Background: Curettage is one of the most common treatment options for benign lytic bone tumors and cystic lesions. In children and young adults, the resultant defect is usually filled with synthetic bone graft, which is a natural calcium phosphate hydroxyappatite (HA) in crystalline ceramic form. Methods: Sixteen cases of benign lytic and cystic lesions of bone were managed by simple curettage and grafting using hydroxyappatite blocks. Displaced pathological fractures or impending peritrochanteric fractures were fixed by implant. Commercially available HA was used for this purpose. Mean duration of follow up was 17.5 months (range 12 -30 months). Mean patient age was 11.2 years (range 6-20 years). Radiological staging of graft incorporation was done as per criteria of Irwin et al. Results: Among 16 cases, 2 patients presented with non-ossifying fibroma and 2 patients with simple bone cyst, 12 cases were aneurysmal bone cyst. 5 patients had pathological fracture. Healing of lesion and graft incorporation is seen in all of the cases. At 6 months of follow up 3 cases were in Irwin stage III, 9 cases were in Irwin stage II and 4 cases were in Irwin stage I. At final follow up 10 cases were in Irwin stage III and rest was in Irwin stage II. No recurrence seen till date. Conclusions: We conclude that meticulous curettage and filling of bone cavity by calcium phosphate hydroxyappatite and fixation with implant in displaced pathological fracture or impending fracture is the procedure of choice of management of benign lytic lesions of bone.
<p class="abstract"><strong>Background:</strong> Different methods exist for fracture reduction and submuscular plating in distal femur intra-articular and metaphyseal extra-articular fractures. Apart from knee flexion, femoral distractor and traction table are commonly used for alignment of fractures in minimally invasive techniques.</p><p class="abstract"><strong>Methods:</strong> 26 distal femoral fractures (all closed fractures) were operated (14 cases in traction table, 12 cases in femoral distractor). Partial articular/unicondylar fractures were excluded from our study. Mean patient age was 42 years (range 18 to 60 years). Evaluation was done by knee society score (KSS).<strong></strong></p><p class="abstract"><strong>Results:</strong> Mean time of radiological union was 23.2 weeks (range 20-28 weeks). 23 fractures united uneventfully, one patient had wound infection, and 2 cases had non-union with implant failure. Debridement in infected implant and re-fixation with long plate and bone grafting were done for fracture union in these two cases. According to KSS, excellent outcome were seen in 6 patients, 10 had good, 8 had fair and 2 had poor outcome.</p><p class="abstract"><strong>Conclusions:</strong> Distraction by traction table or femoral distractor helps us to reduce the fracture by overcoming the pull of gastrocnemius in 2 week old fracture correcting hyperextension/recurvatum deformity. This method can be used as viable alternative in minimally invasive plating causing less chance of infection preserving maximal joint movement.</p><p class="abstract"> </p>
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