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Resume La prise en charge actuelle, multidisciplinaire, et les progres realises font que la survie des patients atteints de tumeurs de l’appareil locomoteur s’est nettement amelioree. Nous devons tenir compte des sequelles orthopediques a long terme dans nos choix chirurgicaux, dues au traitement chirurgical lui-meme (amputation ou conservation de membre – choix du type de reconstruction), mais aussi dues aux therapeutiques associees (chimiotherapie, radiotherapie). Les reconstructions par allogreffe ont des complications durant les trois premieres annees (infections, fractures, pseudarthroses). Passe ce cap, la longevite des allogreffes est correcte, mais a 10 ans de recul, 60 % auront ete otees. Pour ce qui est des protheses articulaires, leur survie globale est de 75 % a 10 ans et de 52 % a 20 ans. Comme pour les allogreffes, les ennuis infectieux surviennent dans les premieres annees. Les changements de prothese plus tardifs sont lies a des causes mecaniques. Il est beaucoup plus difficile de se faire une idee du devenir a long terme des reconstructions plus biologiques du fait du manque de recul, excepte pour les fibula vascularisees qui ont de bons resultats a long terme. La qualite de vie des patients operes d’une tumeur maligne de l’appareil locomoteur a ete l’objet de nombreux articles qui, pour la plupart, comparent les conservations de membre avec les amputations. Globalement, les resultats semblent equivalents. Toutes ces donnees sont a prendre en compte lorsqu’on decide d’un traitement pour un enfant ou un adolescent. La qualite de vie, la fonction du membre atteint, la necessite ou non de reintervenir incitent a proposer des reconstructions, lorsque cela est possible, qui se rapprochent au mieux de l’anatomie normale. Nos connaissances restent fragmentaires du fait de la difficulte d’organiser un suivi sur un tres long terme. Nous ne pourrons progresser qu’en organisant des filieres de soins entre chirurgien d’enfants et chirurgien d’adultes.

Multidisciplinary care, modern care management, and medical progress have brought significant gains in modern survival rates for children and adolescents with tumors of the musculoskeletal system.The surgical approach must rest on the consideration of the long-term orthopedic sequelae likely to be caused by the elected treatment (limb amputation versus limb conservation - reconstruction choices), as well as by adjuvant therapies, such as chemotherapy or radiotherapy. Complications due to allograft reconstructions (infections, fractures, pseudoarthritis) occur within the range of 0 to 36 months. After 36 months, allograft longevity is fair, but 10 years later, 60% of grafts are likely to have failed and been removed. Joint prostheses have overall survival rates of 75% over 10 years, and 52% over 20 years. As for allografts, infectious complications occur within the first few years, while later prosthetic replacements are mostly due to mechanical causes. Assessing the long-term evolution of biological reconstructions proves a lot more challenging, due to the lack of hindsight and available information, except for vascularized fibula grafts, which show good long-term results. Numerous medical reviews have been published that address the quality of life of children treated for malignant tumors of the musculoskeletal system. They mostly consist in comparative studies between limb conservation and limb amputation, and point to similar results overall. Such data must be taken into account when deciding on a treatment for a child or an adolescent: quality of life, the function of the affected limb, the probable need for re-operation all encourage to favor reconstructions whenever they are possible, as they come closest to normal anatomy.Too frequently, medical knowledge remains fragmented among multiple disciplines, because of the difficulty of organizing follow-up over the very long-term. Progress can only be achieved by setting-up multidisciplinary care pathways between pediatric surgeons and surgeons treating adult patients.