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Fibular strut graft for humeral aneurysmal bone cyst with varus deformity

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Abstract

Purpose

Proximal humerus is a common site for ABC and frequently associated with varus deformity that limits shoulder abduction. A prospective study was conducted to evaluate the use of intramedullary non-vascularised autogenous fibular strut graft for reconstruction without internal fixation.

Methods

A total of 20 patients (12 girls, 8 boys) were managed for proximal humeral ABC with varus deformity by extended curettage, osteotomy, intramedullary fibular graft and composite bone substitute. Their ages ranged from 10 to 17 years (average, 13.3 years). The lesion was juxtaphyseal in 16 patients and metaphyseal in 4. All cysts were active and centrally located type 2. The modified Enneking scoring system was used for final functional evaluation. Radiological assessment was done for the extent of defect healing, incorporation of the fibula and correction of the deformity.

Results

After a mean follow-up of 41.2 months (range, 24–74) most of patients were satisfied and resumed daily activities without pain and with good range of shoulder movement. One patient complained of shoulder pain 10 months after surgery and was attributed to local recurrence. Limitation of recreational activity was experienced by one patient. There were no cases of deep infection, nerve deficit or pathological fracture. No cases of failed healing or incorporation of the fibula was detected. The improved shoulder abduction was closely related to the mean correction of the neck shaft angle.

Conclusions

The technique is proved to be effective in controlling disease, correcting deformity and improving function.

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References

  1. Cottalorda J, Kohler R, Sales de Gauzy J, Chotel F, Mazda K, Lefort G, Louahem D, Bourelle S, Dimeglio A (2004) Epidemiology of aneurysmal bone cyst in childrn: a multicenter study and literature review. J Pediatr Orthop B 13:389–394

    Article  PubMed  Google Scholar 

  2. Martinez V, Sissons HA (1988) Aneurysmal bone cyst: a review of 123 cases including primary lesions and those secondary to other bone pathology. Cancer 61:2291–2304

    Article  CAS  PubMed  Google Scholar 

  3. Cottalorda J, Bourelle S (2007) Modern concepts of primary aneurysmal bone cyst. Arch Orthop Trauma Surg 127:105–114

    Article  PubMed  Google Scholar 

  4. Rapp TB, Ward JP, Alaia MJ (2012) Aneurysmal bone cyst: review article. J Am Acad Orthop Surg 20:233–241

    Article  PubMed  Google Scholar 

  5. Varshney MK, Rastogi S, Khan SA, Trikha V (2010) Is sclerotherapy better than intralesional excision for treating aneurysmal bone cysts? Clin Orthop Relat Res 468(6):1649–1659

    Article  PubMed Central  PubMed  Google Scholar 

  6. Topouchian V, Mazda K, Hamze B, Laredo JD, Pennecot GF (2004) Aneurysmal bone cysts in children: complications of fibrosing agent injection. Radiology 232(2):522–526

    Article  PubMed  Google Scholar 

  7. Peraud A, Drake JM, Armstrong D, Hedden D, Babyn P, Wilson G (2004) Fatal ethibloc embolization of vertebrobasilar system following percutaneous injection into aneurysmal bone cyst of the second cervical vertebra. AJNR Am J Neuroradiol 25(6):1116–1120

    CAS  PubMed  Google Scholar 

  8. Rossi G, Rimondi E, Bartalena T, Gerardi A, Alberghini M, Staals EL, Errani C, Bianchi G, Toscano A, Mercuri M, Vanel D (2010) Selective arterial embolization of 36 aneurysmal bone cysts of the skeleton with N-2-butyl cyanoacrylate. Skelet Radiol 39:161–167

    Article  Google Scholar 

  9. Mavrogenis AF, Rossi G, Rimondi E, Ruggieri P (2011) Aneurysmal bone cyst of the acromion treated by selective arterial embolization. J Pediatr Orthop B 20(5):354–358

    Article  PubMed  Google Scholar 

  10. Rossi G, Mavrogenis AF, Papagelopoulos PJ, Rimondi E, Ruggieri P (2012) Successful treatment of aggressive aneurysmal bone cyst of the pelvis with serial embolization. Orthopedics 35(6):e963–e968

    Article  PubMed  Google Scholar 

  11. Mavrogenis AF, Angelini A, Rossi G, Rimondi E, Guerra G, Ruggieri P (2014) Successful NBCA embolization of a T2 aneurysmal bone cyst. Acta Orthop Belg 80:126–131

    PubMed  Google Scholar 

  12. Marcove RC, Sheth DS, Takemoto S, Healey JH (1995) The treatment of aneurysmal bone cyst. Clin Orthop Relat Res 311:157–163

    PubMed  Google Scholar 

  13. Schreuder HW, Veth RP, Pruszczynski M, Lemmens JA, Koops HS, Molenaar WM (1997) Aneurysmal bone cysts treated by curettage, cryotherapy and bone grafting. J Bone Joint Surg (Br) 79:20–25

    Article  CAS  Google Scholar 

  14. Ramirez AR, Stanton RP (2002) Aneurysmal bone cyst in 29 children. J Pediatr Orthop 22:533–539

    PubMed  Google Scholar 

  15. Cottalorda J, Kohler R, Chotel F, de Gauzy JS, Lefort G, Louahem D, Bourelle S, Dimeglio A (2005) Recurrence of aneurysmal bone cysts in young children: a multicentre study. J Pediatr Orthop B 4(3):212–218

    Article  Google Scholar 

  16. Flont P, Kolacinska-Flont M, Niedzielski K (2013) A comparison of cyst wall curettage and en bloc excision in the treatment of aneurysmal bone cysts. World J Surg Oncol 11:109. doi:10.1186/1477-7819-11-109

    Article  PubMed Central  PubMed  Google Scholar 

  17. Dormans JP, Hanna BG, Johnston DR, Khurana JS (2004) Surgical treatment and recurrence rate of aneurysmal bone cysts in children. Clin Orthop Relat Res 421:205–211

    Article  PubMed  Google Scholar 

  18. Cimmings JE, Smith RA, Heck RK Jr (2010) Argon beam coagulator as adjuvant treatment after curettage of aneurysmal bone cysts. Clin Orthop Relat Res 468:231–23

    Article  Google Scholar 

  19. Schindler OS, Cannon SR, Briggs TWR, Blunn GW (2008) Composite ceramic bone graft substitute in the treatment of locally aggressive benign bone tumors. J Orthop Surg 16(1):66–74

    CAS  Google Scholar 

  20. Yanguizawa M, Taberner GS, Aihara AY, Yamaguchi CK, Guimaraes MC, Rosenfeld A, Fernandes JL, Fernandes ARC (2008) Imaging of growth plate injuries. Radiol Bras 41(3):199–204

    Article  Google Scholar 

  21. Nascimento D, Suchard G, Hatem M, de Abreu A (2014) The role of magnetic resonance imaging in the evaluation of bone tumors and tumor-like lesions. Insights Imaging 5:419–440

    Article  PubMed Central  PubMed  Google Scholar 

  22. Capanna R, Bettelli G, Biagini R, Ruggieri P, Bertoni F, Campanacci M (1985) Aneurysmal bone cysts of long bones. Ital J Orthop Traumatol 11:409–417

    CAS  PubMed  Google Scholar 

  23. Enneking WF (1986) A system of staging musculoskeletal neoplasms. Clin Orthop Relat Res 204:9–24

    PubMed  Google Scholar 

  24. Enneking WF, Duncham W, Gebhardt MC, Malawer M, Pritchard DJ (1993) A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res 286:241–246

    PubMed  Google Scholar 

  25. Shih HN, Shih LY, Cheng CY, Hsu KY, Chang CH (2002) Reconstructing humerus defects after tumor resection using an intra-medullary cortical allograft strut. Chang Gung Med J 25(10):656–662

    PubMed  Google Scholar 

  26. Mankin HJ, Hornicek FJ, Ortiz-Cruz E, Villafuerte J, Gebhardt MC (2005) Aneurysmal bone cyst: a review of 150 patients. J Clin Oncol 23:6756–6762

    Article  PubMed  Google Scholar 

  27. Vergel De Dios AM, Bond JR, Shives TC, McLeod RA, Unni KK (1992) Aneurysmal bone cyst: a clinicopathological study of 238 cases. Cancer 69(12):2921–2931

    Article  CAS  PubMed  Google Scholar 

  28. Glancy GL, Brugiori DJ, Eilet RE, Chang FM (1991) Autograft versus allograft for benign lesions in children. Clin Orthop Relat Res 262:28–33

    PubMed  Google Scholar 

  29. Grzegorzewski A, Pogonowicz E, Sibinski M, Marciniak M, Synder M (2010) Treatment of benign lesions of humerus with resection and non-vascularised, autologous fibular graft. Int Orthop 34:1267–1272

    Article  PubMed Central  PubMed  Google Scholar 

  30. Ghert M, Cotterjohn N, Manfrini M (2007) The use of free vascuralized fibular grafts in skeletal reconstruction for bone tumors in children. J Am Acad Orthop Surg 15(10):577–587

    PubMed  Google Scholar 

  31. Arai K, Toh S, Tsubo K, Nishikawa S, Narita S, Miura H (2002) Complications of vascularized fibula graft for reconstruction of long bones. Plast Reconstr Surg 109(7):2301–2306

    Article  PubMed  Google Scholar 

  32. Guven M, Demirel M, Ozler T, Bassorgun IC, Ipek S, Kara S (2012) An aggressive aneurysmal bone cyst of the proximal humerus and related complications in a pediatric patient. Strat Traum Limb Recon 7:51–56

    Article  Google Scholar 

  33. Ozcanli H, Aydin AT, Yeter B, Akyildiz FF, Gurer EI (2008) A new technique for aneurysmal bone cysts of the proximal humerus: Cortical collapsing. Acta Orthop Traumatol Turc 42(3):161–165

    Article  PubMed  Google Scholar 

  34. Wright TW, Miller GJ, Vander Griend RA, Wheeler D, Dell PC (1993) Reconstruction of the humerus with an intramedullary fibular graft: a clinical and biomechanical study. J Bone Joint Surg (Br) 75:804–807

    CAS  Google Scholar 

  35. Lin PP, Brown C, Raymond AK, Deavers MT, Yasko AW (2008) Aneurysmal bone cysts recur at juxtaphyseal locations in skeletally immature patients. Clin Orthop Relat Res 466:722–728

    Article  PubMed Central  PubMed  Google Scholar 

  36. Abuhassan FO, Shannak A (2010) Non-vascularized fubular graft reconstruction after resection of giant aneurysmal bone cyst (ABC). Strat Trauma Limb Recon 5:149–154

    Article  Google Scholar 

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Conflicts of interest

No benefits of any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Orthopaedic Oncology Unit, Mansoura University Hospital, 36 Al-Gomhoria Street, P. O. Box 35516, Mansoura, Egypt

    Mohamed F. Mostafa & Sallam I. Fawzy

Authors
  1. Mohamed F. Mostafa
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  2. Sallam I. Fawzy
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Corresponding author

Correspondence to Mohamed F. Mostafa.

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Mostafa, M.F., Fawzy, S.I. Fibular strut graft for humeral aneurysmal bone cyst with varus deformity. International Orthopaedics (SICOT) 39, 1391–1398 (2015). https://doi.org/10.1007/s00264-015-2746-2

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  • DOI: https://doi.org/10.1007/s00264-015-2746-2

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