Ewing sarcoma of the first metacarpal: a rare case report with thumb-sparing resection and fibular graft reconstruction
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By
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Aouinti Mohamed Nizar
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Sahar Ben Ammar
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Walid Saied
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Hajer Ben Mansour
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Ahmed Hamdi
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Henda Rais
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Sami Bouchoucha
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Rim Boussetta
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April 20, 2026
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Clinical Scorecard: Ewing Sarcoma in the First Metacarpal: A Unique Case of Thumb-Sparing Resection and Reconstruction Using a Fibular Graft
At a Glance
| Category | Detail |
|---|
| Condition | Ewing Sarcoma of the First Metacarpal |
| Key Mechanisms | Malignant primary bone tumor affecting children and adolescents, characterized by aggressive osteolytic lesions. |
| Target Population | Children and adolescents, particularly those with dominant thumb involvement. |
| Care Setting | Pediatric oncology and surgical settings. |
Key Highlights
- Ewing sarcoma in the first metacarpal is exceedingly rare, accounting for less than 1% of cases.
- Limb-sparing surgery with fibular graft reconstruction is a viable alternative to amputation.
- Neoadjuvant chemotherapy followed by surgical resection and adjuvant treatment showed no local recurrence at one-year follow-up.
Guideline-Based Recommendations
Diagnosis
- Diagnosis confirmed via imaging and histological analysis, including biopsy.
Management
- Multimodal approach: systemic chemotherapy, surgical resection, and radiotherapy as indicated.
Monitoring & Follow-up
- Regular follow-up with imaging to assess for local recurrence and metastasis.
Risks
- Potential for local recurrence and complications from chemotherapy and surgery.
Patient & Prescribing Data
Pediatric patients with Ewing sarcoma, particularly those with hand involvement.
Chemotherapy regimens include VDC and IE protocols, with careful monitoring for side effects.
Clinical Best Practices
- Consider limb-sparing approaches in selected pediatric patients to preserve function.
- Adhere to established chemotherapy protocols to optimize treatment outcomes.
- Ensure thorough imaging and histological evaluation for accurate diagnosis.
References
