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Dr F.Ali Janjua

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Dr F.Ali Janjua

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09/06/2026

Happy to share our recent publication

"Outcomes of hemicortical resection and reconstruction with liquid nitrogen-treated autograft for high-grade sarcomas: A retrospective case series."

A small case series from our experience at SKMCH evaluating outcomes of biological reconstruction following hemicortical resection for high-grade bone sarcomas.

Thank you to all co-authors and colleagues involved.

14/01/2026

I have completed my two years of Advanced Training in Musculoskeletal Oncology as a Senior Instructor at Shaukat Khanum Memorial Cancer Hospital, Lahore, under the leadership of Dr. Ilyas Rafi, to whom I am truly indebted for his mentorship and guidance.

During this training, I was extensively exposed to both biological and endoprosthetic reconstructions for adult and paediatric sarcomas, which has been a deeply enriching professional experience.

I also pay heartfelt tribute to our patients and their families, who endure so much in their fight against cancer. The journey has been profoundly emotional, and one truly develops a lasting connection with them.

31/12/2025

Ending the year with a revision megaprosthesis.

Female patient with a distal femur replacement (2017) for tumor resection, later complicated by an RTA-related periprosthetic fracture after 5 years. Plating failed to relieve pain, so we proceeded with revision to a megaprosthesis. Intra-operative findings showed a loose femoral sided implant while a well fixed tibial side.
A custom implant would have been ideal, but in LMICs we often work within limitations—careful cement extraction and bone preservation were key for the tibia side.

$A 9-year-old boy with non-metastatic Ewing sarcoma of the left humerus, initially presenting with a pathological fractur...$

29/12/2025

A 9-year-old boy with non-metastatic Ewing sarcoma of the left humerus, initially presenting with a pathological fracture

Pre NACT imaging showed
Large proximal–to–distal humeral lesion with extensive extra-osseous soft-tissue component
Encasement of axillary and brachial neurovascular bundles
Mildly enlarged axillary lymph nodes
CT chest: No pulmonary metastasis
Given tumor bulk, NVB encasement, and fracture, a forequarter amputation was considered the most oncologically safe option.

Post NACT MRI showed interval size reduction
Good treatment response, despite persistent NVB encasement
No new metastatic disease

With favorable response to neoadjuvant chemotherapy, the plan shifted to limb salvage (fibular graft reconstruction) vs
Shoulder disarticulation, depending on intra-operative findings

Intraoperative finding showed that neurovascular bundle was free from the tumor bulk and hence we were able to resect the mass and perform reconstruction with vascularized fibula based on its anterior tibial artery to preserve the growth of the fibula with the help of our plastic surgery collegues.

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?

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

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.

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.

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.

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.

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