Salvage of the proximal femur following pathological fractures involving benign bone tumors

Carvallo, Pedro I.; Griffin, Anthony M.; Ferguson, Peter C.; Wunder, Jay S.

doi:10.1002/jso.24072

Cited by 15 publications

(10 citation statements)

References 49 publications

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“…Over the past several decades, the treatment for benign bone lesions has consisted mostly of open curettage and packing the lesion cavity with an autograft, allograft, or bone substitute, which remains the mainstay of therapeutic modalities [34] , [35] . The application of open surgery is relatively simple and easy to learn, but some authors do not recommend it as the initial treatment due to concerns of delayed union, bleeding, or iatrogenic fracture [36] .…”

Section: Discussionmentioning

confidence: 99%

The minimally invasive endoscopic technique for the treatment of symptomatic benign bone lesions: Preliminary results from a retrospective study

Xiao

Zhang

et al. 2020

Journal of Bone Oncology

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Highlights Symptomatic benign bone lesions may cause pain and refractory limp. Conventional open surgery usually involves high risks of complications, which may greatly compromise the overall efficacy of surgery in the long term. This single-institution retrospective study of 34 patients with symptomatic benign bone lesions. All surgical procedures were performed under endoscopic guidance for direct visualization followed by complete curettage of tumor tissue. Patients reported significant improvements in pain, quality of life and functional recovery without complications or need for secondary interventions. Study limitations included a relatively small population of Chinese patients and the lack of a comparative surgical or other minimally invasive techniques. The procedure described may be a valuable alternative to open surgery for symptomatic benign bone lesions.

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Section: Discussionmentioning

confidence: 99%

The minimally invasive endoscopic technique for the treatment of symptomatic benign bone lesions: Preliminary results from a retrospective study

Xiao

Zhang

et al. 2020

Journal of Bone Oncology

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“…Fibrous dysplasia, GCT, and chondroblastoma are the most common lesion producing pathological fractures in the proximal femur. The majority of pathological fractures due to these lesions can be treated by curettage and fixation, without increasing the risk of recurrence [31]. Extensive curettage can decrease recurrence in pathological fractures due to GCT.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Radiological Profile of Ten Interesting Though Rare Presentations of Giant Cell Tumor of Bone

Zacharia¹,

Pai²,

Paul

2020

Indian J Surg Oncol

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Giant cell tumor (GCT) is a benign but locally aggressive lesion of the bone. They are common in skeletally matured individuals with female preponderance. Unusual presentations can occur rarely. This study aims to find out the clinical and radiological profile of ten rare presentations of GCT. We have conducted a retrospective analysis of medical records of ten interesting presentations of giant cell tumor of bone. There was a patient with soft-tissue recurrence after excision. In five cases, the GCT occurred at rare sites and a case to discuss the radiological dilemma in the diagnosis. One case of pathological fracture, another case of seeding of tumor cells in the graft donor site, and a case of pulmonary metastasis were included. There were seven females, two males, and a boy. Out of ten patients, all except two cases were primarily treated at our institution. Clinical profiles of soft-tissue recurrence, rare sites of occurrence, diagnostic dilemma, pathological fracture, seeding at donor site, and metastasis were analyzed and presented. GCT, even though it is a benign lesion, can have a variety of clinical presentations and complications.

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“…Proximal femur can be a common site where the femoral head and neck is less frequently involved than the trochanteric region. Patients often seek consultation for help with mechanical symptoms of pain related to activity and difficulty in ambulating due to compromise of osseous integrity [ 1 ]. Different treatment protocols have been described in previous literatures.…”

Section: Introductionmentioning

confidence: 99%

“…The literatures on benign osteolytic lesions in the femoral head and neck are limited so that some problems remain unanswered such as the factors influencing the recurrence and the postoperative complications. This systematic review aims to ascertain the following questions: (1) what are the common benign osteolytic lesions of femoral head and neck? (2) what factors act in the local recurrence after intralesional curettage?…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment of benign osteolytic lesions in the femoral head and neck: a systematic review

Shi

Zhao

Yan

et al. 2021

BMC Musculoskelet Disord

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Background and objectives Treatment of benign osteolytic lesions in the femoral head and neck can be extremely challenging, particularly in children with open physis or for aggressive tumors with pathological fracture. There remains the difficult management decision as to whether to perform complete excision of the involved area or only curettage. Moreover, there is no agreed consensus on the optimal approach to lesion access when performing curettage, which included the transcervical, open and direct approach. The current systematic review aims to provide guidance for selection of surgical methods in clinical practice by comparing the advantages and drawbacks of different procedures. Methods A comprehensive literature search of PubMed, Embase and Web of Science databases were executed for human studies restricted to the English language. The search was filtered to include studies published from January 1980 to January 2020. Results A total of 33 articles including 274 patients were enrolled in the final analysis. The most common diagnosis was chondroblastoma (CBT) (104, 38.0%), followed by giant cell tumor (GCT) (56, 20.4%). There were 57 (20.8%) patients with pathological fracture. Intralesional curettage was performed in 257 (93.8%) patients with the local recurrence of 12.5% at the mean follow-up of 51.5 months. The patients who were presented with open physis or curetted via transcervical approach developed higher local recurrence in patients with CBT (P < 0.001). The local recurrence rate of GCT is 33.3% after curettage, while 8 of 9 (88.9%) patients with fracture were treated successfully with joint preservation. Two of 45 (4.4%) patients developed avascular necrosis (AVN) of femoral head after surgical hip dislocation. The reported Musculoskeletal Tumor Society (MSTS) Score was comparable among patients with different approaches to curettage. Conclusion The majority of benign osteolytic lesions in the femoral head and neck can be treated with intralesional curettage with acceptable local tumor control and satisfactory function. The incidence of local recurrence might be decreased dramatically for lesion access under direct visualization. The native joint maintenance could be achieved even in patients with aggressive lesions presenting pathological fracture.

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Salvage of the proximal femur following pathological fractures involving benign bone tumors

Abstract: The majority of pathologic fractures through a benign bone tumor of the proximal femur can be successfully treated with curettage, burring, bone grafting and internal fixation without increasing the risk of local recurrence or negatively impacting functional outcome.

Cited by 15 publications

References 49 publications

The minimally invasive endoscopic technique for the treatment of symptomatic benign bone lesions: Preliminary results from a retrospective study

The minimally invasive endoscopic technique for the treatment of symptomatic benign bone lesions: Preliminary results from a retrospective study

Clinical and Radiological Profile of Ten Interesting Though Rare Presentations of Giant Cell Tumor of Bone

Surgical treatment of benign osteolytic lesions in the femoral head and neck: a systematic review

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