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Shermetaro J, Jajou L, Seidman A, McCall D. Total Hip Arthroplasty in a Patient With a Large Proximal Femur Aneurysmal Bone Cyst: A Case Report and Literature Review. Arthroplast Today 2024; 27:101392. [PMID: 38774404 PMCID: PMC11106834 DOI: 10.1016/j.artd.2024.101392] [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: 12/21/2023] [Revised: 03/20/2024] [Accepted: 03/30/2024] [Indexed: 05/24/2024] Open
Abstract
Aneurysmal bone cysts (ABCs) are rare benign bone lesions with a predilection for the metaphysis of long bones. They are often cystic, expansive, and osteolytic and may result in bony deformity. In general, there remains debate about optimal treatment for ABCs; however, the mainstay typically consists of a combination of curettage, bone grafting, and considering the need for internal fixation and osteotomies. The goals of treatment include preserving bony anatomy while eliminating the lesion. There is sparse literature regarding the treatment of osteoarthritis adjacent to benign bony tumors. If total hip arthroplasty is chosen as a treatment option, diligent preoperative planning is required, and the surgeon must assess the patient's bone stock, account for bony deformity, and utilize specific implants and techniques based on the patient's characteristics. We present a case of an adult patient with proximal femur ABC and symptomatic adjacent hip osteoarthritis who underwent treatment with total hip arthroplasty.
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Affiliation(s)
- Jacob Shermetaro
- Department of Orthopedic Surgery, Corewell Health Farmington Hills Hospital, Farmington Hills, MI, USA
| | - Lawrence Jajou
- Department of Orthopedic Surgery, Corewell Health Farmington Hills Hospital, Farmington Hills, MI, USA
| | - Aaron Seidman
- Department of Orthopedic Surgery, Corewell Health Farmington Hills Hospital, Farmington Hills, MI, USA
| | - Daniel McCall
- Department of Orthopedic Surgery, Corewell Health Farmington Hills Hospital, Farmington Hills, MI, USA
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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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Ionescu A, Popescu B, Neagu O, Carp M, Tevanov I, Balanescu L, Balanescu RN. Dysplasia Epiphysealis Hemimelica (Trevor's Disease) in Children, Two New Cases: Diagnosis, Treatment, and Literature Review. CHILDREN-BASEL 2021; 8:children8100907. [PMID: 34682172 PMCID: PMC8600412 DOI: 10.3390/children8100907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/02/2021] [Accepted: 10/06/2021] [Indexed: 11/16/2022]
Abstract
Dysplasia epiphysealis hemimelica (DEH), also known as Trevor’s disease, is a rare nonhereditary skeletal disorder affecting one side of the epiphyses or the epiphyses-equivalents. It is often misdiagnosed for traumatic injuries, infections, or other tumors because of the nonspecific clinical features. The diagnosis is mostly based on radiographic involvement of one half of the epiphysis displaying an overgrowth; it is hard to distinguish between DEH and osteochondroma on the gross hystopathological exam. There are few immunohistochemical markers, as well as genetic tests, for EXT1 and EXT2 gene expression that can reveal a more accurate diagnosis. No evidence of malignant changes has been reported and no hereditary transmission or environmental factor has been incriminated as an etiological factor. The natural history of the disease is continuous growth of the lesions until skeletal maturity. Without treatment, the joint might suffer degenerative modification, and the patient can develop early onset osteoarthritis. In the present paper, we report two new cases of DEH of the ankle. The aim of this paper is to consider Trevor’s disease when encountering tumoral masses in the epiphyses of pediatric patients and to present our treatment approach and results.
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Affiliation(s)
- Adelina Ionescu
- Department of Pediatric Orthopedic Surgery, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, 011743 Bucharest, Romania; (A.I.); (B.P.); (I.T.)
| | - Bogdan Popescu
- Department of Pediatric Orthopedic Surgery, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, 011743 Bucharest, Romania; (A.I.); (B.P.); (I.T.)
| | - Oana Neagu
- Department of Pathology, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, 011743 Bucharest, Romania;
| | - Madalina Carp
- Department of Pediatric Orthopedic Surgery, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, 011743 Bucharest, Romania; (A.I.); (B.P.); (I.T.)
- Correspondence: or ; Tel.: +40-21-316-93-72
| | - Iulia Tevanov
- Department of Pediatric Orthopedic Surgery, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, 011743 Bucharest, Romania; (A.I.); (B.P.); (I.T.)
| | - Laura Balanescu
- Department of Pediatric Surgery, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, 011743 Bucharest, Romania; (L.B.); (R.N.B.)
- Department of Pediatric Surgery and Orthopedics, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
| | - Radu Ninel Balanescu
- Department of Pediatric Surgery, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, 011743 Bucharest, Romania; (L.B.); (R.N.B.)
- Department of Pediatric Surgery and Orthopedics, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
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TEOIBAS-SERBAN D, IORDACHE L, STAN V, BLENDEA D. Prevention of lumbar disc herniation in young adult population – Collecting data for the awareness campaign. BALNEO RESEARCH JOURNAL 2020. [DOI: 10.12680/balneo.2020.392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction. Our previous paper discussed the increasing number of young adult population with lumbar disc herniation in the past few years. Most of the patients who seek medical attendance are young healthy male adults. They workout at the gym for a variety of reasons such as weight loss, muscle toning and increasing muscle mass. They are either unaware of the risk that certain exercises involve, or they wish to get faster results, obtaining the opposite effects. Thus, many of them develop lumbar disc herniation at a young age and must maintain certain restraints in order to stop it from evolving or reoccurring. The ideal solution is to increase awareness at the already numerous young male population who frequents the gym to prevent disc herniation. Material and method. The next step for our awareness campaign is to collect data directly from the source. A carefully created questionnaire with specific questions related to general knowledge, way of training and individual research on the topic was given to young adult males in many gyms from Bucharest. The questionnaire was completely anonymous and targeted young adult males which had to respond truthfully and give away only their age. Results and discussions. The statistics show that most of the responders to the questionnaire did know about lumbar disc herniation and the risk involved in exercises such as weightlifting but did not possess the proper knowledge of how to do certain movements in order to prevent it. Conclusions. The data collected showed that most of the young male adults which frequent the gym are not fully prepared with enough knowledge in order to do certain exercises without risking lumbar disk herniation. We must continue our campaign of awareness in this category of population in order to reduce the number of young patients with this disease.
Keywords: lumbar disc herniation, gym, low back pain, exercises,
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Affiliation(s)
| | - Liviu IORDACHE
- 1. Clinical Regional Emergency Hospital Ilfov Bucharest, Romania
| | - Valentin STAN
- 2. Univeristy of Medicine “Titu Maiorescu” Bucharest, Romania
| | - Dan BLENDEA
- 1. Clinical Regional Emergency Hospital Ilfov Bucharest, Romania 2. Univeristy of Medicine “Titu Maiorescu” Bucharest, Romania
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Abstract
PURPOSE The literature lacks recommendations for postoperative rehabilitation following removal of aneurysmal bone cysts (ABCs). This case report describes the rehabilitation with return to age-appropriate functional activities for a 4-year-old following surgical fixation of a femoral ABC, with emphasis on clinical decision-making in the absence of definitive treatment algorithms. SUMMARY OF KEY POINTS The child improved in range of motion, strength, balance, transfers, gait, stair negotiation, and percentile rank on the Test of Gross Motor Development 2. CONCLUSION This case is successful outcomes of a 4-year-old girl (GP) following surgical fixation for an ABC. RECOMMENDATIONS FOR CLINICAL PRACTICE This case fills a current void in the literature emphasizing clinical decision-making and attainment of GP-specific functional goals. A goal-driven approach incorporating key elements of the International Classification of Function model resulted in successful return to age-appropriate activity following surgical fixation of a femoral fracture due to an ABC.
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Ulici A, Florea DC, Carp M, Ladaru A, Tevanov I. Treatment of the aneurysmal bone cyst by percutaneous intracystic sclerotherapy using ethanol ninety five percent in children. INTERNATIONAL ORTHOPAEDICS 2018; 42:1413-1419. [PMID: 29492610 DOI: 10.1007/s00264-018-3841-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 02/11/2018] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Aneurysmal bone cyst (ABC) is a benign intraosseous lesion filled with blood that can determine a blowout distension of the bone. The purpose of this study is to evaluate the efficacy of sclerotherapy by percutaneous intralesional administration of ethanol 96% for the treatment of this pathology in paediatric patients. METHOD The retrospective study includes 17 paediatric patients with ABC who were treated by repeated intracystic injection with ethanol 96%, 1 ml/kg, in our clinic between December 2015 and July 2017. Fluoroscopic guidance was used to inject the cyst with contrast agent. The mean follow-up period was 11 months. RESULTS AND DISCUSSION All cysts are healed or are in the healing process. The mean age was 11 years old. Seven patients needed three repeated injections and ten patients needed two injections until healing. We observed a mean reduction in the size of the lesions, measured on plain X-rays, of 68%. The complications that were observed included the following: dizziness after injection, skin pigmentation at the injection site, local inflammatory reaction, and pain after injection. The current study approves the importance of this minimally invasive treatment with no recurrence after a follow-up of 19 months. The healing rate was 100%. A limitation of this study consists in the small number of patients. CONCLUSION Sclerotherapy with ethanol 96% is a useful method for the treatment of ABC. It is a minimally invasive method, with no major complications, which lowers the risks of open surgical intervention and has a good rate of success.
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Affiliation(s)
- Alexandru Ulici
- Department of Pediatric Orthopedic Surgery, Emergency Hospital for Children "Grigore Alexandrescu", 30-32, Iancu de Hunedoara Bvd, 011733, Bucharest, Romania. .,Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
| | - Daniel-Catalin Florea
- Department of Pediatric Orthopedic Surgery, Emergency Hospital for Children "Grigore Alexandrescu", 30-32, Iancu de Hunedoara Bvd, 011733, Bucharest, Romania
| | - Madalina Carp
- Department of Pediatric Orthopedic Surgery, Emergency Hospital for Children "Grigore Alexandrescu", 30-32, Iancu de Hunedoara Bvd, 011733, Bucharest, Romania
| | - Alin Ladaru
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Iulia Tevanov
- Department of Pediatric Orthopedic Surgery, Emergency Hospital for Children "Grigore Alexandrescu", 30-32, Iancu de Hunedoara Bvd, 011733, Bucharest, Romania
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