{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T09:57:26Z","timestamp":1776679046333,"version":"3.51.2"},"reference-count":13,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"\n Background<\/jats:title>\n Ewing sarcoma is a malignant primary bone tumor that predominantly affects the long bones and pelvis of children and adolescents. Involvement of the hand is exceptionally rare, particularly at the level of the first metacarpal. When the dominant thumb is affected, treatment becomes especially challenging due to the critical functional role of this structure.<\/jats:p>\n <\/jats:sec>\n \n Case presentation<\/jats:title>\n We report the case of an 11-year-old right-handed boy who presented with a painful swelling of the right thumb. Imaging revealed an aggressive osteolytic lesion of the first metacarpal with soft tissue extension. Histology confirmed Ewing sarcoma. After neoadjuvant chemotherapy according to the EuroEWing 2012 protocol, Thumb-sparing resection was performed, including the trapeziometacarpal and metacarpophalangeal joints. Reconstruction was achieved using a non-vascularized fibular autograft. Despite a poor histological response, surgical margins were tumor-free. Adjuvant chemotherapy and radiotherapy were administered. At one-year follow-up, there was no local recurrence, with satisfactory functional outcome of the dominant hand.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Ewing sarcoma of the first metacarpal is exceedingly rare. Limb-sparing surgery with fibular graft reconstruction may represent a valid alternative to amputation in carefully selected pediatric patients, even in cases of limited histological response, provided that oncological principles are respected.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1833919","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T09:07:35Z","timestamp":1776676055000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Ewing sarcoma of the first metacarpal: a rare case report with thumb-sparing resection and fibular graft reconstruction"],"prefix":"10.3389","volume":"13","author":[{"given":"Aouinti","family":"Mohamed Nizar","sequence":"first","affiliation":[{"name":"Pediatric Orthopeadic Departement, Hospital Children B\u00e9chir Hamza","place":["Tunis, Tunisia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sahar","family":"Ben Ammar","sequence":"additional","affiliation":[{"name":"Institut Salah Azaiez","place":["Tunis, Tunisia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Walid","family":"Saied","sequence":"additional","affiliation":[{"name":"Pediatric Orthopeadic Departement, Hospital Children B\u00e9chir Hamza","place":["Tunis, Tunisia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hajer","family":"Ben Mansour","sequence":"additional","affiliation":[{"name":"Institut Salah Azaiez","place":["Tunis, Tunisia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"Hamdi","sequence":"additional","affiliation":[{"name":"Center for Traumatology and Major Burns, Ben Arous","place":["Tunis, Tunisia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henda","family":"Rais","sequence":"additional","affiliation":[{"name":"Institut Salah Azaiez","place":["Tunis, Tunisia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sami","family":"Bouchoucha","sequence":"additional","affiliation":[{"name":"Pediatric Orthopeadic Departement, Hospital Children B\u00e9chir Hamza","place":["Tunis, Tunisia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rim","family":"Boussetta","sequence":"additional","affiliation":[{"name":"Pediatric Orthopeadic Departement, Hospital Children B\u00e9chir Hamza","place":["Tunis, Tunisia"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"B1","first-page":"17","article-title":"Diffuse endothelioma of bone","volume":"21","author":"Ewing","year":"1921","journal-title":"Proc N Y Pathol Soc"},{"key":"B2","volume-title":"Bone Tumors: General Aspects and Data on 8542 Cases","author":"Dahlin","year":"1986"},{"key":"B3","first-page":"574","article-title":"Localized Ewing sarcoma of the hand: a case report and 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applications","volume":"69","author":"Friedlaender","year":"1987","journal-title":"J Bone Joint Surg Am"},{"key":"B12","first-page":"100","article-title":"Bone and soft-tissue tumors of the hand","volume":"36","author":"Athanasian","year":"2011","journal-title":"J Hand Surg Am"},{"key":"B13","doi-asserted-by":"publisher","first-page":"3192","DOI":"10.1200\/JCO.19.00915","article-title":"High-dose chemotherapy compared with standard chemotherapy and lung radiotherapy in patients with pulmonary metastases from Ewing sarcoma: results of the Euro-EWING 99 trial","volume":"37","author":"Dirksen","year":"2019","journal-title":"J Clin Oncol"}],"container-title":["Frontiers in 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