An aggressive aneurysmal bone cyst of the proximal humerus and related complications in a pediatric patient

Abstract

Clinical behavior of aneurysmal bone cyst (ABC) in younger patients can be more aggressive than that in older children and adults. Angular deformity and shortening can occur due to growth plate destruction or tumor resection. A 11-year-old boy who had been operated twice in another center for an ABC located in the left proximal humerus presented to the author’s institution with complaints of pain, deformity and shortening of the left arm. Plain radiographs revealed left proximal humerus nonunion with a large defect. Reconstruction with nonvascularized fibular autograft was applied and left upper extremity was immobilized in a velpou bandage. At the third-month follow-up, graft incorporation was observed in the distal part; however, proximal part did not show adequate healing on radiographs. Additional immobilization in a sling for 3 months was advised to the patient and his family. However, they were lost to follow-up and readmitted to the author’s institution at the 12th month postoperatively. Radiographs showed failure of the fibular graft fixation and nonunion of the humerus. Autogenic bone grafts, either vascularized or nonvascularized are the best treatment method for the large defects after tumor curettage or resection. Nonvascularized grafts are technically much easier to use than vascularized grafts and provide excellent structural bone support at the recipient side. However, they may take several months to be fully incorporated. In addition, good therapeutic outcomes require patience and collaboration with the patient and parents. Most importantly, the patient should be monitored closely.

Giant aneurysmal bone cyst mimicking malignant tumor

“…The strategy of treating aneurysmal bone cyst has been discussed by orthopaedic specialists treating bone tumors. The [2]. However, despite many treatment techniques, between 5 and 40% of relapses are described [3].…”

Surgical Treatment of an Aneurysmal Bone Cyst with Avascular Bone Graft

“…Although they usually involve the metaphyseal region, aneurysmal bone cysts may on occasion cross the physis into the epiphysis or may extend into the diaphysis. Almost 20% of aneurysmal bone cysts involve the spine, can be located anywhere between the axis and the sacrum and may lead to cord compression or spinal deformities (1,2,3,4).…”

“…Management includes combinations of embolization, curettage with or without bone grafting, cementing of the cavity, reconstructive surgery-bone resection and grafting using vascular or avascular bone graft, and most recently sclerotherapy (4,6).…”

“…Curettage with or without bone grafting of aneurysmal cysts has been the standard treatment for many years. Unfortunately, this tumor has a high incidence of local recurrence (14% to 59%) after curettage and other treatments have been indicated (4,6).…”

Treatment of an aggressive aneurysmal bone cyst with percutaneous injection of polidocanol: a case report

“…A variety of treatments is available for ABCs, ranging from curettage (with or without filling of the cavity with polymethylmethacrylate) or autologous en block excisions with reconstruction of the skeletal defect with autograft or allograft, cryosurgery, selective embolization of the feeding arteries or radiation [ 1 – 4 ]. Most authors have relied on a more radical resection and subsequent reconstruction of the skeletal defect in order to treat aggressive ABCs [ 5 – 8 ]. Healing has also been achieved by selective arterial embolization [ 9 ] or radiotherapy, combined or not with cryosurgery [ 1 , 10 ].…”