Ryszard Tomaszewski1,2, Erich Rutz3,4,5, Johannes Mayr6,7, Jerzy Dajka8. 1. Department of Pediatric Traumatology and Orthopedics, Silesian Medical University, Katowice, Poland. 2. Institute of Biomedical Engineering, Faculty of Science and Technology, University of Silesia, Katowice, Poland. 3. Department of Orthopaedics, The Royal Children's Hospital Melbourne, 50 Flemington Road Parkville Victoria, Melbourne, 3052, Australia. erich_rutz@hotmail.com. 4. The University of Basel, Basel, Switzerland. erich_rutz@hotmail.com. 5. Murdoch Children's Research Insitute, MCRI, Melbourne, 3052, Australia. erich_rutz@hotmail.com. 6. Department of Pediatric Surgery, University Children's Hospital Basel, Basel, Switzerland. 7. The University of Basel, Basel, Switzerland. 8. Institute of Computing, University of Silesia, Chorzów, Katowice, Poland.
Abstract
PURPOSE: Benign lesions of the proximal femur region, such as simple bone cysts, aneurysmal bone cysts, and fibrous dysplasia, are common in children. Benign lesions may cause pathologic fractures, limb length inequities, and growth disturbances. Differential diagnoses, e.g., malignant bone tumors and osteomyelitis, are sometimes difficult to rule out. OBJECTIVE: We aimed to evaluate outcomes in children with benign lesions of the proximal femur treated with curettage, bone grafting, and plate fixation. METHODS: In this retrospective study, we included 30 children (median age 10.5 years; range 1.1-17.8 years) suffering from bone cysts and tumor-like lesions of the proximal femur region treated between 2002 and 2018. We analyzed plain X-ray images and CT scans in all children and obtained MRI scans in a selected group of children (63.3%). We examined histopathologic biopsy results for all bone lesions before initiating treatment. Surgical management comprised tumor curettage with adjuvant high-speed drilling and allogenic bone grafting supplemented by bone graft substitutes before plate fixation. Median follow-up interval was 87 months (range 24-156 months). We evaluated the healing of lesions according to Capanna's classification and rated functional outcomes according to Merle d'Aubigné and Postel score. RESULTS: Overall, 25 of 30 (83.3%) patients were admitted to hospital because of a pathologic fracture. We diagnosed simple bone cysts in 15 (50.0%) patients, aneurysmal bone cysts in 7 (23.5%) patients, and fibrous dysplasia in 8 (26.5%) patients. Bone consolidation was achieved in 22 of 30 (73.3%) patients after a mean of 5 months (range 3-7 months). The main complication was recurrence of the lesion in 4 of 30 (13.3%) patients. With respect to the Merle d'Aubigné and Postel scores, 17 of 30 (56.7%) patients obtained an excellent result (18 points), while 12 (40.0%) patients had a good result (15-17 points) and only 1 (3.3%) patient had a fair result (14 points). CONCLUSION: Surgical treatment of bone cysts and tumor-like lesions of the proximal femur by local resection or destruction of the lesion, followed by filling the defect with bone graft material and internal stabilization represents a safe and effective treatment option in children. LEVEL OF EVIDENCE: Therapeutic, retrospective comparative study-Level III.
PURPOSE: Benign lesions of the proximal femur region, such as simple bone cysts, aneurysmal bone cysts, and fibrous dysplasia, are common in children. Benign lesions may cause pathologic fractures, limb length inequities, and growth disturbances. Differential diagnoses, e.g., malignant bone tumors and osteomyelitis, are sometimes difficult to rule out. OBJECTIVE: We aimed to evaluate outcomes in children with benign lesions of the proximal femur treated with curettage, bone grafting, and plate fixation. METHODS: In this retrospective study, we included 30 children (median age 10.5 years; range 1.1-17.8 years) suffering from bone cysts and tumor-like lesions of the proximal femur region treated between 2002 and 2018. We analyzed plain X-ray images and CT scans in all children and obtained MRI scans in a selected group of children (63.3%). We examined histopathologic biopsy results for all bone lesions before initiating treatment. Surgical management comprised tumor curettage with adjuvant high-speed drilling and allogenic bone grafting supplemented by bone graft substitutes before plate fixation. Median follow-up interval was 87 months (range 24-156 months). We evaluated the healing of lesions according to Capanna's classification and rated functional outcomes according to Merle d'Aubigné and Postel score. RESULTS: Overall, 25 of 30 (83.3%) patients were admitted to hospital because of a pathologic fracture. We diagnosed simple bone cysts in 15 (50.0%) patients, aneurysmal bone cysts in 7 (23.5%) patients, and fibrous dysplasia in 8 (26.5%) patients. Bone consolidation was achieved in 22 of 30 (73.3%) patients after a mean of 5 months (range 3-7 months). The main complication was recurrence of the lesion in 4 of 30 (13.3%) patients. With respect to the Merle d'Aubigné and Postel scores, 17 of 30 (56.7%) patients obtained an excellent result (18 points), while 12 (40.0%) patients had a good result (15-17 points) and only 1 (3.3%) patient had a fair result (14 points). CONCLUSION: Surgical treatment of bone cysts and tumor-like lesions of the proximal femur by local resection or destruction of the lesion, followed by filling the defect with bone graft material and internal stabilization represents a safe and effective treatment option in children. LEVEL OF EVIDENCE: Therapeutic, retrospective comparative study-Level III.
Authors: Ernesto Ippolito; Edward W Bray; Alessandro Corsi; Fernando De Maio; Ulrich G Exner; Pamela Gehron Robey; Franz Grill; Roberto Lala; Marco Massobrio; Oswald Pinggera; Mara Riminucci; Slawomir Snela; Christos Zambakidis; Paolo Bianco Journal: J Pediatr Orthop B Date: 2003-05 Impact factor: 1.041
Authors: Rosa Visscher; Nadine Hasler; Marie Freslier; Navrag B Singh; William R Taylor; Reinald Brunner; Erich Rutz Journal: Arch Orthop Trauma Surg Date: 2021-02-23 Impact factor: 2.928