Background: Aneurysmal bone cyst (ABC) is an aggressive benign lesion that may sometimes be difficult to treat. Lesions that occur in the proximal femur require to be addressed aggressively because of the high rate of local recurrence and the risk of fracture. Few articles report the experience of management of ABC in the proximal femur. This location presents a surgical challenge due to its anatomical and biomechanical peculiarity. Methods: We retrospectively reviewed 16 cases with ABC in the proximal femur that were treated in our institution between 2005 and 2014, utilizing extended curettage and liquid nitrogen as adjuvant therapy and reconstruction using nonvascularized autogenous fibular strut graft. The mean follow-up period was 50.5 months. Five cases presented as recurrent cases, while four cases presented with pathological fractures. Results: The functional score ranged from 70 to 90 on modified Musculoskeletal Tumor Society score with a mean score of 81.25, which is considered to be excellent function. Time for graft incorporation ranged from 10 to 12 weeks. One case got local recurrence, and one case got early surgical site infection. Conclusions: Extended curettage and cryotherapy represent a recommended approach for management of ABC in the proximal femur with favorable results.
Background:
Many technical and financial obstacles face surgeons when performing limb-salvage surgeries.
Methods:
We retrospectively studied 15 patients with osteosarcoma around the knee joint treated with limb salvage procedure in the form of wide resection, recycling the resected segment using liquid nitrogen followed by implantation of a hinged knee prosthesis and re-implantation of the autograft-prosthetic composite to the host bone by osteosynthesis, with mean follow-up duration of 66.53 mo.
Results:
The average duration until union of the graft was 7.73 mo (range, 4-13 mo). Implant failure occurred in one of 15 patients with resultant screw pull out for whom revision plating was done. Superficial wound infection occurred in one of 15 patients for whom surgical debridement was done. No prosthesis-related complications were detected until the final follow-up. Musculoskeletal Tumor Society (MSTS) scoring was applicable for 13 patients who were alive at the final follow-up period and was 73%. Eleven of 15 patients were disease free at last follow-up (average follow-up 66.5 mo).
Conclusions:
As far as we know no other research showed population study homogeneity regarding autograft prosthesis composite reconstruction using liquid nitrogen around the knee joint for the same pathology. Use of recycled autograft prosthesis composite is an option that eliminates disadvantages of both stand-alone endoprosthetic replacement and recycled tumor-bearing segment autografts while preserving the advantages of these techniques. The technique provides comparable survival rates to other techniques. It represents an alternative to the use of allograft when culturally unacceptable and saves about 50% of expected cost as compared to megaprosthesis reconstruction.
Background:
Unicameral bone cysts account for 20% of benign bone lesions. A variety of treatment modalities exist with variable outcomes. This was a retrospective study that aimed to compare the clinical and radiographic outcomes of two treatment methods for unicameral bone cysts in children: cyst decompression utilizing intramedullary nailing alone versus marginal resection through curettage, intramedullary nailing, and synthetic bone grafting.
Methods:
Seventy-one patients with unicameral bone cysts were treated with one of two techniques: decompression using elastic intramedullary nails (Group 1, 37 patients) or open curettage and grafting with a calcium sulfate bone substitute with fixation by elastic intramedullary nails (Group 2, 34 patients). Outcome parameters included the radiographic healing rate, time to solid union, recurrence rate, functional outcome, and complication rates.
Results:
The mean follow-up period was 30.9 mo for group 1 and 35.9 mo for group 2. The mean Musculoskeletal Tumor Society scoring was 91 for group 1 and 93 for group 2. Radiographic healing showed Capanna grade 1 in 78% of the patients in group 1 and 85% in group 2 with a similar mean time to healing of 8 wk. Recurrence occurred in two patients in group 1 and in one patient in group 2.
Conclusions:
No statistically significant difference exists regarding the outcomes of both treatment techniques. Therefore, we recommend the use of elastic nails for intramedullary nailing alone as a first line of management of primary unicameral bone cyst because it is a less invasive technique with reliable results.
Level of Evidence:
Level IV.
Background:
The distal tibia is an unusual location for giant cell tumor. Less than 4% occurring in bone involve the foot and ankle region; the exact prevalence in the distal tibia is not known. Treatment remains unclear because of the rarity of the lesion in this location, the anatomy of the ankle, and difficulties associated with reconstruction.
Methods:
We retrospectively reviewed 10 patients who underwent extended curettage for giant cell tumor of the distal tibia, using adjuvant cryotherapy and biological reconstruction with autograft. The age of the patients ranged between 23-50 yr. Nine patients had newly diagnosed giant cell tumor while one patient presented with a recurrent lesion after simple curettage and synthetic bone grafting at another hospital. One patient presented with a nondisplaced pathological fracture of the distal tibia. He was treated initially with a short leg cast until the fracture healed, then surgical intervention was done. No intraarticular extension was present preoperatively in any patient.
Results:
The average follow-up from primary surgical intervention was 57 mo. At the end of the study, the mean musculoskeletal tumor score (MSTS) was 90. Local recurrence occurred in two patients. The average duration until union of the graft was 6.2 mo (range, 4-10 mo).
Conclusions:
Giant cell tumor of the distal tibia is a rare benign but aggressive tumor. Extended curettage and liquid nitrogen as adjuvant, followed by biologic reconstruction using autogenous bone graft is a solid line of treatment for lesions without intraarticular extension that provides good results.
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