

Reconstruction with a 5 cm non-vascularized ipsilateral fibular graft, fixed with a T-plate proximally to the carpus and distally to the osteotomised metacarpal head

Curious to know if any one would have managed it differently. Especially hand surgeons.

Recently performed limb-salvage surgery in an 11-year-old boy with non-metastatic osteosarcoma of the left distal femur ...
05/11/2025

Recently performed limb-salvage surgery in an 11-year-old boy with non-metastatic osteosarcoma of the left distal femur and fixed knee flexion contracture, post-neoadjuvant chemotherapy. Pre-op MRI showed the lesion abutting the neurovascular bundle; intra-operatively the tumor was partially encasing the bundle but could be carefully dissected free, permitting oncologically safe resection and reconstruction with a non-expandable distal femoral replacement. In our LMIC setting, cost and availability make non-expandable implants the only realistic option, and the pre-existing contracture meant accepting intentional shortening of ~0.5–1 cm to achieve a balanced limb.

It’s incredible what modern chemotherapy and teamwork can achieve.This 16-year-old presented with Ewing sarcoma involvin...
29/10/2025

It’s incredible what modern chemotherapy and teamwork can achieve.
This 16-year-old presented with Ewing sarcoma involving the femur with a large soft-tissue component. After neoadjuvant chemotherapy, the mass reduced significantly, making limb salvage possible. We performed a total femur replacement—one of the largest prostheses available—preserving his limb and giving him the best chance at function and being clear of his cancer.

As an orthopaedic oncologist, my primary practice is treating patients suffering from bone tumors. However, the journey ...
12/10/2025

As an orthopaedic oncologist, my primary practice is treating patients suffering from bone tumors. However, the journey often doesn’t end once the cancer is cured — especially in children.

Survivors may later develop deformities as a consequence of tumor excision, growth disturbance, and altered biomechanics. This is where one must bring out the deformity surgeon within and be ready to apply challenging solutions such as the Ilizarov fixator.

This young girl had fibula excision for Ewing sarcoma in childhood. Over time, she developed angulation, shortening, and a rigid foot deformity. Through staged correction, we addressed her leg deformity, and most recently attempted correction of her complex rigid foot deformity with an Ilizarov frame.

Such cases remind us that limb salvage is not just about removing a tumor, but also about restoring function, balance, and quality of life in the long term.

📌 Pediatric Limb Salvage with Liquid Nitrogen–Treated BoneA busy month performing limb salvage surgeries in children usi...
14/09/2025

📌 Pediatric Limb Salvage with Liquid Nitrogen–Treated Bone

A busy month performing limb salvage surgeries in children using liquid nitrogen–treated autografts. This technique provides oncological safety while preserving bone biology and long-term function — a valuable option for childern suffering from Bone tumors.

One week. 2 limb Salvages with Mega prosthesis. Extra Articular and Intra articular resections
09/08/2025

One week. 2 limb Salvages with Mega prosthesis. Extra Articular and Intra articular resections

A 10-year-old male presented with left elbow pain and swelling for 4 months following a fall.Biopsy confirmed a chondrob...
04/07/2025

A 10-year-old male presented with left elbow pain and swelling for 4 months following a fall.

Biopsy confirmed a chondroblastic osteosarcoma. He received neoadjuvant chemotherapy, after which MRI showed an interval reduction in tumor size, with a soft tissue mass involving the proximal meta-diaphysis of the left ulna.

A wide margin excision of the proximal ulna was performed. The bone was recycled using liquid nitrogen.
Recycling of the bone led to fragmentation of the articular surface and olecranon, requiring reconstruction with subsequent fixation and reattachment of the remaining muscles.

Abstract in Global Spine Journal
07/06/2025

Abstract in Global Spine Journal

29/05/2025

Limb Salvage on a 6 years old female with Ewing sarcoma, localized - left femur
Pre Neoadjuvant chemotherapy tumor was crossing Physis which regressed post chemotherapy and spared the physis after which plan was made to salvage the limb with Bone recycling with Liquid Nitrogen. A PHILOS plate was used to engage the remaining epiphyseal region. Moving forward we will plan a Contralateral epiphysiodesis and limb lengthening as her treatment continues.

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