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Tosyalı HK, Kaya H, Kececi B, Sabah D. Management of Chondroblastoma in Pediatric Patients: 21 Years of Single-Center Experience. CHILDREN (BASEL, SWITZERLAND) 2024; 11:672. [PMID: 38929251 PMCID: PMC11202176 DOI: 10.3390/children11060672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/22/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Chondroblastoma (CB), a rare benign bone tumor that produces chondrocytes, often develops in the epiphysis or apophysis of children and young adults. The treatment of these rare tumors is complex. The standard treatment protocol involves curettage with local adjuvants and bone graft or cement application. The authors examined 38 CBs to determine risk factors for local recurrence, complications, and functional outcomes following epiphyseal curettage. METHODS Twenty-two girls and sixteen boys aged 10 to 17 years with histologically confirmed chondroblastoma who arrived at our hospital between January 2000 and June 2021 were reviewed retrospectively. Clinical data, radiographic images, histological results, treatment, functional outcomes, and the local recurrence rate were examined-surgical treatment involved total tumor curettage, followed by bone grafting and adjuvant techniques. Local recurrences have also been reported. RESULTS The most frequently affected site was the proximal femur. Sites of involvement included the proximal femur in 10 (26.3%) cases, the proximal tibia in 8 (20.8%), the humerus in 5 cases (13.2%), the distal tibia in 4 cases (10.5%), the distal femur in 3 cases (7.9%), the supracetabular region in 3 cases (7.9%), the talus in 1 case (2.6%), the calcaneus in 1 case (2.6%), the scapula in 1 case (2.6%), the lumbar spine in 1 case (2.6%), and the iliac bone in 1 (2.6%) patient. The mean follow-up was 144.2 months (24 to 276). The local recurrence rate was 7.9%. The mean Musculoskeletal Tumor Society (MSTS) score was 28.3 points (17 to 30). The mean duration of symptoms at presentation was 5.8 (range, 1 to 28) months. CONCLUSION Aggressive curettage and bone grafting resulted in local control and good outcomes in most pediatric patients. In a relatively small proportion of cases, long-term complications and recurrence can occur due to growth plate damage and late diagnosis. In patients admitted to the pediatric clinic with pain, which is often accompanied by localized edema and joint effusion, early detection via advanced radiological scans (X-ray, CT, or MRI) may prevent delays in diagnosis.
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Affiliation(s)
- Hakan Koray Tosyalı
- Department of Orthopedics and Traumatology, Faculty of Medicine, Celal Bayar University, 45140 Manisa, Türkiye
| | - Hüseyin Kaya
- Department of Orthopedics and Traumatology, Faculty of Medicine, Ege University, 35040 Izmir, Türkiye; (H.K.); (B.K.); (D.S.)
| | - Burcin Kececi
- Department of Orthopedics and Traumatology, Faculty of Medicine, Ege University, 35040 Izmir, Türkiye; (H.K.); (B.K.); (D.S.)
| | - Dündar Sabah
- Department of Orthopedics and Traumatology, Faculty of Medicine, Ege University, 35040 Izmir, Türkiye; (H.K.); (B.K.); (D.S.)
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Brunet L, Torner F, Suñol M, Martínez J, Gracia I, Peiró A, Machado P. Chondroblastomas in Children and Young Adults: Revision of 55 Cases. J Pediatr Orthop 2024; 44:e184-e191. [PMID: 38084007 DOI: 10.1097/bpo.0000000000002589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
BACKGROUND Chondroblastomas are uncommon primary bone tumors localized in long bone epiphyses in children and young adults. The risk of metastasis is rare, but they have a high capacity for local recurrence. Surgical curettage with bone grafting or bone substitute is the preferred treatment. METHODS We performed an observational retrospective study of chondroblastomas treated in 2 hospitals in Barcelona from 1988 to 2018. We reviewed the location of the tumor, clinical presentation, imaging, histopathology, initial treatment, and cases of recurrence with a review of their treatment. We assessed the correlation between recurrence and index surgery, anatomic location, and certain histopathologic findings (presence of mitotic figures, necrosis, and positivity for protein S-100). RESULTS The series included 55 patients treated from 1988 to 2018, with ages ranging from 6 to 26, and a mean follow-up of 6.1 years (±3.7). The most common location was the distal femur metaphyseal/epiphyseal region. The most frequent clinical presentation was pain in the affected. Forty-five cases (81.8%) were treated with curettage of the tumor, and 4 cases (7.3%) with a wide resection. Forty-two cases (85.7%) received bone substitutes after curettage or resection. We found 5 cases of recurrence (9.1% recurrence rate); however, we could not find a statistically significant correlation between index surgery and recurrence ( P =0.24), anatomic location and recurrence ( P =0.49), or recurrence and histopathologic findings (mitotic figures, P =0.49; necrosis, P =0.60; positivity for protein S-100, P =0.52). In all the cases the treatment for the local recurrence was surgical, with a final healing rate of 100%. CONCLUSIONS Chondroblastomas should be considered in children and adolescents when presenting with pain and an image suggestive of a tumoral lesion on plain x-ray, most frequently in epiphyses of long bones.Surgical treatment is preferred, obtaining good results after curettage and bone substitute. Chondroblastomas are tumors with a high capacity for recurrence, therefore an adequate surgical technique and surgeon experience are paramount to achieve good outcomes. LEVEL OF EVIDENCE Level IV (case series). Therapeutic studies-investigating results or treatment.
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Affiliation(s)
- Laia Brunet
- Musculoskeletal Tumour Unit, Department of Orthopaedic Surgery-Hospital Sant Joan de Déu, Barcelona Cancer Center, Universitat de Barcelona
| | - Ferran Torner
- Musculoskeletal Tumour Unit, Department of Orthopaedic Surgery-Hospital Sant Joan de Déu, Barcelona Cancer Center, Universitat de Barcelona
| | - Mariona Suñol
- Pathology Department-Hospital Sant Joan de Déu, Universitat de Barcelona
| | - Judit Martínez
- Musculoskeletal Tumour Unit, Department Orthopaedic Surgery-Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona
| | - Isidre Gracia
- Musculoskeletal Tumour Unit, Department Orthopaedic Surgery-Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona
- School of Health Sciences, Blanquerna - University Ramon Llull, Barcelona, Spain
| | - Ana Peiró
- Musculoskeletal Tumour Unit, Department Orthopaedic Surgery-Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona
| | - Pau Machado
- Musculoskeletal Tumour Unit, Department Orthopaedic Surgery-Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona
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Chen YC, Chen CM, Chen KL, Wang PH, Chen CF, Wu PK, Chen WM. Perioperative complications of using freezing nitrogen ethanol composite to treat bone tumors: Clinical experience from a single center. J Chin Med Assoc 2024; 87:64-69. [PMID: 37962122 DOI: 10.1097/jcma.0000000000001018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The cryoablation efficacy of semisolid freezing nitrogen ethanol composite (FNEC) has been demonstrated. We aimed to investigate the feasibility of adjuvant FNEC-assisted cryoablation in different bone cavity types by assessing the perioperative complication rates. METHODS The medical charts of patients who received intraoperative adjuvant cryoablation using semisolid FNEC for bone tumors from December 2013 to January 2018 were reviewed. The bone cavities were categorized into three types according to liquid spill potential (type 1, able to hold liquid without limb manipulation; type 2, required extensive limb manipulation to retain liquid; type 3, unable to retain liquid). The overall complication rate and the complication rates stratified by bone cavity type were determined. RESULTS Among the 76 patients, 30.3%, 57.9%, and 11.8% had type 1, 2, and 3 bone cavities, respectively. The mean follow-up time for perioperative complications was 43.5 ± 24.1 days. Five patients experienced complications, including two cases of skin damage, two cases of skin infection, and one case of fracture, yielding an overall perioperative complication rate of 6.4%. All cases of skin damage and skin infection were superficial and manageable by oral antibiotics. The patient with a pathologic fracture recovered well after being treated with open reduction and plate fixation. No neuropraxia was noted within the first few days postsurgery in any patient. The complication rates in type 1, 2, and 3 bone cavities were 13%, 4.6%, and 0%, respectively. CONCLUSION All bone cavity types had a low incidence of perioperative complications after treatment with adjuvant FNEC-assisted cryoablation. Semisolid FNEC-assisted cryoablation is a feasible alternative to overcome the liquid spill potential in bone cavities resulting from tumor resection and intralesional curettage.
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Affiliation(s)
- Yi-Chou Chen
- Department of Orthopedics, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan, ROC
- Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chao-Ming Chen
- Department of Orthopedics and Joint Reconstruction, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Orthopedic Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Kuan-Lin Chen
- Department of Orthopedics and Joint Reconstruction, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Orthopedic Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Pai-Han Wang
- Department of Orthopedics and Joint Reconstruction, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Orthopedic Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Cheng-Fong Chen
- Department of Orthopedics and Joint Reconstruction, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Orthopedic Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Po-Kuei Wu
- Department of Orthopedics and Joint Reconstruction, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Orthopedic Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wei-Ming Chen
- Department of Orthopedics and Joint Reconstruction, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Orthopedic Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Gersh MP, Mendelson BZ, Judice A, Aboulafia AJ. Use of a Cannulated, Percutaneous Expandable Reamer for Physeal Sparing Excision of a Femoral Head Chondroblastoma. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202309000-00007. [PMID: 37703503 PMCID: PMC10499101 DOI: 10.5435/jaaosglobal-d-23-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/20/2023] [Accepted: 07/06/2023] [Indexed: 09/15/2023]
Abstract
The treatment of chondroblastoma in the epiphysis of the femoral head in skeletally immature individuals is challenging and often requires surgical hip dislocation. We present a unique method of percutaneous use of an expandable reamer (X-REAM, Wright Medical) to treat a chondroblastoma of the femoral head in a 9-year-old boy without requiring surgical hip dislocation. The described technique provides access to the tumor in the proximal femoral epiphysis and local tumor control. However, the approach involves placing a cannula through the epiphyseal plate, resulting in partial premature epiphyseal closure. At 5 years after surgery, the patient has an asymptomatic leg-length discrepancy and radiographic evidence of premature physeal closure, but no restrictions on activity or evidence of local recurrence. A percutaneous expandable reamer can be used to treat chondroblastoma of the femoral head while avoiding surgical hip dislocation.
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Affiliation(s)
- Mallory P Gersh
- From the Wake Forest University, Winston-Salem, NC (Ms. Gersh); the West Virginia University School of Medicine, Morgantown, WV (Mr. Mendelson); the Vanderbilt University Medical Center, Nashville, TN (Dr. Judice); the Georgetown University School of Medicine, Washington, DC (Dr. Aboulafia); and the MedStar Georgetown/MedStar Franklin Square, and Sinai Hospital, University of Maryland School of Medicine, Baltimore, MD (Dr. Aboulafia)
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Smolle MA, Roessl V, Leithner A. Effect of Local Adjuvants Following Curettage of Benign and Intermediate Tumours of Bone: A Systematic Review of the Literature. Cancers (Basel) 2023; 15:4258. [PMID: 37686534 PMCID: PMC10487159 DOI: 10.3390/cancers15174258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/24/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
Local adjuvants are used upon intralesional resection of benign/intermediate bone tumours, aiming at reducing the local recurrence (LR) rate. However, it is under debate whether, when and which local adjuvants should be used. This PRISMA-guideline based systematic review aimed to analyse studies reporting on the role of adjuvants in benign/intermediate bone tumours. All original articles published between January 1995 and April 2020 were potentially eligible. Of 344 studies identified, 58 met the final inclusion criteria and were further analysed. Articles were screened for adjuvant and tumour type, follow-up period, surgical treatment, and development of LR. Differences in LR rates were analysed using chi-squared tests. Altogether, 3316 cases (10 different tumour entities) were analysed. Overall, 32 different therapeutic approaches were identified. The most common were curettage combined with high-speed burr (n = 774; 23.3%) and high-speed burr only (n = 620; 18.7%). The LR rate for studies with a minimum follow-up of 24 months (n = 30; 51.7%) was 12.5% (185/1483), with the highest rate found in GCT (16.7%; 144/861). In comparison to a combination of curettage, any adjuvant and PMMA, the sole application of curettage and high-speed burr (p = 0.015) reduced the LR rate in GCT. The overall complication rate was 9.6% (263/2732), which was most commonly attributable to postoperative fracture (n = 68) and osteoarthritis of an adjacent joint during follow-up (n = 62). A variety of adjuvants treatment options are reported in the literature. However, the most important step remains to be thorough curettage, ideally combined with high-speed burring.
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Affiliation(s)
- Maria Anna Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria; (V.R.); (A.L.)
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Morsy MG, Gawish HM. Arthroscopic Management of Juxta-articular Proximal Humeral Chondroblastoma: The Bazooka Technique. Arthrosc Tech 2023; 12:e1443-e1456. [PMID: 37654866 PMCID: PMC10466432 DOI: 10.1016/j.eats.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 04/13/2023] [Indexed: 09/02/2023] Open
Abstract
Chondroblastoma is a rare benign cartilaginous lesion located mostly in the epiphyses of the long bones. The most common locations are the proximal tibia or femur, distal femur, and proximal humerus. Open curettage and bone grafting constitute the mainstay treatment for this condition. Few reports have documented the use of arthroscopy in tumor surgery owing to the problem of inadequate removal and the difficulty of bone graft delivery to the tumor cavity. The bazooka technique should solve these 2 main problems. In this article, arthroscopic curettage and grafting are described for the treatment of juxta-articular proximal humeral chondroblastoma to lessen postoperative pain and thus enable early mobilization and a quicker rehabilitation in skeletally immature patients.
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Affiliation(s)
- Mohamed Gamal Morsy
- Department of Orthopedic Surgery and Traumatology, Arthroscopy and Sports Injury Unit, Alexandria University, Alexandria, Egypt
| | - Hesham Mohamed Gawish
- Department of Orthopedic Surgery and Traumatology, Kafr El-Sheik University, Kafr El-Sheik, Egypt
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Slavchev SA, O'Connor PJ, Georgiev GP. Chondroblastoma Affecting the Apophysis of the Greater Trochanter in a Child. Cureus 2023; 15:e34908. [PMID: 36938209 PMCID: PMC10015304 DOI: 10.7759/cureus.34908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
Chondroblastomas are rare primary bone tumours typically affecting the epiphyses and less frequently the apophyses of the growing skeleton. Most cases are treated by intralesional curettage with or without local adjuvants and this technique can produce good long-term outcomes. Herein, we describe a case of chondroblastoma of the greater trochanter in a 12-year-old male child that was treated by intralesional curettage and grafting with calcium phosphate bone cement (Neocement Inject® P, Bioceramed, Loures, Portugal). A brief review of the literature is also presented.
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Affiliation(s)
| | - Philip J O'Connor
- Orthopaedics and Traumatology, Medical University of Sofia, Sofia, BGR
| | - Georgi P Georgiev
- Orthopaedics and Traumatology, Medical University of Sofia, Sofia, BGR
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Salunke A, Amin P, Pandit J, Menon P, Pathak S. A study of 40 patients of chondroblastoma of extremities treated with curettage and reconstruction with bone graft or bone graft substitute or bone cement: What were the outcomes? JOURNAL OF ORTHOPAEDIC DISEASES AND TRAUMATOLOGY 2022. [DOI: 10.4103/jodp.jodp_39_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Wang J, Du Z, Yang R, Tang X, Yan T, Guo W. Analysis for clinical feature and outcome of chondroblastoma after surgical treatment: A single center experience of 92 cases. J Orthop Sci 2022; 27:235-241. [PMID: 33419623 DOI: 10.1016/j.jos.2020.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/07/2020] [Accepted: 12/01/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Chondroblastoma is a rare, benign, cartilaginous bone tumor derived from epiphyseal chondrocytes. Although the clinical characteristics and experience of surgical treatment of the smaller number of patients has been reported in the literature, it is difficult to draw conclusions about the clinical and radiographic features and the outcome for surgical treatment of this disease due to the rarity of chondroblastoma. This study was aiming to review the epidemiologic characteristics and outcome of surgical management for patients with chondroblastoma. METHODS We performed a retrospective analysis of 92 patients with chondroblastoma. Clinical data, radiographic images, surgical treatment and outcome were analyzed. Eighty-two patients received the extensive intralesional curettage and ten cases had the En-block resection. RESULTS The most common site of disease was proximal femur (20.7%, 19/92), followed by distal femur (18.5%, 17/92) and proximal tibia (16.3%, 15/92). The secondary aneurysmal bone cyst component was most common for chondroblastoma of the small irregular bones, such as patella and foot. Four (4.3%, 4/92) cases receiving the extensive intralesional curettage developed the local recurrence, respectively two at the proximal tibia, one at the pelvis and one at the calcaneus. Time to local recurrence were respectively 14.5, 8.8, 27.0 and 5.6 months, with the average 14 months. Kaplan-Meier estimated survivorship curve of local recurrence-free survival rates of one, two and five years were respectively 97.7%, 96.2% and 93.9%. The mean Musculoskeletal Tumor Society (MSTS) score was 29.4. At the last follow-up, no one had the pulmonary metastasis and death associated with the disease. CONCLUSION Intralesional curettage plus local adjuvants can obtain satisfactory outcome for chondroblastoma. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Jun Wang
- Peking University People's Hospital, Musculoskeletal Tumor Center, No. 11 Xizhimen South Street, 100044, Beijing, China.
| | - Zhiye Du
- Peking University People's Hospital, Musculoskeletal Tumor Center, No. 11 Xizhimen South Street, 100044, Beijing, China.
| | - Rongli Yang
- Peking University People's Hospital, Musculoskeletal Tumor Center, No. 11 Xizhimen South Street, 100044, Beijing, China.
| | - Xiaodong Tang
- Peking University People's Hospital, Musculoskeletal Tumor Center, No. 11 Xizhimen South Street, 100044, Beijing, China.
| | - Taiqiang Yan
- Peking University People's Hospital, Musculoskeletal Tumor Center, No. 11 Xizhimen South Street, 100044, Beijing, China.
| | - Wei Guo
- Peking University People's Hospital, Musculoskeletal Tumor Center, No. 11 Xizhimen South Street, 100044, Beijing, China.
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Abo-Elsoud M, Sadek W, Salah-Eldeen M, Abosenna W. Surgical hip dislocation for treatment of femoral head chondroblastoma: efficacy and safety. INTERNATIONAL ORTHOPAEDICS 2021; 46:653-660. [PMID: 34799777 DOI: 10.1007/s00264-021-05264-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/05/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Femoral head chondroblastoma poses a surgical challenge. Anatomical limitations may lead to increased risk of local recurrence, damage to the articular cartilage, growth disturbances, and/or avascular necrosis (AVN). We are presenting our results with surgical hip dislocation approach with the aim to evaluate its efficacy in preventing recurrence and its safety, preserving a functional hip joint and avoiding complications. PATIENTS AND METHODS Ten patients were managed using surgical hip dislocation with direct access to femoral head lesions, extended curettage through a modified trapdoor approach, and cement reconstruction. These were six males and four females, with a mean age of 17 ± 2.7 years (range: 14-20) and a mean follow-up of 34 ± 12 months (range: 17-57). The lesion extended into the neck in 60% of patients with the physis being either closed in seven or closing in three patients. RESULTS We had a single case (10%) of recurrence at the trochanters for which re-curettage was done. However, all patients had their hips preserved with good function at the latest follow-up, and no serious complications recorded. The Musculoskeletal Tumor Society score improved significantly from a pre-operative median of 23.5 (range: 16-28) to a post-operative median of 29 (range: 26-30) (P = 0.005). CONCLUSION This report describes a safe reproducible approach to effectively manage these locally aggressive lesions with good short-term results. This is done while maintaining the integrity of the articular surface, growth plate, as well as preserving the femoral head blood supply.
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Affiliation(s)
- Mohamed Abo-Elsoud
- Department of Orthopaedics and Traumatology, Kasralainy School of Medicine, Cairo University, Cairo, Egypt.
| | - Wael Sadek
- Department of Orthopaedics and Traumatology, Kasralainy School of Medicine, Cairo University, Cairo, Egypt
| | - Mostafa Salah-Eldeen
- Department of Orthopaedics and Traumatology, Kasralainy School of Medicine, Cairo University, Cairo, Egypt
| | - Wesam Abosenna
- Department of Orthopaedics and Traumatology, Kasralainy School of Medicine, Cairo University, Cairo, Egypt
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Huang C, Lü XM, Fu G, Yang Z. Chondroblastoma in the Children Treated with Intralesional Curettage and Bone Grafting: Outcomes and Risk Factors for Local Recurrence. Orthop Surg 2021; 13:2102-2110. [PMID: 34599644 PMCID: PMC8528993 DOI: 10.1111/os.13153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To review the outcomes of surgical management in the pediatric patients with extremity chondroblastoma. Especially the risk factors of recurrence and growth disorder. And discuss a potential method to decrease the rate of growth disorder by preventing the premature physeal closure. METHODS Fifteen girls and twenty-seven boys aged from two to 14 years (mean, 11 years) with histologically proven chondroblastoma, who presented from January 2011 to June 2018 at our Hospital, were retrospectively reviewed. Clinical data, radiographic images, histological findings, treatment, functional outcomes, and local recurrence rate were analyzed. Surgical treatment included complete curettage of the tumor and the walls of the lesion followed by bone grafting, No adjuvant methods were used. Recurrence was defined as a return of symptoms and an expansion radiolucency at the operated site. It was confirmed by the histopathological analysis. When recurrence was diagnosed, the medical data were analyzed to detect the effect of different factors on local recurrence. Functional outcome was measured according to Sailhan's functional criteria, designed to provide a standardized method of assessing pediatric chondroblastoma patient postoperatively. RESULTS The proximal part of the femur was the most frequently involved site. All the patients had at least 24 months of follow-up; mean duration was 30 months (range, 24-60 months). The local recurrence rate was 9.5%. Three resolved after repeat surgeries without further recurrence, one had a second recurrence and received another more aggressive curettage. Local recurrence of chondroblastoma was associated with age (P < 0.05), while not associated with sex, tumor location, the radiological character of the lesion or the grafting method (P > 0.05). No pulmonary metastasis was noted at latest follow-up. Five patients suffered from premature closure of physis due to physis injury. Thirty-one patients (73.8%) had a good outcome, and all returned to normal unrestricted activities. Six patients (14.3%) had a fair outcome due to occasional pain, asymmetric range of motion, or radiographic joint changes without arthritis. And five patients (11.9%) had a poor outcome because of chronic pain, loss of joint motion impairing normal life activities, or a limb-length discrepancy and limp. CONCLUSIONS Aggressive curettage and bone grafting resulted in local control and good outcomes in most pediatric patients. Being less than 12 years of age was the risk factor for recurrence. For those growing patients, premature physeal closure was observed after the curettage, interpositional technique with PMMA would be a good choice for prevention.
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Affiliation(s)
- Cong Huang
- Department of Pediatric Orthopaedics, Beijing Jishuitan Hospital, Peking University, Beijing, China
| | - Xue-Min Lü
- Department of Pediatric Orthopaedics, Beijing Jishuitan Hospital, Peking University, Beijing, China
| | - Gang Fu
- Department of Pediatric Orthopaedics, Beijing Jishuitan Hospital, Peking University, Beijing, China
| | - Zheng Yang
- Department of Pediatric Orthopaedics, Beijing Jishuitan Hospital, Peking University, Beijing, China
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Shi J, Zhao Z, Yan T, Guo W, Yang R, Tang X, Qu H, Dong S. Surgical treatment of benign osteolytic lesions in the femoral head and neck: a systematic review. BMC Musculoskelet Disord 2021; 22:549. [PMID: 34134687 PMCID: PMC8210383 DOI: 10.1186/s12891-021-04442-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/02/2021] [Indexed: 12/29/2022] Open
Abstract
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. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04442-y.
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Affiliation(s)
- Jingtian Shi
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Zhiqing Zhao
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Taiqiang Yan
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China.
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Rongli Yang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Xiaodong Tang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Huayi Qu
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Sen Dong
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
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13
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Chen J, Jie K, Feng W, Zeng H, Cao H, Deng P, Wu K, Ye P, Li J, Qi X, Zeng J, Zeng Y. Total Calcanectomy and Bilateral Iliac Bone Autograft Reconstruction for the Treatment of Calcaneal Chondroblastoma Involving a Secondary Aneurysmal Bone Cyst: A Case Report and Literature Review. J Foot Ankle Surg 2021; 59:616-624. [PMID: 32354519 DOI: 10.1053/j.jfas.2019.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/24/2019] [Accepted: 10/01/2019] [Indexed: 02/03/2023]
Abstract
Chondroblastoma is a rare, benign, cartilaginous-derived tumor accounting for ∼1% to 2% of all primary bone tumors and almost 9% of all benign bone tumors. In this case report, we describe a patient with chondroblastoma and a secondary aneurysmal bone cyst, with the adjacent talus being mildly affected. The initial diagnosis was giant cell tumor and was then confirmed after computed tomography-assisted biopsy. We performed a total calcanectomy via bilateral structural iliac bone autografting to relieve pain and reconstruct the loadbearing function because of the presence of extensive lesions. The patient was pain free and expressed satisfaction with postsurgical dorsiflexion and plantarflexion function at the 60-month follow-up visit. Radiographic images showed that the autografted iliac bone was completely healed, with no evidence of local recurrence.
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Affiliation(s)
- Jinlun Chen
- Surgeon, Department of Orthopaedic Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ke Jie
- Resident, First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wenjun Feng
- Surgeon, Department of Orthopaedic Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Huiliang Zeng
- Surgeon, Department of Orthopaedic Surgery, Foshan Hospital of Traditional Chinese Medicine, Foshan, China
| | - Houran Cao
- Resident, First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Peng Deng
- Surgeon, First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Keliang Wu
- Resident, First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Pengcheng Ye
- Surgeon, Department of Orthopaedic Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jie Li
- Surgeon, Department of Orthopaedic Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xinyu Qi
- Resident, First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jianchun Zeng
- Surgeon, Department of Orthopaedic Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yirong Zeng
- Surgeon and Professor, Department of Orthopaedic Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
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14
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Zekry KM, Yamamoto N, Hayashi K, Takeuchi A, Araki Y, Alkhooly AZA, Abd-Elfattah AS, Fouly EH, Elsaid ANS, Tsuchiya H. Surgical treatment of chondroblastoma using extended intralesional curettage with phenol as a local adjuvant. J Orthop Surg (Hong Kong) 2020; 27:2309499019861031. [PMID: 31315494 DOI: 10.1177/2309499019861031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The aim of this study is to report the clinical and radiological outcomes following surgical treatment of chondroblastoma by means of an extended intralesional curettage using high-speed burr, with phenol as a local adjuvant which is followed by the implantation of synthetic bone graft, aiming to lower the recurrence rate of this tumor. PATIENTS AND METHODS This retrospective study included 20 patients with chondroblastoma lesions during the period between 2000 and 2015. RESULTS Fifteen males and five females were followed up for a mean of 63.35 (26-144) months with average age at the time of presentation was 20.8 (range: 12-32) years. Nineteen patients (95%) were complaining of pain at the time of presentation, and the lesion was discovered accidently in one patient. The mean operative time was 138.5 min (75-250). At the most recent follow-up, all patients had regained full physical function without pain at the operation site. CONCLUSION The aggressive treatment of chondroblastoma by an extended intralesional curettage using high-speed burr with phenol as a local adjuvant seems effective in lowering the incidence of local recurrence and secondary more aggressive surgeries. Implantation of the bone defects that result from curettage with the synthetic bone substitutes is a good alternative due to rapid restoration of the mechanical strength with good remodeling.
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Affiliation(s)
- Karem M Zekry
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan.,2 Department of Orthopaedic Surgery, Faculty of Medicine, Minia University, Minya, Egypt
| | - Norio Yamamoto
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Katsuhiro Hayashi
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Akihiko Takeuchi
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yoshihiro Araki
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Ali Zein Aa Alkhooly
- 2 Department of Orthopaedic Surgery, Faculty of Medicine, Minia University, Minya, Egypt
| | | | - Ezzat H Fouly
- 2 Department of Orthopaedic Surgery, Faculty of Medicine, Minia University, Minya, Egypt
| | | | - Hiroyuki Tsuchiya
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
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15
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Outani H, Kakunaga S, Hamada K, Takenaka S, Nakai S, Yasuda N, Imura Y, Naka N, Araki N, Ueda T, Yoshikawa H. Clinical outcomes of chondroblastoma treated using synthetic bone substitute: risk factors for developing radiographic joint degeneration. World J Surg Oncol 2020; 18:47. [PMID: 32122388 PMCID: PMC7053063 DOI: 10.1186/s12957-020-01829-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 02/27/2020] [Indexed: 12/19/2022] Open
Abstract
Background Chondroblastoma (CB) is a rare locally aggressive bone tumor that commonly occurs in the epiphysis or apophysis of long bones. Although surgical treatment of CB carries potential risk for physeal or articular cartilage damage, risk factors for joint degeneration have not been well described. In addition, we have mainly used synthetic bone substitute (SBS) to fill the bone defect after intralesional curettage as treatment for CB. This study thus aimed to evaluate the incidence of and risk factors for adjacent-joint radiographic degeneration after SBS treatment for CB. Methods We retrospectively reviewed 48 patients treated for CB at our institutions between 1996 and 2017. Clinical data, radiographic images, treatments, and local recurrence were analyzed. Results We identified 40 patients [29 males and 11 females with a mean age of 19 years (range, 8–35 years)] who received SBS to fill the defect after curettage with a minimum follow-up of 1 year. The mean follow-up period was 71 months (range, 13–239 months). A total of 8 patients (20%) developed local recurrence. Radiographic analysis showed that 5 patients (16.7%) developed radiographic joint degeneration. Joint degeneration was significantly associated with the affected joint (p = 0.004). Conclusions Curettage and SBS filling had been found to be a reasonable treatment method for CB, which commonly occurs in the epiphysis or apophysis. Radiographic joint degeneration was not uncommon after CB treatment, especially in the talus and proximal humerus.
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Affiliation(s)
- Hidetatsu Outani
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Shigeki Kakunaga
- Department of Orthopaedic Surgery, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, 540-0006, Japan
| | - Kenichiro Hamada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Satoshi Takenaka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Sho Nakai
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Naohiro Yasuda
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yoshinori Imura
- Musculoskeletal Oncology Service, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Norifumi Naka
- Musculoskeletal Oncology Service, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Nobuhito Araki
- Department of Orthopaedic Surgery, Ashiya Municipal Hospital, 39-1 Asahigaoka-cho, Ashiya, Hyogo, 659-8502, Japan
| | - Takafumi Ueda
- Department of Orthopaedic Surgery, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, 540-0006, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
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16
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Lang Y, Yu Q, Liu Y, Yang L. Chondroblastoma of the patella with pathological fracture in an adolescent: a case report. World J Surg Oncol 2019; 17:218. [PMID: 31831014 PMCID: PMC6909653 DOI: 10.1186/s12957-019-1760-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/25/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Chondroblastoma is a rare primary bone tumor of young people that generally occurs in the epiphyseal plate of long bones. To date, only 13 cases of patella with pathological fracture in chondroblastoma have been previously published. CASE PRESENTATION A 15-year-old male patient presented with acute pain in the left knee after an injury occurred while playing basketball. Plain radiographs and computed tomography showed a pathological fracture of the left patella with an osteolytic lesion (1.5 × 2 × 3 cm). Magnetic resonance imaging revealed an expansile lesion within the patella with a slightly high signal on the T1-weighted image, a high signal on the T2-weighted image and soft tissue swelling in front of the patella. A m99Tc bone scintigraphy revealed moderate uptake. The preoperative diagnosis was chondroblastoma. This patient underwent intralesional meticulous extended curettage, adjuvant high-speed burr, 95% alcohol and electrotome treatment, autogenous iliac crest bone grafting, and internal fixation. A postoperative pathological diagnosis was chondroblastoma. The patient's function was satisfactory, and there was no sign of tumor recurrence. The internal fixator was good, with no loosening or migration observed at the last follow-up at 20 months after surgery. CONCLUSIONS Rarely, chondroblastoma of the patella can present with acute pain due to pathological fracture. We present the 14th such case in the literature to associate patellar chondroblastoma with pathological fracture. The patient was treated with curettage, inactivation, autogenous bone grafting, and internal fixation. A satisfactory therapeutic effect was obtained. This case may be beneficial to the diagnosis and treatment of chondroblastoma patella.
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Affiliation(s)
- Yun Lang
- Department of Orthopedics, People's Hospital of Deyang City, Taishan North Road 173#, Deyang, 618000, Sichuan Province, People's Republic of China
| | - Qing Yu
- Department of Pathology, People's Hospital of Deyang City, Taishan North Road 173#, Deyang, 618000, Sichuan Province, People's Republic of China
| | - Yuehong Liu
- Department of Orthopedics, People's Hospital of Deyang City, Taishan North Road 173#, Deyang, 618000, Sichuan Province, People's Republic of China
| | - Lejin Yang
- Department of Orthopedics, People's Hospital of Deyang City, Taishan North Road 173#, Deyang, 618000, Sichuan Province, People's Republic of China.
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17
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O'Dell MC, Vatsky S. Percutaneous Treatment of Musculoskeletal Disease in Children. Semin Roentgenol 2019; 54:384-394. [PMID: 31706371 DOI: 10.1053/j.ro.2019.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M Cody O'Dell
- Department of Radiology, AdventHealth Orlando, Orlando, FL.
| | - Seth Vatsky
- Perelman School of Medicine, Philadelphia, PA; Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA
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18
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Liu Q, He H, Yuan Y, Zeng H, Long F, Tian J, Luo W. Have the difficulties and complications of surgical treatment for chondroblastoma of the adjoining knee joint been overestimated? J Bone Oncol 2019; 17:100240. [PMID: 31193486 PMCID: PMC6535629 DOI: 10.1016/j.jbo.2019.100240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/08/2019] [Accepted: 05/08/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Chondroblastoma is difficult to treat as the tumor is surrounded by both articular cartilage and the epiphyseal plate. The differences in joint shape further complicate the problem. This retrospective study evaluates the efficacy of intraregional aggressive curettage and allogeneic bone grafting for treating chondroblastoma of the adjoining knee joint. METHODS From February 2010 to February 2017, 36 patients with chondroblastoma of the adjoining knee joint were identified. All patients were treated with intraregional aggressive curettage, phenolization, and allogeneic bone grafting. Follow-up for lesion healing, local recurrence, functional outcomes and secondary osteoarthritis were assessed both clinically and radiologically. RESULTS Thirty-six patients (mean age 17 years) were enrolled with a mean follow-up of 51.8 months (18-98 months). The tumor locations were as follows: distal femur (14), proximal tibia (20), and patella (2). Only 1 patient relapsed, 10 months post-operation. All patients had good bone healing. No knee varus or valgus deformity developed. The mean Musculoskeletal Tumor Society functional score was 28.6 ± 1.1 post-operation. At the last follow-up, secondary osteoarthritis was found in 1 patient, the patient was asymptomatic. CONCLUSIONS Intraregional aggressive curettage, phenolization, and allogeneic bone grafting are effective for treatment of chondroblastoma of the adjoining knee joint.
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Affiliation(s)
- Qing Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hongbo He
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yuhao Yuan
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Hao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Feng Long
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Jian Tian
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Wei Luo
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
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19
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Bernthal NM, Upfill-Brown A, Burke ZDC, Ishmael CR, Hsiue P, Hori K, Hornicek F, Eckardt JJ. Long-term follow-up of custom cross-pin fixation of 56 tumour endoprosthesis stems: a single-institution experience. Bone Joint J 2019; 101-B:724-731. [PMID: 31154850 DOI: 10.1302/0301-620x.101b6.bjj-2018-0993.r1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
AIMS Aseptic loosening is a major cause of failure in cemented endoprosthetic reconstructions. This paper presents the long-term outcomes of a custom-designed cross-pin fixation construct designed to minimize rotational stress and subsequent aseptic loosening in selected patients. The paper will also examine the long-term survivorship and modes of failure when using this technique. PATIENTS AND METHODS A review of 658 consecutive, prospectively collected cemented endoprosthetic reconstructions for oncological diagnoses at a single centre between 1980 and 2017 was performed. A total of 51 patients were identified with 56 endoprosthetic implants with cross-pin fixation, 21 of which were implanted following primary resection of tumour. Locations included distal femoral (n = 36), proximal femoral (n = 7), intercalary (n = 6), proximal humeral (n = 3), proximal tibial (n = 3), and distal humeral (n = 1). RESULTS The median follow-up was 132 months (interquartile range (IQR) 44 to 189). In all, 20 stems required revision: eight for infection, five for structural failure, five for aseptic loosening, and two for tumour progression. Mechanical survivorship at five, ten, and 15 years was 84%, 78%, and 78%, respectively. Mechanical failure rate varied by location, with no mechanical failures of proximal femoral constructs and distal femoral survivorship of 82%, 77%, and 77% at five, ten, and 15 years. The survivorship of primary constructs at five years was 74%, with no failure after 40 months, while the survivorship for revision constructs was 89%, 80%, and 80% at five, ten, and 15 years. CONCLUSION The rate of mechanical survivorship in our series is similar to those reported for other methods of reconstruction for short diaphyseal segments, such as compressive osseointegration. The mechanical failure rate differed by location, while there was no substantial difference in long-term survival between primary and revision reconstructions. Overall, custom cross-pin fixation is a viable option for endoprosthetic reconstruction of short metaphyseal segments with an acceptable rate of mechanical failure. Cite this article: Bone Joint J 2019;101-B:724-731.
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Affiliation(s)
- N M Bernthal
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - A Upfill-Brown
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Z D C Burke
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - C R Ishmael
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - P Hsiue
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - K Hori
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - F Hornicek
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - J J Eckardt
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
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20
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Liu Q, He HB, Zeng H, Yuan YH, Long F, Tian J, Luo W. Modified trapdoor procedures by surgical dislocation approach to treat chondroblastoma of the femoral head. Bone Joint J 2019; 101-B:732-738. [PMID: 31154843 DOI: 10.1302/0301-620x.101b6.bjj-2018-1599.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIMS The aim of this study was to evaluate the efficacy of the surgical dislocation approach and modified trapdoor procedure for the treatment of chondroblastoma of the femoral head. PATIENTS AND METHODS A total of 17 patients (ten boys, seven girls; mean age 16.4 years (11 to 26)) diagnosed with chondroblastoma of the femoral head who underwent surgical dislocation of the hip joint, modified trapdoor procedure, curettage, and bone grafting were enrolled in this study and were followed-up for a mean of 35.9 months (12 to 76). Healing and any local recurrence were assessed via clinical and radiological tests. Functional outcome was evaluated using the Musculoskeletal Tumour Society scoring system (MSTS). Patterns of bone destruction were evaluated using the Lodwick classification. Secondary osteoarthritis was classified via radiological analysis following the Kellgren-Lawrence grading system. Steinberg classification was used to evaluate osteonecrosis of the femoral head. RESULTS The epiphyseal plate was open, closing, and closed in five, five, and seven patients, respectively. In total, eight, six, and three patients were classified as having Lodwick classification IA, IB, and IC, respectively. Allogeneic and autogenous bone grafting was used in 13 and four patients, respectively. All patients had good bone healing and no local recurrence was observed. One patient developed osteonecrosis of the femoral head (Steinberg IA) and one developed secondary osteoarthritis of the hip joint (Kellgren-Lawrence Grade II). The mean postoperative MSTS functional score was 27.7 (24 to 30). CONCLUSION Surgical dislocation and modified trapdoor procedures are safe and effective techniques for treating chondroblastoma in the femoral head. Cite this article: Bone Joint J 2019;101-B:732-738.
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Affiliation(s)
- Q Liu
- Central South University, Xiangya Hospital, Department of Orthopaedics, Changsha, China.,Central South University, Second Xiangya Hospital, Department of Spine Surgery, Changsha, China
| | - H-B He
- Central South University, Xiangya Hospital, Department of Orthopaedics, Changsha, China
| | - H Zeng
- Central South University, Xiangya Hospital, Department of Orthopaedics, Changsha, China
| | - Y-H Yuan
- Central South University, Xiangya Hospital, Department of Orthopaedics, Changsha, China
| | - F Long
- Central South University, Xiangya Hospital, Department of Orthopaedics, Changsha, China
| | - J Tian
- Central South University, Xiangya Hospital, Department of Orthopaedics, Changsha, China
| | - W Luo
- Central South University, Xiangya Hospital, Department of Orthopaedics, Changsha, China
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21
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Omlor GW, Lohnherr V, Lange J, Gantz S, Mechtersheimer G, Merle C, Raiss P, Fellenberg J, Lehner B. Outcome of conservative and surgical treatment of enchondromas and atypical cartilaginous tumors of the long bones: retrospective analysis of 228 patients. BMC Musculoskelet Disord 2019; 20:134. [PMID: 30922289 PMCID: PMC6440168 DOI: 10.1186/s12891-019-2502-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 03/13/2019] [Indexed: 12/11/2022] Open
Abstract
Background Sufficient data on outcome of patients with clinically and radiologically aggressive enchondromas and atypical cartilaginous tumors (ACT) is lacking. We therefore analyzed both conservatively and surgically treated patients with lesions, which were not distinguishable between benign enchondroma and low-grade malignant ACT based upon clinical and radiologic appearance. Methods The series included 228 consecutive cases with a follow-up > 24 months to assess radiological, histological, and clinical outcome including recurrences and complications. Pain, satisfaction, functional limitations, and the musculoskeletal tumor society (MSTS) score were evaluated to judge both function and emotional acceptance at final follow-up. Results Follow-up took place at a mean of 82 (median 75) months. The 228 patients all had comparable clinical and radiological findings. Of these, 153 patients were treated conservatively, while the other 75 patients underwent intralesional curettage. Besides clinical and radiological aggressiveness, most lesions were histologically judged as benign enchondromas. 9 cases were determined to be ACT, while the remaining 7 cases had indeterminate histology. After surgery, three patients developed a recurrence, and a further seven had complications of which six were related to osteosynthesis. Both groups had excellent and almost equal MSTS scores of 96 and 97%, respectively, but significantly less functional limitations were found in the non-surgery group. Further sub-analyses were performed to reduce selection bias. Sub-analysis of histologically diagnosed enchondromas in the surgery group found more pain, less function, and worse MSTS score compared to the non-surgery group. Sub-analysis of smaller lesions (< 4.4 cm) did not show significant differences. In contrast, larger lesions displayed significantly worse results after surgery compared to conservative treatment (enchondromas > 4.4 cm: MSTS score: 94.0% versus 97.3%, p = 0.007; pain 2.3 versus 0.8, p = 0.001). The majority of lesions treated surgically was filled with polymethylmethacrylate bone-cement, while the remainder was filled with cancellous-bone, without significant difference in clinical outcome. Conclusion Feasibility of intralesional curettage strategies for symptomatic benign to low-grade malignant chondrogenic tumors was supported. Surgery, however, did not prove superior compared to conservative clinical and radiological observation. Due to the low risk of transformation into higher-grade tumors and better functional results, more lesions might just be observed if continuous follow-up is assured.
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Affiliation(s)
- Georg W Omlor
- Department of Orthopaedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, Heidelberg, Germany.
| | - Vera Lohnherr
- Department of Orthopaedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, Heidelberg, Germany
| | - Jessica Lange
- Department of Orthopaedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, Heidelberg, Germany
| | - Simone Gantz
- Department of Orthopaedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, Heidelberg, Germany
| | | | - Christian Merle
- Department of Orthopaedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, Heidelberg, Germany
| | - Patric Raiss
- Department of Orthopaedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, Heidelberg, Germany
| | - Joerg Fellenberg
- Department of Orthopaedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, Heidelberg, Germany
| | - Burkhard Lehner
- Department of Orthopaedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, Heidelberg, Germany
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Wagener J, Schweizer C, Horn Lang T, Zwicky L, Schaefer DJ, Hintermann B. Vascularized Bone Autograft for the Treatment of Chondroblastoma of the Talus at Imminent Risk of Joint Breakdown: Three Case Reports. J Foot Ankle Surg 2019; 58:363-367. [PMID: 30612869 DOI: 10.1053/j.jfas.2018.08.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Indexed: 02/03/2023]
Abstract
Surgical treatment options in a chondroblastoma of the talus breaching the subchondral layer with imminent risk of talar collapse in the weightbearing area are limited. A joint-preserving surgery should be advocated. Because current treatment options such as curettage, cryosurgery, or radiofrequency ablation may not be able to prevent a talar dome breakdown in large defects, nonvascularized bone grafting has been advocated to fill the void. To overcome the lack of vitality, a vascularized bone autograft might be an attractive alternative. We present 3 cases where a large talar defect owing to a chondroblastoma was treated with a vascularized bone autograft. In 1 of the cases, a free microvascular iliac crest bone graft was used, whereas in the other 2 cases, a vascularized graft was harvested from the medial femoral condyle. Computed tomographic scans demonstrated a stable incorporation of the graft in all cases. All patients were highly satisfied with the obtained results and showed a clinical functional outcome similar to the contralateral foot after 36, 60, and 72 months. At the latest radiographic follow-up, no evidence of recurrence was observed. In conclusion, a free vascularized bone autograft can be used to treat a large talar defect owing to chondroblastoma in young patients.
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Affiliation(s)
- Joe Wagener
- Attending Surgeon, Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland.
| | - Christine Schweizer
- Research Associate, Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Tamara Horn Lang
- Research Associate, Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Lukas Zwicky
- Research Associate, Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | | | - Beat Hintermann
- Professor, Associate Professor, and Chair, Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
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Özer D, Arıkan Y, Gür V, Gök C, Akman YE. Chondroblastoma: An evaluation of the recurrences and functional outcomes following treatment. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2018; 52:415-418. [PMID: 30249436 PMCID: PMC6318575 DOI: 10.1016/j.aott.2018.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 01/11/2018] [Accepted: 07/26/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Chondroblastoma is a benign aggressive tumor which needs surgical treatment and has a recurrence rate up to 35%. Extended (aggressive) curettage is the mainstay of treatment and local adjuvants have been reported to decrease the recurrence rate. METHODS The recurrence rates and the functional results of 14 patients who were treated in our institution and 2 other patients who were treated elsewhere between the years 2004-2016 were evaluated. Seventeen cases (13 male, 3 female; mean age: 17.1 [range: 13 to 32] years) who had been diagnosed, treated and followed up in our hospital between 2004 and 2016 were evaluated in terms of recurrence rates and functional outcomes. The average follow-up period was 41.6 (range: 12 to 132) months. RESULTS Five cases of recurrence were observed. Two cases had undergone their primary treatment in another institution. Seven cases were performed curettage alone whereas nine others were administered adjuvant treatments. One of the five recurrence patients was advised to undergo disarticulation. Another was treated with curettage and grafting and the remaining three patients with curettage and cementing. No recurrence was observed in their follow-up period. Their mean MSTS score was 27.3 (range: 4 to 30) over a maximum of 30 points and their functional results were good. CONCLUSION Chondroblastoma is a tumor with high recurrence rates in the post-treatment period. However, good functional outcomes can be achieved with early diagnosis and appropriate treatment even after recurrence. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Thibaut A, Bouhamama A, Boespflug A, Vaz G, Cuinet M, Kalenderian AC, Menassel B, Ricoeur A, Mastier C, Pilleul F. Percutaneous Cryotherapy for Treatment of Chondroblastoma: Early Experience. Cardiovasc Intervent Radiol 2018; 42:304-307. [PMID: 30327928 DOI: 10.1007/s00270-018-2085-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/26/2018] [Indexed: 11/25/2022]
Abstract
Surgical curettage is currently the standard of care for the chondroblastoma, but in peri-articular tumors it is limited by its morbidity. In this preliminary report, we evaluate the feasibility of percutaneous cryotherapy as an alternative ablative treatment for chondroblastoma. Three patients with a chondroblastoma treated by CT scan-guided cryotherapy are presented in this article. Pain permanently disappeared 2 days after the procedure. No local tumor recurrence or cartilage damage was observed by MRI performed 1 year after the intervention. This preliminary case report suggests that percutaneous cryotherapy may be a possible alternative to the current standard of care in chondroblastoma. Further studies are needed to evaluate if this technique offers similar anti-tumoral efficacy while providing better pain relief and less morbidity than curettage.
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Affiliation(s)
- Antoine Thibaut
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008, Lyon, France.
| | - Amine Bouhamama
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008, Lyon, France
| | - Amélie Boespflug
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008, Lyon, France
| | - Gualter Vaz
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008, Lyon, France
| | - Marie Cuinet
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008, Lyon, France
| | - Anne-Charlotte Kalenderian
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008, Lyon, France
| | - Badis Menassel
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008, Lyon, France
| | - Alexis Ricoeur
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008, Lyon, France
| | - Charles Mastier
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008, Lyon, France
| | - Frank Pilleul
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008, Lyon, France
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Ryu JJ, Kim W, Lee JS, Kim YK, Lee HS, Seo SG. Combined Autograft and Bone Cement for Painful Chondroblastoma: A Case Report. J Foot Ankle Surg 2018; 57:396-400. [PMID: 29307744 DOI: 10.1053/j.jfas.2017.08.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Indexed: 02/03/2023]
Abstract
Chondroblastomas of the talus can lead to joint collapse and are often treated using curettage and bone grafting. In the present report, we describe the case of a 19-year-old female with a large chondroblastoma of the talus associated with a secondary aneurysmal cyst. We treated the large cartilage lesion, which involved most of the talus, with an iliac bone graft combined with bone cement to fill the large bone defect and preserve the subchondral bone of the articular surface of the dome of the talus.
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Affiliation(s)
- Jae Jung Ryu
- Orthopedic Surgeon, Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Wanlim Kim
- Orthopedic Surgeon, Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong Seok Lee
- Orthopedic Surgeon, Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - You Keun Kim
- Orthopedic Surgeon, Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ho Seong Lee
- Orthopedic Surgeon, Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Gyo Seo
- Orthopedic Surgeon, Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Abstract
Giant cell rich lesions of the temporal bone encompass a wide spectrum of disease that includes infectious, reactive, and neoplastic processes. When dealing with any lesion that can potentially involve bone, it is important to understand both the clinical presentation and to correlate the histologic findings with the radiologic imaging. This review discusses the clinical, the pathologic features including the differential diagnosis, and the treatment of some of the more commonly encountered giant cell rich entities in this region.
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Xiong Y, Lang Y, Yu Z, Liu H, Fang X, Tu C, Duan H. The effects of surgical treatment with chondroblastoma in children and adolescents in open epiphyseal plate of long bones. World J Surg Oncol 2018; 16:14. [PMID: 29361956 PMCID: PMC5781291 DOI: 10.1186/s12957-018-1314-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 01/10/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Chondroblastoma is a rare benign cartilaginous tumor, which primarily occurs in children and adolescents. Chondroblastoma commonly originates in the epiphyseal plate of long bones. An aggressive curettage treatment is recommended to manage lesion, which may jeopardize an open epiphyseal plate and result in limb shortening and deformity as the limb grows and develops. The purpose is to observe surgical effects of chondroblastoma on open epiphyseal plate of long bones in children and adolescents and explore influences on limb growth and development. METHODS We retrospectively reviewed 18 cases of long bone chondroblastoma with open epiphyseal growth plate during March 2004 to October 2010 in our center. Seven females and 11 males with mean age of 11.6 ± 2.0 years old (8-15 years) were included. Patients, who suffered from trauma and pathological fracture of the epiphyseal plate or congenital diseases such as poliomyelitis, congenital dementia, and cartilage malnutrition, were excluded. All patients were treated with meticulous intralesional curettage and inactivity with alcohol followed by bone grafts. All cases were followed up 8.2 ± 1.7 years (5-11.5 years). RESULTS All had no local recurrence and distance metastasis. The length of the affected limb was short, 18.47 ± 7.22 mm (1.5-30 mm). There was no obvious relativity with tumor activity (P = 0.061). Meanwhile, there were obvious relativity with the greatest dimension of the lesion (TGD) (P = 0.003), the vertical dimension between edge of lesion and epiphyseal line (TVD) (P = 0.010), and area ratio of lesion to local epiphysis (lesion/growth plate) (P = 0.015). The MSTS93 (Revised Musculoskeletal Tumor Society Rating Scale 93) and SF-36 (Medical Outcomes Study 36-Item Short-Form Health Survey) had been significantly improved (P < 0.01). CONCLUSION Managing of chondroblastoma located in open epiphyseal plate of a long bone with meticulous curettage, inactivity, and bone grafts can control tumor progression and recurrence effectively. Meanwhile, early detection and prompt surgical treatment intervention, which reduced significantly the tumor to influence limb growth and development, get encouraging limb function. TRIAL REGISTRATION This is a retrospective study, which was not registered in any trial registry.
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Affiliation(s)
- Yan Xiong
- Department of Orthopedics, West China Hospital, Sichuan University, No 37 Guo Xue Lane, Wuhou District, 610041, Chengdu, Sichuan, People's Republic of China
| | - Yun Lang
- Department of Orthopedics, West China Hospital, Sichuan University, No 37 Guo Xue Lane, Wuhou District, 610041, Chengdu, Sichuan, People's Republic of China
| | - Zeping Yu
- Department of Orthopedics, West China Hospital, Sichuan University, No 37 Guo Xue Lane, Wuhou District, 610041, Chengdu, Sichuan, People's Republic of China
| | - Hongyuan Liu
- Department of Orthopedics, West China Hospital, Sichuan University, No 37 Guo Xue Lane, Wuhou District, 610041, Chengdu, Sichuan, People's Republic of China
| | - Xiang Fang
- Department of Orthopedics, West China Hospital, Sichuan University, No 37 Guo Xue Lane, Wuhou District, 610041, Chengdu, Sichuan, People's Republic of China
| | - Chongqi Tu
- Department of Orthopedics, West China Hospital, Sichuan University, No 37 Guo Xue Lane, Wuhou District, 610041, Chengdu, Sichuan, People's Republic of China
| | - Hong Duan
- Department of Orthopedics, West China Hospital, Sichuan University, No 37 Guo Xue Lane, Wuhou District, 610041, Chengdu, Sichuan, People's Republic of China.
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Chen C, Garlich J, Vincent K, Brien E. Postoperative complications with cryotherapy in bone tumors. J Bone Oncol 2017; 7:13-17. [PMID: 28413772 PMCID: PMC5390658 DOI: 10.1016/j.jbo.2017.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 04/04/2017] [Indexed: 11/19/2022] Open
Abstract
The technique of cryosurgery has been used to control local recurrence in a variety of benign and malignant bone tumors. Early studies revealed significant complication rates (25%) that included fracture, infection, and soft tissue injury. Our method of cryosurgery has yielded excellent tumor control with improved complication rates. The objective of this study is to determine the characteristics of postoperative complications after pouring liquid nitrogen into curettaged bone defects, and to review our current indications and surgical technique in bone tumor management. We reviewed charts in over 200 patients who received cryoablation for bone tumors from 1994 to 2015. Imaging studies were evaluated in all patients diagnosed with a complication. All patients receiving cryotherapy had soft tissue management intraoperatively that included warm saline directed to the structures. Liquid nitrogen was poured into the bone defect and in some cases, additional spraying with a cryogun into the defect was performed. The majority of cryotherapy was used in cases of active or aggressive benign tumors. Our low complication rate of 2.34% included 1 post-operative fracture, 3 infection, and 1 paraesthesia. Bone graft or cementation was used in the majority of patients, all of which fully incorporated. Cryoablation is an excellent from of adjuvant therapy for active and aggressive benign tumors and may be used in malignant tumors as well. Soft tissue protection is critical to avoid skin necrosis and wound breakdown. We recommend the use of cryotherapy in active and aggressive bone tumors as an adjuvant treatment prior to bone grafting or cementation. Cryoablation as an adjuvant treatment is recommended in active and aggressive benign tumors. A combination of a slow freeze and quick thaw, repeated for two cycles giving optimal penetration and stability across structures. Soft tissue management with warm saline is critical in preventing intraoperative injury. Controlled cryotherapy techniques can limit complication rates and local recurrence rates.
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Affiliation(s)
- Clark Chen
- School of Medicine, University of Miami, Miami, Fl 33136, United States
- Corresponding author.
| | - John Garlich
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Katie Vincent
- Brigham Young University, Provo, UT 84602, United States
| | - Earl Brien
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA 90048, United States
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Cho HS, Park YK, Oh JH, Lee JH, Han I, Kim HS. Proximal Tibia Chondroblastoma Treated With Curettage and Bone Graft and Cement Use. Orthopedics 2016; 39:e80-5. [PMID: 26726978 DOI: 10.3928/01477447-20151222-04] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 05/27/2015] [Indexed: 02/03/2023]
Abstract
Chondroblastoma has a predilection for the epiphyses or apophyses of long tubular bones. Management of lesions in the proximal tibia is challenging because it is difficult to gain access to intraepiphyseal lesions for completion of curettage. From October 2007 to December 2011, 9 patients with de novo chondroblastoma of the proximal tibia underwent surgery at the authors' institution. All patients initially presented with pain, and 5 patients had limitation of range of motion of the ipsilateral knee. Four lesions abutted the tibial attachment sites of the cruciate ligaments. Surgical procedures included intralesional tumor curettage, additional burring, and packing of the defect with bone graft and/or bone cement. The extra-articular approach was used according to tumor location. The medial or lateral parapatellar approach was used when the tumor was located in the anterior two-thirds of the horizontal plane. When a lesion was located in the posterior third, the posteromedial or posterolateral approach was used as the lesion was cornered. Mean duration of follow-up was 47.2 months (range, 27-80 months). No local recurrence or pulmonary metastasis was noted at latest follow-up. Mean functional score was 29.3 points (range, 28-30 points). All patients fully recovered range of motion in the affected knee. No avulsion fracture or anteroposterior instability of the knee joint was detected. Results of the current study suggest that intralesion curettage followed by additional burring with an extra-articular approach is a successful treatment option for chondroblastoma of the proximal tibia.
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Liquid nitrogen recycled autograft prosthesis composite reconstruction for osteosarcoma around the knee: review of 15 cases. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Complete local tumor control after curettage of chondroblastoma-a retrospective analysis. Orthop Traumatol Surg Res 2016; 102:473-8. [PMID: 27067177 DOI: 10.1016/j.otsr.2016.01.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 01/20/2016] [Accepted: 01/28/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Chondroblastoma is an uncommon benign bone tumor with an incidence of 1 to 2% among all primary bone tumors. In the past, treatment for chondroblastoma has been highly variable leading to different rates of recurrences. Therefore we aimed to determine: (1) the rate of recurrence, (2) the complication rate, (3) and functional outcome after intralesional curettage of chondroblastoma. HYPOTHESES Intralesional curettage with high speed burring and packing can avoid local recurrences. PATIENTS AND METHODS Experiences of 22 patients with chondroblastoma of the bone were retrospectively reviewed. The patient group consisted of 16 men; 6 women; mean age 24years (range; 12-58years) affecting in 15 the lower- (68%) and in seven the upper extremity (32%). RESULTS There was no local recurrence or malignant transformation. All patients underwent intralesional curettage, followed by defect filling presenting in 19 patients (87%) excellent clinical and oncological results (mean MSTS 98.9). Complications were seen in two patients. Pain was the main revealing symptom of the chondroblastoma (n=16, 73%). Mean follow-up of all patients was 114months (range, 25 to 480months). DISCUSSION Aggressive curettage and packing provided excellent local tumor control and functional results in our patients with chondroblastoma. Malignant transformation is extremely rare, however, present in literature but was not seen in any of our patients. LEVEL OF EVIDENCE Level IV, retrospective study.
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Davidson D. CORR Insights®: what are the results using the modified trapdoor procedure to treat chondroblastoma of the femoral head? Clin Orthop Relat Res 2014; 472:3468-70. [PMID: 25163690 PMCID: PMC4182391 DOI: 10.1007/s11999-014-3907-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 08/15/2014] [Indexed: 01/31/2023]
Affiliation(s)
- Darin Davidson
- Department of Orthopaedics and Sports Medicine, University of Washington, 1959 NE Pacific St, Box 356500, Seattle, WA 98195-6500 USA
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Abstract
BACKGROUND Benign bone tumors and tumor-like lesions are much more frequent than malignant bone tumors among the total number of tumors of the skeleton. OBJECTIVE This article gives a presentation of the characteristics and treatment modalities of benign bone tumors. MATERIAL AND METHODS In this article in-house treatment principles are compared with those in the currently available literature. RESULTS Benign bone tumors are frequently found incidentally; however, the term benign does not always signify that a purely observational role is needed. Benign bone tumors differ in their biological behavior and can be latent, active or aggressive which determines the treatment approach. Some benign bone tumors are just as aggressive locally as malignant tumors. The most important diagnostic feature is still conventional radiography and a thorough systematic analysis is necessary. Therapy options range from ignore, wait and see up to wide resection. In contrast to malignant tumors the radicalism of resection can be weighed against the accompanying local control and loss of function. CONCLUSION The treatment of benign bone tumors depends on the histological type and the biological activity. Most benign bone tumors are diagnosed incidentally and do not necessitate any treatment.
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Affiliation(s)
- A Hillmann
- Orthopädische Klinik, Klinikum Ingolstadt, 85049, Ingolstadt, Deutschland,
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