Eligible studies compared limb salvage or amputation to a control for the treatment of high-grade and localised osteosarcoma in patients with pathological fracture. Eligible studies had to report sufficient data on the primary outcome of interest: local recurrence. Secondary outcomes included five-year overall survival rate and occurrence of metastasis after limb salvage. Case reports were excluded from the review.
All studies directly compared amputation and limb salvage. Included studies were conducted in USA, Canada, Asia and Europe (two were UK) between 1975 and 2006 (where reported). Median age of patients (where reported) ranged between 11 and 30 years. Most patients were male. Most patients underwent limb salvage and (where reported) between 17% and 71% had displaced fracture. Where reported, between 12% and 43% of patients had poor chemotherapy response (as defined in the review). Where reported, most studies were of patients with Enneking stage-IIB disease.
Two reviewers independently screened studies for inclusion.