Abstract
Purpose
We aimed to develop a surgical treatment strategy for benign bone lesions of the proximal femur based upon retrospective review of our data in 62 children.
Methods
Sixty-two children [38 male, 24 female; median age 9 years (range 5–18 years)] with proximal femoral benign bone lesions were surgically treated between 2005 and 2013. Histopathological diagnoses were simple (31) or aneurysmal (27) bone cysts, and nonossifying fibromas (4). The pathological fracture rate was 77.4 %. Surgical treatment was determined due to four criteria, including patient’s skeletal maturity, localization and initial diagnosis of lesion, and amount of bone loss in the femoral neck and lateral proximal femur. Surgical procedure consisted of biopsy, curettage, bone grafting, and internal fixation when required. The median follow-up was 45 months (range 25–89 months).
Results
Complete clinical recovery was achieved in 56 (90.3 %) patients between 4 and 8 months postoperatively; full weight-bearing and mobilization, without pain and limping, was possible. The median preoperative and postoperative last follow-up Musculoskeletal Tumor Society (MSTS) scores were 13.3 % (range 10–23.3 %) and 96.6 % (range 90–100 %), respectively (p < 0.0001). The pathological fractures were healed in 10 weeks on average (range 8–12 weeks). Fifty-seven (92 %) patients demonstrated complete or significant partial radiographic healing between 5 and 7 months that maintained throughout follow-up. Local recurrence was not observed, and only 1 (1.6 %) patient required reoperation for partial cyst healing. There were 5 (8 %) complications, 1 (1.6 %) of which required reoperation.
Conclusions
This treatment strategy can provide good local control and excellent functional and radiological results in the management of benign bone lesions of the proximal femur in children.
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References
Arkader A, Dormans JP (2010) Pathological fractures associated with tumors and unique conditions of the musculoskeletal system. In: Beaty JH, Skaggs DL, Flynn JM, Waters K (eds) Rockwood and Wilkins’ fractures in children, 7th edn. Lippincott Williams & Wilkins, Philadelphia, pp 120–191
Dormans JP, Pill SG (2002) Fractures through bone cysts: unicameral bone cysts, aneurysmal bone cysts, fibrous cortical defects, and non-ossifying fibromas. Instr Course Lect 51:457–467
Ortiz EJ, Isler MH, Navia JE, Canosa R (2005) Pathological fractures in children. Clin Orthop Relat Res 432:116–126
Erol B, Dormans JP (2005) Musculoskeletal tumors in children. In: Dormans JP (ed) Core knowledge in orthopaedics. Pediatric orthopaedics. Philadelphia: Elsevier Mosby, pp 290–336
Erol B, Pill SG, Guttenberg ME, Meyer JS, Dormans JP (2002) Pathologic hip fracture in a 4-year-old boy. Clin Orthop Relat Res 403:264–273
Saraph V, Linhart WE (2005) Modern treatment of pathological fractures in children. Injury 36:64–74
Shih HN, Cheng CY, Chen YJ, Huang TJ, Hsu RW (1996) Treatment of the femoral neck and trochanteric benign lesions. Clin Orthop Relat Res 328:220–226
Wai EK, Davis AM, Griffin A, Bell RS, Wunder JS (2001) Pathologic fractures of the proximal femur secondary to benign bone tumors. Clin Orthop Relat Res 393:279–286
Abdel-Mota’al MM, Mohamad ASO, Katchy KC, Mallur AA, Ahmad FH, El-Alfy B (2008) Management of unicameral bone cyst of proximal femur: experience of 14 cases and review of literature. Kuwait Med J 40:202–210
Cohen J (1977) Unicameral bone cysts: a current synthesis of reported cases. Orthop Clin North Am 8(4):715–736
Malkawi H, Shannak A, Amr S (1984) Surgical treatment of pathological subtrochanteric fractures due to benign lesions in children and adolescents. J Pediatr Orthop 4(1):63–69
Roposch A, Saraph V, Linhart WE (2000) Flexible intramedullary nailing for the treatment of unicameral bone cysts in long bones. J Bone Joint Surg Am 82-A(10):1447–1453
Roposh A, Saraph V, Linhart WE (2004) Treatment of femoral neck and trochanteric simple bone cysts. Arch Orthop Trauma Surg 124(7):437–442
Vigler M, Weigl D, Schwarz M, Ben-Itzhak I, Salai M, Bar-On E (2006) Subtrochanteric femoral fractures due to simple bone cysts in children. J Pediatr Orthop B 15(6):439–442
Arata MA, Peterson HA, Dahlin DC (1981) Pathological fractures through non-ossifying fibromas. J Bone Joint Surg 63(6):980–988
Enneking WF (1983) Natural history. In: Enneking WF (ed) Musculoskeletal tumor surgery. Churchill Livingstone, New York, pp 1–23
Enneking WF, Dunham W, Gebhardt MC, Malawar 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
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
Gibbs CP Jr, Hefele MC, Peabody TD, Montag AG, Aithal V, Simon MA (1999) Aneurysmal bone cyst of the extremities. Factors related to local recurrence after curettage with a high-speed burr. J Bone Joint Surg Am 81(12):1671–1678
Erol B, Topkar MO, Calıskan E, Erbolukbası R (2015) Surgical treatment of active or aggressive aneurysmal bone cysts in children. J Pediatr Orthop B 24(5):461–468
Biesecker JL, Marcove RC, Huvos AG, Miké V (1970) Aneurysmal bone cysts. A clinicopathologic study of 66 cases. Cancer 26(3):615–625
Marcove RC, Sheth DS, Takemoto S, Healey JH (1995) The treatment of aneurysmal bone cyst. Clin Orthop Relat Res 311:157–163
Ozaki T, Hillmann A, Lindner N, Winkelmann W (1997) Cementation of primary aneurysmal bone cysts. Clin Orthop Relat Res 337:240–248
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(1):20–25
Glancy GL, Brugioni DJ, Eilert RE, Chang FM (1991) Autograft versus allograft for benign lesions in children. Clin Orthop 262:28–33
Bumci I, Vlahović T (2002) Significance of opening the medullar canal in surgical treatment of simple bone cyst. J Pediatr Orthop 22(1):125–129
Givon U, Sher-Lurie N, Schindler A, Ganel A (2004) Titanium elastic nail-a useful instrument for the treatment of simple bone cyst. J Pediatr Orthop 24(3):317–318
Santori F, Ghera S, Castelli V (1988) Treatment of solitary bone cysts with intramedullary nailing. Orthopedics 11(6):873–878
Cha SM, Shin HD, Kim KC, Kang DH (2013) Flexible intramedullary nailing in simple bone cysts of the proximal humerus: prospective study for high-risk cases of pathologic fracture. J Pediatr Orthop B 22(5):475–480
de Sanctis N, Andreacchio A (2006) Elastic stable intramedullary nailing is the best treatment of unicameral bone cysts of the long bones in children? Prospective long-term follow-up study. J Pediatr Orthop 26(4):520–525
Glanzmann MC, Campos L (2007) Flexible intramedullary nailing for unicameral cysts in children’s long bones. J Child Orthop 1(2):97–100
Masquijo JJ, Baroni E, Miscione H (2008) Continuous decompression with intramedullary nailing for the treatment of unicameral bone cysts. J Child Orthop 2(4):279–283
Hou HY, Wu K, Wang CT, Chang SM, Lin WH, Yang RS (2010) Treatment of unicameral bone cyst: a comparative study of selected techniques. J Bone Joint Surg Am 92(4):855–862
Hunt KJ, Bergeson A, Coffin CM, Randall RL (2009) Percutaneous curettage and bone grafting for humeral simple bone cysts. Orthopedics. 32(2):89
Mik G, Arkader A, Manteghi A, Dormans JP (2009) Results of a minimally invasive technique for treatment of unicameral bone cysts. Clin Orthop Relat Res 467(11):2949–2954
Schreuder HW, Conrad EU 3rd, Bruckner JD, Howlett AT, Sorensen LS (1997) Treatment of simple bone cysts in children with curettage and cryosurgery. J Pediatr Orthop 17(6):814–820
Hirata M, Murata H, Takeshita H, Sakabe T, Tsuji Y, Kubo T (2006) Use of purified beta-tricalcium phosphate for filling defects after curettage of benign bone tumors. Int Orthop 30:510–513
Dormans JP, Sankar WN, Moroz L, Erol B (2005) Percutaneous intramedullary decompression, curettage, and grafting with medical-grade calcium sulfate pellets for unicameral bone cysts in children: a new minimally invasive technique. J Pediatr Orthop 25:804–811
Gentile JV, Weinert CR, Sclechter JA (2013) Treatment of unicameral bone cysts in pediatric patients with an injectable regenerative graft: a preliminary report. J Pediatr Orthop 33:254–261
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Erol, B., Topkar, M.O., Aydemir, A.N. et al. A treatment strategy for proximal femoral benign bone lesions in children and recommended surgical procedures: retrospective analysis of 62 patients. Arch Orthop Trauma Surg 136, 1051–1061 (2016). https://doi.org/10.1007/s00402-016-2486-9
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DOI: https://doi.org/10.1007/s00402-016-2486-9