Multiple osteotomies with Zickel nail fixation for polyostotic fibrous dysplasia involving the proximal part of the femur.

Freeman, Barbara; Bray, Edward W.; Meyer, Ludger

doi:10.2106/00004623-198769050-00009

Cited by 55 publications

(49 citation statements)

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“…A cortical strut graft will very likely not be able to address the extensive forces applied on the proximal femur without this form of stability. Based on the results with internal fixation in other studies [1, 4, 5, 8, 10, 12–14, 17, 20, 23–25] and the findings from our present study, we recommend primary internal fixation in patients with extensive lesions that threaten to fracture or have already induced a fracture, because this approach has shown promising results in several studies. More importantly, although only the combination of internal fixation and autografts has so far been studied, there might be an important role for implantations in combination with cortical allografts in patients with preoperative risk factors.…”

Section: Discussionsupporting

confidence: 63%

What Is the Role of Allogeneic Cortical Strut Grafts in the Treatment of Fibrous Dysplasia of the Proximal Femur?

Majoor

Peeters-Boef

Sande

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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BackgroundManagement of fibrous dysplasia of the proximal femur is a progressive, often recurrent condition of bone that can cause skeletal deformity, fractures, and pain. Allogeneic cortical strut grafting to minimize the risk of fracture or as part of fracture treatment is a promising treatment option, but evidence is scarce on the intermediate- to long-term results of this procedure and there are no data on factors associated with graft failure.Questions/purposesThe purposes of this study were (1) to evaluate the revision-free survivorship; (2) radiographic findings; (3) factors associated with failure; and (4) complications associated with cortical strut allograft to prevent or treat fractures of the proximal femur in patients with fibrous dysplasia.MethodsBetween 1980 and 2013 we performed cortical strut allografting in 30 patients for impending or actual fractures of the proximal femur, of whom 28 (93%) were available for followup at a minimum of 2 years (mean, 13 years; range, 4–37 years) and of whom 22 (73%) had also been evaluated within the last 5 years. During that time, the indications for cortical strut allografting were an impending fracture of the proximal femur, persistent pain, or an actual nondisplaced femoral fracture. In patients who presented with a diaphyseal fracture, a fracture with severe dislocation of severe varus deformity, which required an osteotomy, placement of a blade plate was instead performed and these patients are not included here. During that time, for patients with diaphyseal fractures, and in patients with a displaced femoral fracture of the proximal femur, placement of a blade plate without strut grafting was instead performed; these patients are not included here. The primary outcome was the success rate of allogeneic cortical strut grafting surgery as assessed by the absence of revision surgery for a newly sustained fracture, resorption of the graft, or progressive deformity of the proximal femur. The association of possible contributing factors to graft failure such as gender, age at surgery, preoperative fracture, and anchoring distances of the graft in healthy bone was also evaluated using Cox regression analysis.ResultsRevision surgery was performed in 13 patients, resulting in a mean survival time of 13 years (Kaplan-Meier 95% confidence interval [CI], 10–16). Radiological resorption of the graft was observed in 15 of 28 patients (54%). However, revision surgery was not performed in all patients who developed graft resorption, because of the absence of a risk for fracture on the basis of the anatomical site of resorption. Identified risk factors for graft failure included preoperative fractures (hazard ratio [HR], 4.5; 95% CI, 1.2–17.2; p = 0.028) and insufficient proximal anchoring of the graft in healthy bone (HR, 6.02; 95% CI, 1.3–27; p = 0.02). One patient sustained a refracture after surgery resulting from an in-hospital fall. The fracture was treated without further surgery, and it healed.ConclusionsOur findings from this study suggest that cortical strut all...

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Section: Discussionsupporting

confidence: 63%

What Is the Role of Allogeneic Cortical Strut Grafts in the Treatment of Fibrous Dysplasia of the Proximal Femur?

Majoor

Peeters-Boef

Sande

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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“…[16][17][18] Guille Kumar and MacEwen 19 reported that none of the lesions in their series was eradicated or diminished in size, and that all bone grafts were absorbed. Curettage and bone grafting is not suitable in patients with deformity and pathological fracture.…”

Section: Discussionmentioning

confidence: 99%

“…osteotomies and Zickel nail fixation. 20 Freeman et al 16 recommended this technique because it provided intramedullary stabilisation, reduced the stress concentration distally and, when combined with osteotomy, can correct deformity. However, Guille et al 19 reported a patient with fibrous dysplasia treated with a Zickel nail who at longterm follow-up demonstrated thinning of the medial cortex, probably caused by stress shielding resulting from the intramedullary nail.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of benign bone tumours using external fixation

Tsuchiya

Morsy

Matsubara

et al. 2007

The Journal of Bone and Joint Surgery. British volume

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We present a retrospective study of patients suffering from a variety of benign tumours in whom external fixators were used to treat deformity and limb-length discrepancy, and for the reconstruction of bone defects. A total of 43 limbs in 31 patients (12 male and 19 female) with a mean age of 14 years (2 to 54) were treated. The diagnosis was Ollier's disease in 12 limbs, fibrous dysplasia in 11, osteochondroma in eight, giant cell tumour in five, osteofibrous dysplasia in five and non-ossifying fibroma in two. The lesions were treated in the tibia in 19 limbs, in the femur in 16, and in the forearm in eight. The Ilizarov frame was used in 25 limbs, the Taylor Spatial Frame in seven, the Orthofix fixator in six, the Monotube in four and the Heidelberg fixator in one. The mean follow-up was 72 months (22 to 221). The mean external fixation period was 168 days (71 to 352). The mean external fixation index was 42 days/cm (22.2 to 102.0) in the 22 patients who required limb lengthening. The mean correction angle for those with angular deformity was 23 degrees (7 degrees to 45 degrees ). At final follow-up all patients had returned to normal activities. Four patients required a second operation for recurrent deformity of further limb lengthening. Local recurrence occurred in one patient, requiring further surgery.

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“…Connolly 62 and Freeman et al 63 reported on five patients with extensive polyostotic fibrous dysplasia in whom a proximal femoral deformity extending well distal to the femoral neck had been treated with multiple osteotomies and intramedullary Zickel nail fixation. The Zickel nail allowed stabilization of the entire femur and femoral neck, with fewer failures of fixation or progressive deformities.…”

Section: Correction Of Deformitymentioning

confidence: 99%

Fibrous Dysplasia<sbt aid="1027210">Pathophysiology, Evaluation, and Treatment</sbt>

DiCaprio¹

2005

J Bone Joint Surg Am

390

535

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Fibrous dysplasia is a common benign skeletal lesion that may involve one bone (monostotic) or multiple bones (polyostotic) and occurs throughout the skeleton with a predilection for the long bones, ribs, and craniofacial bones. The etiology of fibrous dysplasia has been linked to an activating mutation in the gene that encodes the alpha subunit of stimulatory G protein (G(s)alpha) located at 20q13.2-13.3. Most lesions are monostotic, asymptomatic, and identified incidentally and can be treated with clinical observation and patient education. Bisphosphonate therapy may help to improve function, decrease pain, and lower fracture risk in appropriately selected patients with fibrous dysplasia. Surgery is indicated for confirmatory biopsy, correction of deformity, prevention of pathologic fracture, and/or eradication of symptomatic lesions. The use of cortical grafts is preferred over cancellous grafts or bone-graft substitutes because of the superior physical qualities of remodeled cortical bone.

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Multiple osteotomies with Zickel nail fixation for polyostotic fibrous dysplasia involving the proximal part of the femur.

Cited by 55 publications

References 0 publications

What Is the Role of Allogeneic Cortical Strut Grafts in the Treatment of Fibrous Dysplasia of the Proximal Femur?

What Is the Role of Allogeneic Cortical Strut Grafts in the Treatment of Fibrous Dysplasia of the Proximal Femur?

Treatment of benign bone tumours using external fixation

Fibrous Dysplasia<sbt aid="1027210">Pathophysiology, Evaluation, and Treatment</sbt>

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