Fig. 1

A Prechemotherapy X-ray examination showing osteolytic bone destruction in the left distal femur of a 7-year-old male patient who underwent joint preservation intraoperative extracorporeal inactivated autograft replantation for osteosarcoma of the distal femur. Bone destruction was observed on the medial side, with a local soft tissue mass and periosteal reaction. B Two months after chemotherapy, the X-ray examination revealed that osteolytic bone destruction had markedly decreased in the distal femur. The soft tissue mass had disappeared. C Postchemotherapy coronal MRI scan shows a mix of high and low signals inside the medullary cavity. The surrounding soft tissue and bone marrow response area were clearly demarcated. D After 30 min and 50 Gy dose irradiation by cobalt 60, the 13 cm length of inactivated autogenous segment was returned for reconstruction. E The radiographs taken 1 week after surgery showed apparent reduction of the distal femur by solid internal fixation and joint preservation. F Four months after surgery, the X-ray examination revealed bone healing and a normal joint space. G The X-ray examination showed excellent bone healing, and the internal fixation device was removed 2 years after limb salvage surgery. H At the 4-year follow-up, the full-length X-ray of the left lower extremity showed that the extremity was approximately 5 cm shorter than normal