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Bone mineral density changes in a free vascularised fibular graft in the distal femoral bone after osteosarcoma in a 10-year-old boy: a 7-year follow-up
  1. Andrea René Jørgensen1,
  2. Peter Holmberg Jørgensen2,3,
  3. Birgitte Jul Kiil4 and
  4. Maiken Stilling2,3
  1. 1Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark
  2. 2Department of Orthopedic Surgery, Aarhus Universitetshospital, Aarhus N, Region Midt, Denmark
  3. 3Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
  4. 4Department of Plastic Surgery, Aarhus University Hospital, Aarhus N, Denmark
  1. Correspondence to Andrea René Jørgensen; anjo{at}


A 10-year-old boy presented with continuous reports of pain located to the left knee. Imaging revealed a sclerotic process in the left distal femur, and biopsies were consistent with chondroblastic osteosarcoma. As part of standard treatment the patient underwent neoadjuvant chemotherapy followed by limb sparring surgery and adjuvant chemotherapy. The entire tumour was excised and femoral bone reconstruction was performed with a double barrel free vascularised fibular graft. Bone mineral density (BMD) can be decreased in childhood survivors of cancer. The patient was followed for 7 years with dual-energy X-ray absorptiometry scans in order to assess BMD and graft adaption. Despite two accidental fractures to the graft region local and global BMD underwent an overall increase. Approximately 7 years after tumour resection the patient had a global Z-score of 0.2, which is considered within normal range.

  • cancer intervention
  • paediatric oncology
  • orthopaedics
  • osteoporosis

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  • Contributors BJK and PHJ performed the surgery and collected relevant perioperative data. PHJ and MS collected the data and analysed the data. ARJ drafted the first manuscript and analysed the data. All authors revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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