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Gaelen JI, Wu C, Yang A, Rajeswaran S, Lazar A, Cheon EC, Vargas AA. Use of regional anesthesia within a pediatric interventional radiology suite reduced periprocedural opioid use without delaying the overall workflow: a retrospective study. Reg Anesth Pain Med 2024:rapm-2024-105416. [PMID: 38925711 DOI: 10.1136/rapm-2024-105416] [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: 02/23/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Nerve block utility has been extensively described in the operating room, however, there is a paucity of evidence regarding blocks in the interventional radiology (IR) suite, with no studies examining its safety and efficacy in children. METHODS A retrospective study was conducted at a single tertiary-care children's hospital to evaluate the analgesic utility of nerve blocks during IR-performed sclerotherapy for bone cysts, venous malformations, and lymphatic malformations. Lymphatic and venous malformations were combined for final analysis. Patients between January 2016 and September 2022 had their medical records reviewed for procedural data, postprocedural pain scores, and analgesic administration data. RESULTS 309 patients were included in the final analysis. Opioids were required significantly less frequently intraprocedurally and postprocedurally across subgroups. The proportion of patients who received opioids during their hospital course was significant between block and non-block patients, respectively: bone cyst: 62.7% vs 100% (p<0.001); venous and lymphatic malformation: 65.7% vs 97.4% (p<0.001). Average maximum postanesthesia care unit (PACU) pain scores were significantly lower in bone cyst patients with no significant difference seen in pain scores among venous and lymphatic malformation patients. There were no reported nerve block-related complications. DISCUSSION Nerve blocks demonstrated an opioid-sparing effect intraprocedurally and postprocedurally for all subgroups. Their use among bone cyst patients was associated with significant reductions in average maximum PACU pain scores. Nerve blocks may constitute an effective opioid-sparing component of multimodal analgesia in pediatric patients undergoing IR sclerosis procedures. Prospective data are needed to establish the optimal utility of nerve blocks in the IR setting.
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Affiliation(s)
- Jordan I Gaelen
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Chunyi Wu
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Amy Yang
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Shankar Rajeswaran
- Division of Interventional Radiology, Department of Radiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Alina Lazar
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Eric C Cheon
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Angelica A Vargas
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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Scheider P, Farr S. Outcomes and complications of surgical treatment modalities for simple bone cysts of the humerus in children and adolescents. INTERNATIONAL ORTHOPAEDICS 2024; 48:1619-1626. [PMID: 38570348 DOI: 10.1007/s00264-024-06158-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/19/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE The aim of this study was to evaluate and compare different surgical treatment modalities for simple bone cysts (SBC) of the humerus regarding their effectiveness and recurrence rate. METHODS In this retrospective study, patients who received surgical treatment for previously untreated primary SBCs of the humerus were analyzed. Demographic data, cyst-specific as well as treatment-specific parameters, complications, treatment failures, and recurrence rates were collected and correlated with different treatment modalities. Observed procedures were categorized as open procedure (n=20) or osteosynthesis alone (n=3). For the open procedure group, four subgroups could be defined. RESULTS Twenty-three patients were included. The mean age at diagnosis was 11.6 ± 2.5 years, and the mean postoperative follow-up was 3.9 ± 2.6 years (range 1.0-10.3). After surgical intervention, a total of five (21.7%) patients showed at least one recurrence. Fracture occurred in three (13.0%) cases. The incidence of treatment failure was significantly higher in the curettage, allograft, adjuvants group, with five (83.3%) of six cases showing recurrence, than in the other subgroups (≤ 25.0%) including the osteosynthesis alone group (p=.024). For the open procedure group, the failure-free survival rates were 80.0% after two years and 50.4% after five years. For the three cases treated by osteosynthesis alone, no failures were observed. CONCLUSION Open procedures showed similar failure rates except for the subgroup using curettage, allograft, and adjuvants which showed significantly higher treatment failure. Promising results were observed in the group which received solely osteosynthesis without cyst excision or filling, as no treatment failure was observed here.
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Affiliation(s)
- Philipp Scheider
- Department of Pediatric Orthopaedics and Foot and Ankle Surgery, Orthopaedic Hospital Speising, Speisingerstraße 109, 1130, Vienna, Austria.
| | - Sebastian Farr
- Department of Pediatric Orthopaedics and Foot and Ankle Surgery, Orthopaedic Hospital Speising, Speisingerstraße 109, 1130, Vienna, Austria
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Costa DD, Gabrielli E, Cerrone M, Di Gialleonardo E, Maccauro G, Vitiello R. Pathological Fractures in Aneurysmal Bone Cysts: A Systematic Review. J Clin Med 2024; 13:2485. [PMID: 38731012 PMCID: PMC11084630 DOI: 10.3390/jcm13092485] [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: 03/14/2024] [Revised: 04/18/2024] [Accepted: 04/21/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Aneurysmal bone cysts (ABCs) are osteolytic, non-malignant, vascular lesions of the bone. Pathological fractures can be a manifestation of the ABCs, which occur in about 8% of ABCs. Different treatments have been described in the literature, but, nowadays, an optimal management of the pathological fractures in patients with ABCs is still a matter of debate and there are no standard guidelines for treatment nor any shared indication about the best surgical intervention. The aim of our study is to review the current literature available on this matter exploring and confronting different surgical treatments for pathological fractures in ABC in order to clarify the surgical approach to these patients. Methods: A systematic review of the literature indexed in PubMed, MEDLINE, and Cochrane Library databases was carried out. The Preferred Reporting Items for Systematically Reviews and Meta-Analyses (PRISMA) were followed. Results: A total of 37 articles were relevant and were finally included in the study. In total, we reached a population of 140 patients. Of the 140 patients included in the review, 124 patients (88.6%) underwent curettage surgery, 15 patients (10.7%) underwent en bloc resection surgery. A total of 47% of patients (70) underwent synthesis surgery with a plate, screw, nail, or external fixator. Adjuvant treatments were used in 8.6% of patients (12). Complications involved 20.7% of the patients (29). Conclusions: In conclusion, the treatment of pathological fractures in aneurysmal bone cysts requires careful patient assessment, considering factors such as age, the presence of open growth plates, the location of the lesion, and the surgeon's expertise.
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Affiliation(s)
- Doriana Di Costa
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.D.C.); (M.C.); (E.D.G.); (G.M.); (R.V.)
- Department of Orthopaedic Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Elena Gabrielli
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.D.C.); (M.C.); (E.D.G.); (G.M.); (R.V.)
- Department of Orthopaedic Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Mariagrazia Cerrone
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.D.C.); (M.C.); (E.D.G.); (G.M.); (R.V.)
- Department of Orthopaedic Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Emidio Di Gialleonardo
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.D.C.); (M.C.); (E.D.G.); (G.M.); (R.V.)
- Department of Orthopaedic Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giulio Maccauro
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.D.C.); (M.C.); (E.D.G.); (G.M.); (R.V.)
- Department of Orthopaedic Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Raffaele Vitiello
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.D.C.); (M.C.); (E.D.G.); (G.M.); (R.V.)
- Department of Orthopaedic Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Vanderniet JA, Szymczuk V, Högler W, Beck-Nielsen SS, Uday S, Merchant N, Crane JL, Ward LM, Boyce AM, Munns CF. Management of RANKL-mediated Disorders With Denosumab in Children and Adolescents: A Global Expert Guidance Document. J Clin Endocrinol Metab 2024; 109:1371-1382. [PMID: 38041865 PMCID: PMC11031248 DOI: 10.1210/clinem/dgad657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 12/04/2023]
Abstract
CONTEXT Denosumab is an effective treatment for many receptor activator of nuclear factor kappa-B ligand (RANKL)-mediated disorders but there are potential safety considerations and limited data to guide its use in children and adolescents. OBJECTIVE This document seeks to summarize the evidence and provide expert opinion on safe and appropriate use of denosumab in pediatric RANKL-mediated disorders. PARTICIPANTS Ten experts in pediatric bone and mineral medicine from 6 countries with experience in the use of denosumab participated in the creation of this document. EVIDENCE Data were sourced from the published literature, primarily consisting of case reports/series and review articles because of the lack of higher level evidence. Expert opinion of the authors was used substantially when no published data were available. CONCLUSION Denosumab is an effective treatment for RANKL-mediated disorders in children and adolescents but is often not curative and, in some cases, is best used in conjunction with surgical or other medical treatments. Careful multidisciplinary planning is required to define the goals of treatment and expert oversight needed to manage the risk of mineral abnormalities. Substantive, collaborative research efforts are needed to determine optimal treatment regimens and minimize risks.
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Affiliation(s)
- Joel A Vanderniet
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney and Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Sydney, NSW 2145, Australia
| | - Vivian Szymczuk
- Metabolic Bone Disorders Unit, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD 20814, USA
| | - Wolfgang Högler
- Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Linz 4020, Austria
| | - Signe S Beck-Nielsen
- Centre for Rare Diseases, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus N DK-8200, Denmark
| | - Suma Uday
- Department of Endocrinology and Diabetes, Birmingham Women's and Children's Hospital and Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TG, UK
| | - Nadia Merchant
- Division of Endocrinology and Diabetes, Children's National Hospital, Washington, DC 20010, USA
| | - Janet L Crane
- Department of Pediatrics and Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Leanne M Ward
- Department of Pediatrics, University of Ottawa and Division of Endocrinology, Children's Hospital of Eastern Ontario, Ottawa, Ontario K1H 8L1, Canada
| | - Alison M Boyce
- Metabolic Bone Disorders Unit, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD 20814, USA
| | - Craig F Munns
- Child Health Research Centre and Mayne Academy of Paediatrics, University of Queensland, Brisbane, QLD 4101, Australia
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Khatib M, Hasani IW. Acetabular Aneurysmal Bone Cyst During the Syrian Conflict: A Case Report of Surgical Treatment and Outcomes. Cureus 2024; 16:e56474. [PMID: 38638726 PMCID: PMC11025696 DOI: 10.7759/cureus.56474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/20/2024] Open
Abstract
Aneurysmal bone cysts (ABCs) are uncommon benign bone lesions that consist of blood-filled vascular spaces surrounded by fibrous tissue septa. Their diagnosis and surgical management are challenging in a war-torn region. In this case report, we present a rare case of a giant aneurysmal bone cyst located around the acetabulum in a 10-year-old female child who presented with an antalgic limp and left hip pain. The lesion was successfully treated with curettage and mixed autologous and synthetic bone grafts, and the follow-up for two years revealed a complete resolution of symptoms and radiological evidence of bone regeneration. This case highlights the successful surgical treatment of a challenging case of ABC in a difficult setting during the Syrian conflict.
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Affiliation(s)
| | - Ibrahim W Hasani
- Biochemistry, Idlib University Hospital, Idlib, SYR
- Biochemistry, Mary Private University (MPU), Idlib, SYR
- Biochemistry, Al-Shamal Private University (SPU), Idlib, SYR
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Lin CS, Lin SM, Rwei SP, Chen CW, Lan TY. Simple bone cysts of the proximal humerus presented with limb length discrepancy: A case report. World J Clin Cases 2024; 12:1130-1137. [PMID: 38464921 PMCID: PMC10921303 DOI: 10.12998/wjcc.v12.i6.1130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 01/10/2024] [Accepted: 01/30/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Simple bone cysts (SBC) are benign tumor-like bone lesions typically identified in children. While SBC may lead to growth disturbances or growth arrest, such cases are uncommon. The mechanisms behind these observations remain unclear. Additionally, research on the etiology of SBC remains inconclusive, and there has been no consensus on the appropriate timing and methodology for treatment. CASE SUMMARY Here, we present our experience in the successful surgical management of a 10-year-old girl with SBC, who presented with a pathological fracture complicated by malunion of the displaced fracture, varus deformity, and limb length discrepancy. We hypothesized two possible etiologies for the patient's growth arrest and subsequent humerus varus deformity: (1) Direct disruption of the physis by fluid from the cyst itself; and (2) damage to the epiphysis due to repetitive pathological fractures associated with SBC. In addressing this case, surgical intervention was undertaken to correct the proximal humerus varus deformity. This approach offered the advantages of simultaneously correcting angular abnormalities, achieving mild limb lengthening, providing definitive SBC treatment, and reducing the overall treatment duration. CONCLUSION As per current literature, acute correction of acute angular deformity in proximal humeral SBC is not well comprehended. However, in this specific case, acute correction was considered an optimal solution.
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Affiliation(s)
- Cing Syue Lin
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
| | - Shang Ming Lin
- Department of Materials and Textiles, Asia Eastern University of Science and Technology, New Taipei City 220, Taiwan
| | - Syang-Peng Rwei
- Institute of Organic and Polymeric Materials, National Taipei University of Technology, Taipei City 10608, Taiwan
| | - Chin-Wen Chen
- Institute of Organic and Polymeric Materials, National Taipei University of Technology, Taipei City 10608, Taiwan
| | - Tsung-Yu Lan
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
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Bakarman KA. Diagnosis and Current Treatment of Aneurysmal Bone Cysts. Cureus 2024; 16:e53587. [PMID: 38449944 PMCID: PMC10915701 DOI: 10.7759/cureus.53587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2024] [Indexed: 03/08/2024] Open
Abstract
The purpose of this review is to increase awareness about the evolution and development of current trends in the diagnosis and treatment of aneurysmal bone cysts (ABCs). ABCs are benign, but locally aggressive bone tumors that mainly affect children. ABCs comprise 1% of all primary bone tumors and occur most frequently during the first two decades of life. The diagnosis is made using a variety of imaging modalities and has the characteristic features of an expansile, radiolucent lesion that is often seen in the metaphyseal region of the bone and has fluid-fluid levels that are apparent on MRI. In the pediatric population, telangiectatic osteosarcoma and unicameral bone cyst (UBC) are the main differential diagnoses of an ABC. Giant cell tumors (GCTs) also include in differential diagnosis, which often manifest in patients older than 15 and do not penetrate the open physis although they develop after the physeal closure. Imaging alone cannot rule out telangiectatic osteosarcoma; therefore, a biopsy is recommended. A variety of treatment options have been described; traditionally, most patients are treated with curettage and bone grafting. Curettage alone, however, usually results in tumor recurrence following excision. A variety of adjuvants have been utilized with varying degrees of effectiveness to reduce the risk of local recurrence. When a cyst is in the pelvis, its location and size are such that surgery is a very risky option. Selective arterial embolization has significantly contributed to the development of effective treatments for these situations. Embolization or radiation, as well as denosumab therapy, are widely used as therapies for ABCs in anatomic locations where surgery would significantly increase morbidity.
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van Geloven TPG, van der Heijden L, Laitinen MK, Campanacci DA, Döring K, Dammerer D, Badr IT, Haara M, Beltrami G, Hobusch GM, Kraus T, Scheider P, Soto-Montoya C, Umer M, Saeed J, Funovics PT, Fiocco M, van de Sande MAJ, de Witte PB. As simple as it sounds? The treatment of simple bone cysts in the proximal femur in children and adolescents: Retrospective multicenter EPOS study of 74 patients. J Child Orthop 2024; 18:85-95. [PMID: 38348433 PMCID: PMC10859114 DOI: 10.1177/18632521231221553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/03/2023] [Indexed: 02/15/2024] Open
Abstract
Purpose Simple bone cysts are among the most prevalent benign cystic tumor-like lesions in children. Proximal femoral simple bone cysts may require specific treatment because of increased fracture risk. With limited literature available on this specific localization, consensus regarding optimal treatment is lacking. We present a large international multicenter retrospective cohort study on proximal femoral simple bone cysts. Methods All consecutive pediatric patients with proximal femoral simple bone cyst from 10 tertiary referral centers for musculoskeletal oncology were included (2000-2021). Demographics, primary treatment, complications, and re-operations were evaluated. Primary outcomes were time until full weight-bearing and failure-free survival. Results Overall, 74 simple bone cyst patients were included (median age 9 years (range = 2-16), 56 (76%) male). Median follow-up was 2.9 years (range = 0.5-21). Index procedure was watchful waiting (n = 6), percutaneous procedure (n = 12), open procedure (n = 50), or osteosynthesis alone (n = 6). Median time until full weight-bearing was 8 weeks (95% confidence interval = 0.1-15.9) for watchful waiting, 9.5 (95% confidence interval = 3.7-15.3) for percutaneous procedure, 11 (95% confidence interval = -0.7 to 13.7) for open procedure, and 6.5 (95% confidence interval = 5.9-16.1) for osteosynthesis alone (p = 0.58). Failure rates were 33%, 58%, 29%, and 0%, respectively (p = 0.069). Overall failure-free survival at 1, 2, and 5 years was 77.8% (95% confidence interval = 68.2-87.4), 69.5% (95% confidence interval = 58.5-80.5), and 62.0% (95% confidence interval = 47.9-76.1), respectively. Conclusion A preferred treatment for proximal femoral simple bone cysts remains unclear, with comparable failure rates and times until full weight-bearing. Watchful waiting may be successful in certain cases. If not feasible, osteosynthesis alone can be considered. Treatment goals should be cyst control, minimizing complications and swift return to normal activities. Therefore, an individualized balance should be made between undertreatment, with potentially higher complication risks versus overtreatment, resulting in possible larger interventions and accompanying complications. Level of evidence Level IV, retrospective multicentre study.
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Affiliation(s)
- Thomas PG van Geloven
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Lizz van der Heijden
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Minna K Laitinen
- Bone Tumor Unit, Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Domenico A Campanacci
- Orthopedic Oncology and Reconstructive Surgery, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Kevin Döring
- Division of Orthopedics, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Dietmar Dammerer
- Department of Orthopaedics and Traumatology, University Hospital of Krems, Krems, Austria
| | - Ismail T Badr
- Orthopedic Surgery, Menoufia University, Shebin El-Kom, Egypt
| | - Mikko Haara
- Pediatric Surgery and Orthopedics, New Children’s Hospital Helsinki, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Giovanni Beltrami
- Pediatric Orthopedics, Azienda Ospedaliero Universitaria Meyer, Florence, Italy
| | - Gerhard M Hobusch
- Division of Orthopedics, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Tanja Kraus
- Pediatric Orthopedic Unit, Orthopedics and Traumatology, University of Graz, Graz, Austria
| | - Philipp Scheider
- Trauma Surgery, University Clinic of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Masood Umer
- Orthopedic Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Javeria Saeed
- Orthopedic Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Phillipp T Funovics
- Division of Orthopedics, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Marta Fiocco
- Medical Statistics Section, Department of Biomedical Data Science, Leiden University Medical Center, Leiden, The Netherlands
- Mathematical Institute, Leiden University, Leiden, The Netherlands
| | | | - Pieter Bas de Witte
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Wen Z, Kuang G, Jiang Y, Wu Y, Liu E, Qiu L, Xu X, Lu M. Autogenous fibula head transplantation for aneurysmal bone cyst of distal radius: A case report followed up for 7 years. Medicine (Baltimore) 2024; 103:e36210. [PMID: 38215118 PMCID: PMC10783419 DOI: 10.1097/md.0000000000036210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/30/2023] [Indexed: 01/14/2024] Open
Abstract
RATIONALE Aneurysmal bone cyst (ABC) is a rare primary or secondary tumor that usually occurs in young women aged between 10 and 20 years, mostly in the long tubular bone and spine. However, there are no definite standards for its clinical treatment. To our knowledge, this is the first report of a young female patient with distal radius ABC who was successfully treated with tumor resection and autogenous fibular head transplantation. PATIENT CONCERNS A 28-year-old married Chinese young woman presented to our hospital with swelling and pain in her right wrist for 2 years and aggravation of wrist movement restriction for 1 week. DIAGNOSES Pathological biopsy confirmed ABC. INTERVENTIONS We performed a pathological examination of the tumor on the right wrist and preliminarily confirmed the diagnosis of ABC. The right wrist joint was reconstructed by total surgical resection of the ABC tumor in the right wrist joint and autogenous fibular head transplantation. OUTCOMES During follow-up within 7 years, good right wrist function was confirmed. The tumor did not recur, the swelling of the right wrist disappeared, the joint pain and limitation of movement significantly improved, and the function of the right wrist was not impaired in daily activities. Radiography showed that the fracture had healed. LESSONS Our results suggest that autofibular head transplantation is an effective treatment for reconstruction of wrist function in adult patients with ABC of the distal radius.
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Affiliation(s)
- Zhi Wen
- Department of Joint Orthopedics, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
- Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Gaoyan Kuang
- Department of Joint Orthopedics, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Yong Jiang
- Department of Pediatric Orthopedics, Traditional Chinese Medicine Hospital in Huaihua, Huaihua, Hunan, China
| | - Yuyuan Wu
- Department of Pediatric Orthopedics, Traditional Chinese Medicine Hospital in Huaihua, Huaihua, Hunan, China
| | - Enxu Liu
- Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Liguo Qiu
- Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Xiaotong Xu
- Department of Joint Orthopedics, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Min Lu
- Department of Joint Orthopedics, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
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Galán-Olleros M, Miranda-Gorozarri C, Rey-Cañas R, Alonso-Hernández J, Azorín-Cuadrillero D, Palazón-Quevedo Á. Hexapod Frame Correction of Proximal Tibial Recurvatum Caused Indirectly by a Femoral Aneurysmal Bone Cyst in an Adolescent: A Case Report and Systematic Review. JBJS Case Connect 2024; 14:01709767-202403000-00041. [PMID: 38452160 DOI: 10.2106/jbjs.cc.23.00496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
CASE A 16-year-old boy presented with a recurrent distal femur aneurysmal bone cyst accompanied by a combined sagittal knee deformity (20° of femoral antecurvatum and 26.8° of tibial recurvatum) and limb shortening. After preoperative planning, the treatment involved new intralesional curettage, phenolization, and bone allograft filling. Additional procedures included distal extension femoral osteotomy with plate fixation, and proximal tibial osteotomy with, gradually corrected through a hexapod frame. At 2-year follow-up, lower limbs exhibited normoalignment and equal length. CONCLUSION Complex knee deformities may occur with tumoral lesions around the knee but can be effectively addressed through double osteotomy and application of a hexapod frame.
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Affiliation(s)
- María Galán-Olleros
- Orthopaedic Surgery and Traumatology Department. Hospital Infantil Universitario Niño Jesús, Madrid
| | - Carlos Miranda-Gorozarri
- Orthopaedic Surgery and Traumatology Department. Hospital Infantil Universitario Niño Jesús, Madrid
| | - Roberto Rey-Cañas
- Orthopaedic Surgery and Traumatology Department, Hospital Universitario de Getafe, Madrid
| | - Javier Alonso-Hernández
- Orthopaedic Surgery and Traumatology Department. Hospital Infantil Universitario Niño Jesús, Madrid
| | | | - Ángel Palazón-Quevedo
- Orthopaedic Surgery and Traumatology Department. Hospital Infantil Universitario Niño Jesús, Madrid
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Annamalai S, Kandasamy V, Chandrasekaran S, Muthu S. Cross-beam Non-vascular Fibular Graft Reconstruction in the Management of Long Bone Giant Aneurysmal Bone Cyst - A Case Series. J Orthop Case Rep 2023; 13:141-147. [PMID: 38162373 PMCID: PMC10753678 DOI: 10.13107/jocr.2023.v13.i12.4112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/03/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Aneurysmal bone cyst (ABC) is a benign expansile osteolytic lesion, characterized by a blood-filled cavity in the bone. Giant ABC (GABC) is an uncommon condition due to the delayed presentation of an ABC that is difficult to handle when it occurs in long weight-bearing bones due to its aggressive nature. The common treatment relies on total resection of tumor with reconstruction of the resultant defect. Case Report We present the results of 5 cases of GABCs of long bones managed with non-vascularized fibular graft in a cross-beam fashion along with internal fixation. All patients achieved complete consolidation of the lesion by 12 months along with full incorporation of the graft with good-excellent musculoskeletal tumor society scores. None of the patients had recurrence/pathological fracture till 2 years of follow-up. Conclusion We suggest the method of using a non-vascularized fibula graft in a cross-beam fashion to reconstruct the void from the resection of long-bone GABC as a safe, reliable technique with excellent functional and radiological results.
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Affiliation(s)
- Saravanan Annamalai
- Department of Orthopaedics, Thiruvallur Medical College, Thiruvallur, Tamil Nadu, India
| | - Velmurugan Kandasamy
- Department of Orthopaedics, Government Kilpauk Medical College, Chennai, Tamil Nadu, India
| | | | - Sathish Muthu
- Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
- Department of Biotechnology, Faculty of Engineering, Karpagam Academy of Higher Education, Coimbatore, Tamil Nadu, India
- Department of Orthopaedics, Government Medical College, Karur, Tamil Nadu, India
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Andreani L, Ipponi E, Serrano E, De Franco S, Cordoni M, Bechini E, D’Arienzo A, Parchi PD. Aneurysmal Bone Cyst of the Pelvis in Children and Adolescents: Effectiveness of Surgical Treatment with Curettage, Cryotherapy and Bone Grafting. Healthcare (Basel) 2023; 11:2658. [PMID: 37830695 PMCID: PMC10572795 DOI: 10.3390/healthcare11192658] [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: 07/31/2023] [Revised: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Aneurysmal bone cysts (ABCs) are benign but locally aggressive cystic lesions of the bone. Pelvic ABCs are extremely rare and hard to treat due to their high risk of local recurrence and the tough access to pelvic bones. METHODS In this retrospective study, we evaluated pediatric cases with pelvic ABC treated with curettage, cryotherapy and bone grafting treated in our institution between 2016 and 2022. Complications were recorded, as well as local recurrences. Patients' post-operative functionality was assessed with the MSTS score. RESULTS Fourteen consecutive cases were included in our study. Their mean age at surgery was 13.5 years. The mean lesion size was 55 mm. The mean follow-up was 38 months. Two cases (11.8%) had local recurrences, which were successfully treated with further curettage. At their latest FU, 13 cases were continuously disease free (CDF), and one had no evidence of disease (NED). Only one case had a post-operative compilation (wound dehiscence). Patients' mean post-operative MSTS score was 29.6. CONCLUSIONS Pelvic ABCs are a challenge, even for the most experienced orthopedic surgeon. Our study suggests that the association of an accurate curettage, intraoperative cryotherapy and bone grafting can be a reliable and effective therapeutic option for large-sized ABCs of the pelvis.
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Affiliation(s)
| | - Edoardo Ipponi
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56126 Pisa, Italy; (L.A.); (E.S.); (S.D.F.); (M.C.); (E.B.); (A.D.); (P.D.P.)
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13
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Weber KS, Jensen CL, Petersen MM. Sclerotherapy as a primary or salvage procedure for aneurysmal bone cysts: A single-center experience. World J Orthop 2023; 14:698-706. [PMID: 37744716 PMCID: PMC10514711 DOI: 10.5312/wjo.v14.i9.698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/17/2023] [Accepted: 08/23/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Aneurysmal bone cysts (ABC) are benign cystic bone tumors of an osteolytic and locally aggressive nature. As an alternative to the primary treatment of choice, which consists of curettage with bone grafting, alternative treatment methods with promising results have been described. At our department, we have, in recent years, used percutaneous sclerotherapy with polidocanol. The objective of this study was to identify the healing rate and safety of sclerotherapy with polidocanol. AIM To identify the efficacy and safety of sclerotherapy with polidocanol in primary and recurrent ABC. METHODS Twenty-two consecutive patients (median age 12.5 years; range 1-27) with 23 ABCs treated with sclerotherapy with polidocanol from 2016-2021 were included retrospectively. Eleven patients (48%) had undergone different forms of previous treatment with recurrence. Under general anesthesia and fluoroscopic guidance, repeated percutaneous injections of 4mg polidocanol/kg body weight were performed. Through review of the electronic medical records, the following were identified: healing and recurrence rate, number of treatments, gender, age, comorbidity, location of the tumor and side effects / complications, as well as any previous surgery for ABC. The median length of radiographic follow-up was 19.5 mo. RESULTS All ABCs except one (96%) showed healing or stable disease after a median of 4 (range 1-8) injections. Complete clinical and radiographic healing was observed in 16 cysts (70%), while partial radiographic healing with resolution of pain was seen in 6 cases (26%) and considered as stable disease. The cyst that failed to heal had previously undergone curettage twice with recurrence. One patient with a large pelvic ABC experienced, right after two injections, a sudden drop in blood pressure, which could quickly be reversed. One patient with a juxtaphyseal ABC in the femoral neck showed a minor limb length discrepancy because of deformity. Beyond that, no complications were observed. CONCLUSION Percutaneous sclerotherapy with polidocanol appears to be a safe alternative for treatment of aneurysmal bone cysts. In our series of both primary and recurrent cysts, it showed the ability to achieve healing or stable disease in 22 of 23 cases (96%). Further studies are needed to decide if this provides a long-lasting effect.
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Laliotis N, Konstantinidis P, Chrysanthou C, Giannakopoulou L, Papadopoulou E. Restoration of Limb Length Discrepancy and Alignment With the Ilizarov Device After Management of an Aneurysmal Bone Cyst Crossing the Distal Femoral Physis. Cureus 2023; 15:e46259. [PMID: 37908925 PMCID: PMC10615118 DOI: 10.7759/cureus.46259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 11/02/2023] Open
Abstract
An aneurysmal bone cyst (ABC), when located juxta-physeal, may rarely penetrate the growth plate and extend into the epiphysis. The recurrence rate is considered higher when ABC is in contact with the active growth plate. Treatment methods usually focus on cyst healing and the rate of cyst recurrence. We present the method of treatment used for addressing the lesion of the growth plate following the surgical management and healing of a juxta-physeal ABC. A seven-year-old girl had an aggressive ABC in the juxta-physeal area of the distal femur, penetrating the growth plate and extending in the epiphysis. Surgical treatment was performed, including curettage and autologous bone grafting, avoiding the growth plate. The cyst healed; however, physis presented an obliteration. The affected limb developed valgus deformity and severe leg length discrepancy (LLD). To address this issue, once our patient completed her growth, we proceeded with distraction osteogenesis, using the Ilizarov device, with asymmetrical lengthening of the rods. We achieved the correction of the limb alignment and resolved the LLD. ABCs in the juxta-physeal area of a growing child are benign metaphyseal tumors that exceptionally may penetrate the physis and extend into the epiphysis. Our report highlights that the growth plate's lesion, despite the cyst's healing, may compromise the final result. The use of the Ilizarov device is an effective method for correcting the malalignment and the LLD that may emerge.
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Affiliation(s)
| | | | - Chrysanthos Chrysanthou
- Orthopaedics, Interbalkan Medical Center, Thessaloniki, GRC
- Anatomy and Surgical Anatomy, Aristotle University of Thessaloniki, Thessaloniki, GRC
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Gruenewald LD, Koch V, Gruber-Rouh T, Thalhammer A, Frank J, Marzi I, Booz C, Yel I, Mahmoudi S, Bernatz S, Laudenberger I, Lingwal N, Vogl TJ, Eichler K. MR angiography facilitates the differentiation of aneurysmal from unicameral bone cysts. Br J Radiol 2023; 96:20220849. [PMID: 36745072 PMCID: PMC10078881 DOI: 10.1259/bjr.20220849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES The objective of this work was to evaluate the incremental value of MR angiography over plain radiographs and MRI for the differentiation of aneurysmal bone cysts (ABCs) from unicameral bone cysts (UBCs). METHODS Thirty-six juvenile patients with histologically secured primary ABCs or UBCs were included in this retrospective study. Two radiologists assessed all obtained images in a blinded fashion using a catalog of previously suggested imaging findings. A second readout with supplementary MR angiography images was performed after 8 weeks to prevent observer recall bias. Diagnostic accuracy parameters were calculated for individual imaging findings, and overall diagnostic accuracy and diagnostic confidence were assessed for all readouts. Receiver operating characteristic (ROC) curve comparison was used to determine the incremental value of MR angiography. RESULTS Of 16 imaging features, only abnormal vascularization in MR angiography provided sufficient diagnostic accuracy for the identification of ABCs. Other imaging features such as fluid-fluid levels and internal septations were insufficient for the differentiation of UBCs from ABCs. Availability of MR angiography images significantly increased diagnostic accuracy (94.4 vs 75.0% and 83.3 vs 69.4%, respectively, p < 0.05) and diagnostic confidence (4.5 vs 3.7, p < 0.05) of reading radiologists. CONCLUSION The presence of arterial feeders in MR angiography can accurately discriminate primary ABCs from UBCs and increases the diagnostic accuracy and diagnostic confidence of reporting radiologists. ADVANCES IN KNOWLEDGE Radiographic differentiation of cystic bone lesions such as ABCs and UBCs remains challenging. We demonstrate that MR angiography provides incremental value and suggest inclusion in standard examination protocols.
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Affiliation(s)
- Leon David Gruenewald
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Vitali Koch
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Tatjana Gruber-Rouh
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Axel Thalhammer
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Johannes Frank
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Ibrahim Yel
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Scherwin Mahmoudi
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Simon Bernatz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Isabella Laudenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Neelam Lingwal
- Department of Biostatistics and Mathematical Modeling, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Katrin Eichler
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
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Feasibility of Percutaneous Image-Guided Combined Treatment of Symptomatic Bone Cyst Using Cryoablation and Bone Graft Substitute. Cardiovasc Intervent Radiol 2023; 46:512-518. [PMID: 36826492 DOI: 10.1007/s00270-023-03390-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE To describe the feasibility and technique of percutaneous image-guided combined treatment of bone cyst (BC) using cryoablation and bone graft substitute injection. MATERIALS AND METHODS Between July 2019 and January 2022, six consecutive patients (ages between 16 and 33 years) with symptomatic BC in pelvic and lower extremity bones underwent percutaneous image-guided combined treatment using cryoablation and bone graft substitute. To induce bone mineralization as early as possible, the cyst cavity was filled with bone graft substitute. Technical success of the procedure was evaluated, and clinical success was defined as satisfactory clinical symptom relief using visual analogue scale (VAS). Radiologic success was defined as early BC remineralization on radiographic studies. Detailed demographic data with lesion location, size, time to and degree of BC mineralization, complications, clinical outcomes, and radiological follow-up were retrospectively assessed. RESULTS Technical success was 100% achieved in all patients. BC mineralization was observed in all patients, with a median time to reach 80% mineralization at 6 months, with one patient reaching 80% at 5 months and another reaching 100% at 3 months. A significant drop in VAS was observed in all patients, reflecting significant pain relief. There were no major complications. The median follow-up period was 31.5 months, with a minimum follow-up of 5 months and a maximum follow-up of 3 years. CONCLUSION Percutaneous image-guided combined treatment with cryoablation and bone graft substitute for symptomatic BC is technically feasible and was safe in this limited series.
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Lechtholz-Zey E, Matti NY, Fredrickson VL, Buchanan I, Donoho DA. Vertebral Aneurysmal Bone Cyst Mimicking Osteosarcoma: Case Report and Review of the Literature. Cureus 2023; 15:e35033. [PMID: 36938191 PMCID: PMC10023236 DOI: 10.7759/cureus.35033] [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: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
Aneurysmal bone cysts are benign osseous lesions containing blood-filled cavities separated by walls of connective tissue. They can be difficult to identify clinically due to similarities in presentation, imaging, and histology with other pathologies. Specifically, it is important to distinguish these benign lesions from malignant processes, as both surgical and medical management differ. We present the case of a 21-year-old patient who presented with impaired motor and sensory function in his lower extremities. Radiologic findings were concerning for an invasive neoplasm, and the intraoperative frozen section supported this conclusion. However, an additional histological investigation was confirmatory for a diagnosis of an aneurysmal bone cyst. The patient underwent corpectomy, laminectomy, and a posterior spinal fusion, and regained motor and sensory function shortly thereafter. This report details the importance of considering aneurysmal bone cysts in the differential of infiltrative bone lesions, despite their benign nature, as medical and surgical management can vary greatly.
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Affiliation(s)
- Elizabeth Lechtholz-Zey
- Orthopaedic Surgery, Keck School of Medicine of University of South California, Los Angeles, USA
| | - Nawar Y Matti
- Pathology, Southwest Healthcare System, Los Angeles, USA
| | | | | | - Daniel A Donoho
- Neurological Surgery, Children's National Hospital, Washington, DC, USA
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18
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Abstract
PURPOSE OF REVIEW Aneurysmal bone cysts are rare, locally aggressive bone tumors. Optimal treatment of ABCs is still matter of debate as therapies including sclerotherapy, selective arterial embolization and systemic treatment with denosumab are increasingly utilized, in addition to or instead of traditional curettage. The purpose of this review is to discuss current concepts and difficulties in diagnosing and treating primary ABCs, based on latest available literature. RECENT FINDINGS In diagnostics, multiple new fusion partners of USP-6 have been described on next-generation sequencing specifically for primary ABCs. In a recent systematic review, failure rates of percutaneous injections and surgery were comparable. In a literature review, the use of denosumab seemed effective but resulted in multiple cases of severe hypercalcemia in children. SUMMARY Accurately diagnosing primary ABC is crucial for treatment decisions. Curettage remains a valid treatment option, especially with adjuvant burring, autogenous bone grafting and phenolization. Percutaneous sclerotherapy represents a solid alternative to surgery, with polidocanol showing good results in larger studies. Systematic therapy with denosumab exhibits favorable results but should be reserved in the pediatric population for unresectable lesions, as it may result in severe hypercalcemia in children. When selecting a treatment option, localization, stability and safety should be considered.
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Obermeier KT, Schmöckel E, Otto S, Haidari S. Frequency of translocation of USP-6 in the aneurysmal bone cyst of the jaw. J Oral Pathol Med 2023; 52:145-149. [PMID: 36504363 DOI: 10.1111/jop.13393] [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: 05/22/2022] [Revised: 11/07/2022] [Accepted: 11/15/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND This study aims to detect USP6 translocation in aneurysmal cysts located in the jaw and to give an overview of demographic data. METHODS The present retrospective cohort study includes 10 patients who underwent surgery due to an aneurysmal cyst of the jaw in our hospital between 2002 and 2021. Unstained formalin-fixed and paraffin-embedded tissue sections cut at 4 μm thickness were subjected to USP6 FISH testing. RESULTS All patients underwent surgical treatment. In four of ten patients (40%) USP-6-translocations have been found. CONCLUSION Based on the study, it is hypothesized that the aneurysmal bone cyst of the jaw bone may be subject to a different pathomechanism than that of the long bones. Therefore, it seems conceivable that the primary cause of aneurysmal bone cysts in the jaw might differ.
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Affiliation(s)
- Katharina Theresa Obermeier
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich University of Munich, Munich, Germany
| | - Elisa Schmöckel
- Department of Pathology, LMU Munich University of Munich, Munich, Germany
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich University of Munich, Munich, Germany
| | - Selgai Haidari
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich University of Munich, Munich, Germany
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Do's and Don'ts in Primary Aneurysmal Bone Cysts of the Proximal Femur in Children and Adolescents: Retrospective Multicenter EPOS Study of 79 Patients. J Pediatr Orthop 2023; 43:37-45. [PMID: 36102541 PMCID: PMC9746336 DOI: 10.1097/bpo.0000000000002267] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Aneurysmal bone cysts (ABC) are rare benign cystic bone tumors, generally diagnosed in children and adolescents. Proximal femoral ABCs may require specific treatment strategies because of an increased pathologic fracture risk. As few reports are published on ABCs, specifically for this localization, consensus regarding optimal treatment is lacking. We present a large retrospective study on the treatment of pediatric proximal femoral ABCs. METHODS All eligible pediatric patients with proximal femoral ABC were included, from 11 tertiary referral centers for musculo-skeletal oncology (2000-2021). Patient demographics, diagnostics, treatments, and complications were evaluated. Index procedures were categorized as percutaneous/open procedures and osteosynthesis alone. Primary outcomes were: time until full weight-bearing and failure-free survival. Failure was defined as open procedure after primary surgery, >3 percutaneous procedures, recurrence, and/or fracture. Risk factors for failure were evaluated. RESULTS Seventy-nine patients with ABC were included [mean age, 10.2 (±SD4.0) y, n=56 male]. The median follow-up was 5.1 years (interquartile ranges=2.5 to 8.8).Index procedure was percutaneous procedure (n=22), open procedure (n=35), or osteosynthesis alone (n=22). The median time until full weight-bearing was 13 weeks [95% confidence interval (CI)=7.9-18.1] for open procedures, 9 weeks (95% CI=1.4-16.6) for percutaneous, and 6 weeks (95% CI=4.3-7.7) for osteosynthesis alone ( P =0.1). Failure rates were 41%, 43%, and 36%, respectively. Overall, 2 and 5-year failure-free survival was 69.6% (95% CI=59.2-80.0) and 54.5% (95% CI=41.6-67.4), respectively. Risk factors associated with failure were age younger than 10 years [hazard ratios (HR)=2.9, 95% CI=1.4-5.8], cyst volume >55 cm 3 (HR=1.7, 95% CI=0.8-2.5), and fracture at diagnosis (HR=1.4, 95% CI=0.7-3.3). CONCLUSIONS As both open and percutaneous procedures along with osteosynthesis alone seem viable treatment options in this weight-bearing location, optimal treatment for proximal femoral ABCs remains unclear. The aim of the treatment was to achieve local cyst control while minimizing complications and ensuring that children can continue their normal activities as soon as possible. A personalized balance should be maintained between undertreatment, with potentially higher risks of pathologic fractures, prolonged periods of partial weight-bearing, or recurrences, versus overtreatment with large surgical procedures, and associated risks. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Young VA, Thakor AS, Josephs SC. Update on Pediatric Interventional Radiology. Radiographics 2022; 42:1580-1597. [DOI: 10.1148/rg.220019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Victoria A. Young
- From the Division of Pediatric Radiology, Department of Radiology, Stanford University School of Medicine, 725 Welch Rd, Room 1927, Palo Alto, CA 94304
| | - Avnesh S. Thakor
- From the Division of Pediatric Radiology, Department of Radiology, Stanford University School of Medicine, 725 Welch Rd, Room 1927, Palo Alto, CA 94304
| | - Shellie C. Josephs
- From the Division of Pediatric Radiology, Department of Radiology, Stanford University School of Medicine, 725 Welch Rd, Room 1927, Palo Alto, CA 94304
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Rai AK, Rathod TN, Bansal D, Hadole BS, Rahman SH, Kumar K G G, Prabhu RM. Clinicoradiological outcome of percutaneous intralesional polidocanol in Aneurysmal Bone Cysts: A prospective study of 43 patients in a single tertiary care centre. J Orthop 2022; 32:72-77. [DOI: 10.1016/j.jor.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/04/2022] [Accepted: 05/12/2022] [Indexed: 10/18/2022] Open
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Aneurysmal bone cyst of the spine in adult patients: A systematic review and comparison of primary vs secondary lesions. J Clin Neurosci 2022; 100:15-22. [DOI: 10.1016/j.jocn.2022.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/26/2022] [Indexed: 11/19/2022]
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Dawod MS, Alisi MS, Rabab’a H, Abdulelah AA, Almaaitah HW, Haddad B. Surgical Management of Aneurysmal Bone Cyst of the Pubis: A Case Report and Review of Literature. Int Med Case Rep J 2022; 15:287-292. [PMID: 35726264 PMCID: PMC9206452 DOI: 10.2147/imcrj.s369073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/31/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Case Report Conclusion
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Affiliation(s)
- Mohd Said Dawod
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, Mutah University, Al Karak, Jordan
| | - Mohammed S Alisi
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
- Correspondence: Mohammed S Alisi, The University of Jordan, School of Medicine, Queen Rania Al Abdullah St 266 Al Jubaiha, Amman, 11942, Jordan, Tel +962790983284, Email
| | - Hammam Rabab’a
- School of Medicine, The University of Jordan, Amman, Jordan
| | | | | | - Bassem Haddad
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
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Restrepo R, Zahrah D, Pelaez L, Temple HT, Murakami JW. Update on aneurysmal bone cyst: pathophysiology, histology, imaging and treatment. Pediatr Radiol 2022; 52:1601-1614. [PMID: 35941207 PMCID: PMC9360065 DOI: 10.1007/s00247-022-05396-6] [Citation(s) in RCA: 2] [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: 01/14/2022] [Revised: 04/05/2022] [Accepted: 05/03/2022] [Indexed: 11/26/2022]
Abstract
Aneurysmal bone cyst (ABC) is a benign but locally aggressive lesion that predominantly affects children and young adults. ABC, which accounts for approximately 70% of the cases, is now recognized to be a true neoplasm, whereas ABC-like changes associated to other bone neoplasms (also referred in the literature as secondary ABC) accounts for the remaining 30%. The solid variant of ABC is also considered a true neoplasm but is rare. ABC can involve any bone in the body, and although it has a metaphyseal preference, it can involve any part of a bone and soft tissues. As with any bone tumor, the initial evaluation of ABCs should be done with radiographs followed by magnetic resonance imaging or less frequently computed tomography for further characterization. The imaging appearance of ABC is variable; however, a lytic and expansile lesion with fluid-fluid levels is the most common presentation. The main differential diagnosis of an ABC in the pediatric population is unicameral bone cyst (UBC) and telangiectatic osteosarcoma, therefore a biopsy is recommended before treatment. The therapeutic options of ABC range from curettage with or without adjuncts such as phenol, liquid nitrogen, argon laser and bone grafting or bone substitutes to more recently employed alternatives such as image-guided sclerotherapy with various sclerosing agents and monoclonal antibodies (e.g., Denosumab).
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Affiliation(s)
- Ricardo Restrepo
- grid.415486.a0000 0000 9682 6720Department of Radiology, Nicklaus Children’s Hospital, Miami, FL USA
| | - David Zahrah
- grid.4367.60000 0001 2355 7002School of Arts and Sciences, Washington University, St. Louis, MO USA
| | - Liset Pelaez
- grid.415486.a0000 0000 9682 6720Department of Pathology, Nicklaus Children’s Hospital, Miami, FL USA
| | - H. Thomas Temple
- grid.26790.3a0000 0004 1936 8606Department of Orthopedic Surgery, Miller School of Medicine, University of Miami, Miami, FL USA
| | - James W. Murakami
- grid.240344.50000 0004 0392 3476Department of Radiology, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205 USA
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