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Introduction Osteosarcoma epidemiology in children younger than 5-year-old is very rare. Currently, limb salvage surgery becomes the preferred treatment in osteosarcoma. Wide excision using cryosurgery has been reported as an effective and safe procedure for malignant bone tumors. Case report A 5-year-old girl was presented with pain and a lump on her right knee. Physical examination showed a solid circumferential mass in the proximal tibia, with limited range of motion due to mass and pain. Osteoblastic lesion with a discrete margin and narrow transition zone on the proximal tibia from plain radiograph and magnetic resonance imaging (MRI) examination. Histopathological examination suggested osteosarcoma with a giant cell rich osteosarcoma subtype. Three cycles of neoadjuvant chemotherapy was conducted with cisplatin, ifosfamide, and adriamycin. We performed limb salvage surgery by wide excision with cryosurgery and vascularized fibular graft reconstruction. Wide excision was performed with the respect to preserve the epiphyseal plate. The proximal tibia segment was recycled using liquid nitrogen and re-implanted, fixed with a locking 2.7 mm T-plate and a straight reconstruction 2.7 mm reconstruction plate. Vascularized fibular graft was used to fill the bone defect on the medial side. Post-operative radiograph showed the plate and screws are well-fixated and the post-operative histopathological examination confirmed the diagnosis of conventional osteosarcoma HUVOS I. There was no post-operative complication observed, and the functional outcome was good. Conclusions Cryosurgery and vascularized fibular graft is a viable reconstructive option for proximal tibia osteosarcoma in very young children.

Introduction Osteosarcoma is the second most common malignant bone tumor. The humerus is the third most common anatomical location for osteosarcoma, however, osteosarcoma around the elbow joint is uncommon. The intricacy of the elbow joint, limited soft tissue coverage, and proximity to nerves and arteries make the surgical resection and reconstruction complicated. Case report A 17-year-old boy came with a chief complaint of lump and pain on his left elbow. One month later, the patient felt there was a lump with a size of a marble on the left elbow, which getting bigger to a size of a tenis ball. Physical examination showed mass on the posterior aspect of the elbow with the size 14x12cm. Plain radiographs revealed osteolytic lesion and periosteal reaction of the distal humerus and the magnetic resonance imaging (MRI) showed a low intensity on T2-weighted imaging. Histopathological examination suggested osteosarcoma. The patient underwent neoadjuvant chemotherapy for 3 cycles. The patient was treated with limb salvage surgery by wide excision, cryosurgery followed by total elbow arthroplasty and ORIF with plate and screw. Postoperative plain radiographs showed the plate and screws are well-fixated. The patient can slowly regain his elbow motion without limitation one month postoperatively. Conclusions Distal humerus in an unusual site for osteosarcoma. Total elbow arthroplasty and ORIF with plate and screw is a favorable reconstruction option for distal humerus osteosarcoma with excellent postoperative functional outcomes.