1
|
Jiang X. Application of the Locking Compression Pediatric Hip Plate™ in children with proximal femoral tumors. J Orthop Surg Res 2022; 17:536. [PMID: 36503578 PMCID: PMC9743614 DOI: 10.1186/s13018-022-03433-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Pediatric proximal femoral tumors often present with accumulative and severe bone destruction and are often complicated by pathological fractures and malunion. Such tumors are treated clinically by lesion scraping and graft reconstruction with autologous iliac bone alone or in combination with artificial bone. This study aimed to determine the efficacy of the Locking Compression Pediatric Hip Plate™ in treating pediatric proximal femoral tumors. METHODS From 2012-2017, the Locking Compression Pediatric Hip Plate™ was applied for internal fixation in 28 children in the Department of Pediatric Surgery. The complications were pathological fractures in 19 patients and multiple lesions in 5 patients. Tumors were removed by tumor curettage and reconstruction with autogenous iliac bone or artificial bone graft. The Locking Compression Pediatric Hip Plate™ was then applied. Postoperative pathological examination confirmed the diagnosis. RESULTS The cohort comprised 20 males and 8 females (mean age 7.8 ± 2.9 years). The mean follow-up duration was 26.1 ± 8.1 months (range 18-48 months). Post-treatment radiography showed that the lesions and local pathological fractures were healed in 3.2 ± 0.4 months (range 3-4 months), with no complications. Four patients continued to receive antineoplastic therapy postoperatively. Four patients experienced recurrence in situ, while another four developed distant metastases. The radiographic and joint function findings indicated that the affected limbs had excellent function. The mean Enneking score was 28.7 ± 1.0 points (range 27-30 points). CONCLUSIONS Internal fixation with the Locking Compression Pediatric Hip Plate™ in children achieves good therapeutic effects. Moreover, the Locking Compression Pediatric Hip Plate™ resolves the shortcomings of external fixation by traditional plaster casts and internal fixation by Kirschner wires and elastic intramedullary screws.
Collapse
Affiliation(s)
- Xin Jiang
- grid.13291.380000 0001 0807 1581Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| |
Collapse
|
2
|
Rajasekaran RB, Jayaramaraju D, Palanisami DR, Agraharam D, Thippeswamy PB, Rajasekaran S. Role of impaction bone grafting of allografts in the management of benign lesions of the proximal femur. J Orthop 2022; 34:189-195. [PMID: 36104992 PMCID: PMC9465316 DOI: 10.1016/j.jor.2022.08.025] [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: 06/24/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose of study The use of allografts to reconstruct benign lesions of the proximal femur after curettage has seldom been reported. We report our experience of impaction bone grafting of only allografts combined with osteosynthesis to manage benign lesions involving the proximal femur. Materials and methods Between 2013 and 2019, 35 patients of a mean age of 23.8 years (14-41) who had a biopsy proven benign pathology and a median pre-operative Mirels' score of 9 (8-11) were managed using extended curettage, impaction bone grafting of allografts combined with osteosynthesis through a lateral approach. Radiographs were assessed to see for any recurrence at follow-ups, and functional outcomes were assessed using Musculoskeletal Tumour Society (MSTS) score and Harris hip score (HHS). Results At a mean follow-up was 41.5 months (23-80), patients demonstrated favorable functional outcomes with a mean MSTS of 28.3 (18-30) and a mean HHS of 94.3 (66-100) at the last follow-up. Two cases (GCT = 1; fibrous dysplasia = 1) had a recurrence of disease. Allografts demonstrated a particular integration pattern on radiographs that involved an intermediate period of lucency followed by consolidation and integration with the parent bone. Conclusion Impaction grafting of allografts in benign lesions of the proximal femur allows adequate bony consolidation of the cavity after extended curettage and can be effectively used as a permanent solution to manage such lesions in most cases. The intermediate period of lucency seen on radiographs must not be confused for recurrence, and patients must be followed up continuously. Study design Retrospective Case Series. Level of evidence Level IV.
Collapse
Affiliation(s)
- Raja Bhaskara Rajasekaran
- Department of Orthopaedics & Trauma, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Dheenadhayalan Jayaramaraju
- Department of Orthopaedics & Trauma, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Dhanasekara Raja Palanisami
- Department of Orthopaedics & Trauma, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Devendra Agraharam
- Department of Orthopaedics & Trauma, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Pushpa Bhari Thippeswamy
- Department of Radiology, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Shanmuganathan Rajasekaran
- Department of Orthopaedics & Trauma, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| |
Collapse
|
3
|
Park CW, Oh SJ, Kim KS, Jang MC, Kim IS, Lee YK, Chung MJ, Cho BH, Seo SW. Artificial intelligence-based classification of bone tumors in the proximal femur on plain radiographs: System development and validation. PLoS One 2022; 17:e0264140. [PMID: 35202410 PMCID: PMC8870496 DOI: 10.1371/journal.pone.0264140] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/03/2022] [Indexed: 12/22/2022] Open
Abstract
Purpose
Early detection and classification of bone tumors in the proximal femur is crucial for their successful treatment. This study aimed to develop an artificial intelligence (AI) model to classify bone tumors in the proximal femur on plain radiographs.
Methods
Standard anteroposterior hip radiographs were obtained from a single tertiary referral center. A total of 538 femoral images were set for the AI model training, including 94 with malignant, 120 with benign, and 324 without tumors. The image data were pre-processed to be optimized for training of the deep learning model. The state-of-the-art convolutional neural network (CNN) algorithms were applied to pre-processed images to perform three-label classification (benign, malignant, or no tumor) on each femur. The performance of the CNN model was verified using fivefold cross-validation and was compared against that of four human doctors.
Results
The area under the receiver operating characteristic (AUROC) of the best performing CNN model for the three-label classification was 0.953 (95% confidence interval, 0.926–0.980). The diagnostic accuracy of the model (0.853) was significantly higher than that of the four doctors (0.794) (P = 0.001) and also that of each doctor individually (0.811, 0.796, 0.757, and 0.814, respectively) (P<0.05). The mean sensitivity, specificity, precision, and F1 score of the CNN models were 0.822, 0.912, 0.829, and 0.822, respectively, whereas the mean values of four doctors were 0.751, 0.889, 0.762, and 0.797, respectively.
Conclusions
The AI-based model demonstrated high performance in classifying the presence of bone tumors in the proximal femur on plain radiographs. Our findings suggest that AI-based technology can potentially reduce the misdiagnosis of doctors who are not specialists in musculoskeletal oncology.
Collapse
Affiliation(s)
- Chan-Woo Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong-Je Oh
- Medical AI Research Center, Samsung Medical Center, Seoul, Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Kyung-Su Kim
- Medical AI Research Center, Samsung Medical Center, Seoul, Korea
| | - Min-Chang Jang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Il Su Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Keun Lee
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myung Jin Chung
- Medical AI Research Center, Samsung Medical Center, Seoul, Korea
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Baek Hwan Cho
- Medical AI Research Center, Samsung Medical Center, Seoul, Korea
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea
- * E-mail: (SWS); (BHC)
| | - Sung-Wook Seo
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail: (SWS); (BHC)
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Maes DJA, Kaneuchi Y, Abudu A, Stevenson JD. Biological reconstruction of the proximal femur after treatment of benign lesions: comparison of functional and oncological outcomes for children and adults. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:559-566. [PMID: 34047855 DOI: 10.1007/s00590-021-03015-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/21/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Describe and compare the functional and oncological outcomes and complications between paediatric and adult patients after intra-lesional treatment of benign tumours of the proximal femur, stabilised with an autologous non-vascularised fibular strut graft (NVFSG). METHODS Retrospective review including 54 patients with a benign histopathological diagnosis treated between 1987 and 2018. The mean age at operation was 17 years (range, 3 to 37 years) with a median follow-up of 39.5 months (IQR 46.7 months). Patients were grouped according to their age at diagnosis (< 16 years versus ≥ 16 years). Data collection included weight-bearing status, Musculoskeletal Tumour Society (MSTS) score, local recurrence, revision surgery and complications. Local recurrence-free survival (LRFS) and revision-free survival (RFS) were calculated and compared between groups. RESULTS The median MSTS score for all patients was 98.3% (IQR 6.7%) without a statistically significant difference (p = 0.146) between both groups. The median time to full weight-bearing was 12 weeks (IQR 0 weeks). Local recurrence occurred in five (9%) patients. LRFS for all patients was 96% at 2 years and 88% at 5 years. Although local recurrence was more frequent in the paediatric group, LRFS did not significantly differ (p = 0.155, 95% CI 223.9 to 312.3) between both groups. Reoperation rate was 13% and was indicated for local recurrence, post-operative fracture, graft resorption and avascular necrosis. RFS for all patients was 90% at 2 years and 85% at 5 years. There was no statistically significant difference (p = 0.760, 95% CI 214.1 to 304.6) regarding RFS between both groups. CONCLUSION The use of an autogenous NVFSG after intra-lesional curettage of benign proximal femoral lesions allows for a biological, structural stabilisation without additional osteosynthesis, hastening weight-bearing and avoiding metalwork-related complications with minimal post-operative morbidity and complications and excellent functional and oncological outcome for both children and adults.
Collapse
Affiliation(s)
- Danielle J A Maes
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.
| | - Yoichi Kaneuchi
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.,Department of Orthopaedic Surgery, Fukushima Medical, University School of Medicine, Fukushima, 960-1295, Japan
| | - Adesegun Abudu
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
| | - Jonathan D Stevenson
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.,Aston University Medical School, Aston University, Birmingham, UK
| |
Collapse
|
6
|
Tao Y, Cai K, Liu S, Zhang Y, Chi Z, Xu J. Pseudo target release behavior of simvastatin through pH-responsive polymer based on dynamic imine bonds: Promotes rapid proliferation of osteoblasts. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 113:110979. [PMID: 32487396 DOI: 10.1016/j.msec.2020.110979] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 12/11/2022]
Abstract
In this article, a simvastatin loaded pentaerythritol tetra(3-mercaptopropionate)-allylurea-poly(ethylene glycol) (SIM-loaded PETMP-AU-PEG) polymer with excellent biocompatibility by means of in-situ loading method was synthesized. The presence of the imine bonds has given the polymer system an excellent response performance to weak acidic environment. Specifically, for the SIM-loaded polymer, the simvastatin cumulative release dose is only 2.2% in the first 2 h, and the first 32 h of the cumulative release dose is less than 10% in pH 7.4; However, in pH 6.0, the first 2 h of the cumulative release dose is 65.2%, and the first 32 h of the cumulative release dose is almost 100%. MC3T3-E1 osteoblast cell culture experiments show that the SIM-loaded polymer at pH 6.0 can accelerate the proliferation of osteoblasts significantly, which is expected to promote the rapid proliferation of bone cells in clinical applications and accelerate the healing of the lesion region.
Collapse
Affiliation(s)
- Yangchun Tao
- PCFM Lab, GD HPPC Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, Guangdong 510275, China
| | - Kuan Cai
- PCFM Lab, GD HPPC Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, Guangdong 510275, China
| | - Siwei Liu
- PCFM Lab, GD HPPC Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, Guangdong 510275, China.
| | - Yi Zhang
- PCFM Lab, GD HPPC Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, Guangdong 510275, China
| | - Zhenguo Chi
- PCFM Lab, GD HPPC Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, Guangdong 510275, China
| | - Jiarui Xu
- PCFM Lab, GD HPPC Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, Guangdong 510275, China
| |
Collapse
|
7
|
Admagusta R, Magetsari R, Prabowo Putro Y. Functional outcome in critical-size defect aneurysmal bone cyst of the distal humerus patient treated with curettage and nonvascularized autologous fibular graft. FORMOSAN JOURNAL OF SURGERY 2020. [DOI: 10.4103/fjs.fjs_16_20] [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
|
8
|
Rahman MA, El Masry AM, Azmy SI. Review of 16 cases of aneurysmal bone cyst in the proximal femur treated by extended curettage and cryosurgery with reconstruction using autogenous nonvascularized fibula graft. J Orthop Surg (Hong Kong) 2019; 26:2309499018783905. [PMID: 29954245 DOI: 10.1177/2309499018783905] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Aneurysmal bone cyst (ABC) is an aggressive benign lesion that may sometimes be difficult to treat. Lesions that occur in the proximal femur require to be addressed aggressively because of the high rate of local recurrence and the risk of fracture. Few articles report the experience of management of ABC in the proximal femur. This location presents a surgical challenge due to its anatomical and biomechanical peculiarity. METHODS We retrospectively reviewed 16 cases with ABC in the proximal femur that were treated in our institution between 2005 and 2014, utilizing extended curettage and liquid nitrogen as adjuvant therapy and reconstruction using nonvascularized autogenous fibular strut graft. The mean follow-up period was 50.5 months. Five cases presented as recurrent cases, while four cases presented with pathological fractures. RESULTS The functional score ranged from 70 to 90 on modified Musculoskeletal Tumor Society score with a mean score of 81.25, which is considered to be excellent function. Time for graft incorporation ranged from 10 to 12 weeks. One case got local recurrence, and one case got early surgical site infection. CONCLUSIONS Extended curettage and cryotherapy represent a recommended approach for management of ABC in the proximal femur with favorable results.
Collapse
Affiliation(s)
- Mohamed Abdel Rahman
- Department of Orthopaedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Sherif Ishak Azmy
- Department of Orthopaedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| |
Collapse
|
9
|
Luo S, Jiang T, Yang X, Yang Y, Zhao J. Treatment of tumor-like lesions in the femoral neck using free nonvascularized fibular autografts in pediatric patients before epiphyseal closure. J Int Med Res 2018; 47:823-835. [PMID: 30556444 PMCID: PMC6381492 DOI: 10.1177/0300060518813510] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objectives Surgical resection of benign bone tumors and tumor-like lesions at the
femoral neck presents a difficult reconstructive challenge. However, the
safety and efficacy of free nonvascularized fibular autografts (FNFAs) in
the treatment of femoral neck tumor-like lesions before epiphyseal closure
in young patients remain unknown. Methods Sixteen pediatric patients who had not yet undergone epiphyseal closure were
treated with FNFAs after resection of tumor-like lesions in the femoral neck
from August 2012 to September 2016. All patients underwent supplementary
skeletal traction through the supracondylar femur for 4 to 6 weeks after
resection. Demographic data were recorded and clinical and radiological
outcomes were evaluated during the follow-up. Results All patients could walk with partial weight bearing 4 weeks postoperative,
and full weight bearing was permitted after a mean of 8 weeks. Graft union
was attained in all 16 patients at a mean of 2 months. The donor site of the
fibular cortical strut showed good regeneration in all patients. The Harris
hip score significantly improved from 65% to 95%. Conclusions Application of an FNFA is a feasible method in the treatment of tumor-like
lesions in the femoral neck before epiphyseal closure in pediatric
patients. Level of Evidence Level IV.
Collapse
Affiliation(s)
- Shanchao Luo
- Yulin Orthopedics Hospital of Chinese and Western Medicine,
Yulin, China
- Postdoctoral Innovation Practice Base, The Ninth Affiliated
Hospital of Guangxi Medical University, Beihai, China
- Guangxi Engineering Center in Biomedical Materials for Tissue
and Organ Regeneration & Guangxi Collaborative Innovation Center for
Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning,
China
- *These authors contributed equally to this
work
| | - Tongmeng Jiang
- Guangxi Engineering Center in Biomedical Materials for Tissue
and Organ Regeneration & Guangxi Collaborative Innovation Center for
Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning,
China
- Department of Orthopaedics & Guangxi Key Laboratory of
Regenerative Medicine, International Joint Laboratory on Regeneration of Bone
and Soft Tissue, The First Affiliated Hospital of Guangxi Medical University,
Nanning, China
- School of Materials Science and Engineering, Zhejiang
University, Hangzhou, China
- *These authors contributed equally to this
work
| | - Xiaoping Yang
- Yulin Orthopedics Hospital of Chinese and Western Medicine,
Yulin, China
| | - Yingnian Yang
- Yulin Orthopedics Hospital of Chinese and Western Medicine,
Yulin, China
| | - Jinmin Zhao
- Postdoctoral Innovation Practice Base, The Ninth Affiliated
Hospital of Guangxi Medical University, Beihai, China
- Guangxi Engineering Center in Biomedical Materials for Tissue
and Organ Regeneration & Guangxi Collaborative Innovation Center for
Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning,
China
- Department of Orthopaedics & Guangxi Key Laboratory of
Regenerative Medicine, International Joint Laboratory on Regeneration of Bone
and Soft Tissue, The First Affiliated Hospital of Guangxi Medical University,
Nanning, China
- Jinmin Zhao, Department of Orthopaedics
& Guangxi Key Laboratory of Regenerative Medicine, International Joint
Laboratory on Regeneration of Bone and Soft Tissue, The First Affiliated
Hospital of Guangxi Medical University, Shuangyong Road #22, Nanning 530021,
China.
| |
Collapse
|
10
|
Evaluation of Bone Sialoprotein Coating of Three-Dimensional Printed Calcium Phosphate Scaffolds in a Calvarial Defect Model in Mice. MATERIALS 2018; 11:ma11112336. [PMID: 30469365 PMCID: PMC6267578 DOI: 10.3390/ma11112336] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 11/15/2018] [Accepted: 11/16/2018] [Indexed: 01/31/2023]
Abstract
The bioactive coating of calcium phosphate cement (CPC) is a promising approach to enhance the bone-healing properties of bone substitutes. The purpose of this study was to evaluate whether coating CPCs with bone sialoprotein (BSP) results in increased bone formation. Forty-five female C57BL/6NRj mice with an average age of six weeks were divided into three groups. Either a BSP-coated or an uncoated three-dimensional plotted scaffold was implanted into a drilled 2.7-mm diameter calvarial defect, or the defect was left empty (control group; no CPC). Histological analyses revealed that BSP-coated scaffolds were better integrated into the local bone stock eight weeks after implantation. Bone volume/total volume (BV/TV) ratios and bone thickness at the bone–implant contact were analyzed via micro computed tomography (µCT) after eight weeks. BSP-coated scaffolds and uncoated CPC scaffolds increased bone thickness in comparison to the control (CPC + BSP: 691.1 ± 253.5 µm, CPC: 603.1 ± 164.4 µm, no CPC: 261.7 ± 37.8 µm, p < 0.01). Accordingly, BV/TV was enhanced in both scaffold groups (CPC + BSP: 1.3 ± 0.5%, CPC: 0.9 ± 0.5%, no CPC: 0.2 ± 0.3%, p < 0.01). The BSP coating showed a tendency towards an increased bone thickness (p = 0.18) and BV/TV (p = 0.18) in comparison to uncoated CPC scaffolds. However, a significant increase in bone formation through BSP coating was not found.
Collapse
|
11
|
Zekry KM, Yamamoto N, Hayashi K, Takeuchi A, Alkhooly AZAA, Abd-Elfattah AS, Fouly EH, Ahmed AR, Tsuchiya H. Treatment of the benign lytic lesions of the proximal femur with synthetic bone graft. J Orthop Surg Res 2018; 13:270. [PMID: 30373674 PMCID: PMC6206894 DOI: 10.1186/s13018-018-0982-z] [Citation(s) in RCA: 6] [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: 08/24/2017] [Accepted: 10/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Benign bone tumors and tumor-like conditions are commonly located in the proximal femur. The main indications for surgical treatment are lesions with impending or actual pathological fractures, or with aggressive or recurrent lesions. However, patients complaining of persistent pain, limping, or abnormal gait patterns are also considered for surgical treatment. In this study, we describe the outcomes of the surgical treatment of benign lytic lesions of the proximal femur by curettage followed by implantation of synthetic bone graft. METHODS This retrospective study included 27 patients (22 females and 5 males) with benign lytic lesions of the proximal femur. The average age was 25.5 years (6-65 years), and the mean follow-up period was 54.5 months (9-145 months). The histopathological diagnoses were fibrous dysplasia (8 patients), simple bone cyst (8 patients), chondroblastoma (7 patients), giant cell tumor (3 patients), and eosinophilic granuloma (1 patient). These lesions were managed with curettage followed by implantation of the bone defects with alpha tricalcium phosphate in 14 patients, beta tricalcium phosphate granules in 11 patients, hydroxyapatite granules in 1 patient, and combined beta tricalcium phosphate and hydroxyapatite granules in 1 patient. Internal fixation was performed in three patients. RESULTS The mean operative time was 143 min (80-245 min). Patients had regained normal unrestricted activity without pain at the operation site. Patients treated with beta tricalcium phosphate achieved radiographic consolidation of the bone defects within 1 year after the surgery, and those treated with alpha tricalcium phosphate or hydroxyapatite experienced no progression nor recurrence of the lesions. Local tumor recurrence was observed in one patient with giant cell tumor 5 years after the surgery. Post-operative pathological fracture was occurred in one patient with a simple bone cyst of the subtrochanteric region 1 month after surgery. No post-operative infection was observed. CONCLUSION We concluded that the treatment of benign lytic lesions of the proximal femur, either primary or recurrent, using synthetic bone graft is a safe and satisfactory method and the addition of internal fixation should be carefully planned.
Collapse
Affiliation(s)
- Karem M Zekry
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.,Department of Orthopaedic Surgery, Faculty of Medicine, Minia University, El-Minya, Egypt
| | - Norio Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
| | - Katsuhiro Hayashi
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Akihiko Takeuchi
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Ali Zein A A Alkhooly
- Department of Orthopaedic Surgery, Faculty of Medicine, Minia University, El-Minya, Egypt
| | | | - Ezzat H Fouly
- Department of Orthopaedic Surgery, Faculty of Medicine, Minia University, El-Minya, Egypt
| | - Adel Refaat Ahmed
- Department of Orthopaedic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| |
Collapse
|
12
|
Yung D, Kikuta K, Sekita T, Asano N, Nakayama R, Nakamura M, Matsumoto M. Conservative surgical management of simple monostotic fibrous dysplasia of the proximal femur in a 19-year-old basketballer: a case report. J Med Case Rep 2018; 12:240. [PMID: 30165901 PMCID: PMC6117941 DOI: 10.1186/s13256-018-1763-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 07/07/2018] [Indexed: 12/02/2022] Open
Abstract
Background Fibrous dysplasia is a rare benign, intramedullary, fibro-osseous lesion. It is thought to be a developmental disorder of bone maturation where normal lamellar bone is replaced by irregular trabecular bone ensnared with fibrous dysplastic tissue that is unable to complete maturation resulting in significant loss of mechanical strength. This, together with the inability to mineralize sufficiently, leads to deformity, pain, and pathological fractures. It typically presents in young adults, with an equal representation in both genders. Surgical intervention is necessary in mild cases with chronic symptoms to prevent pathological fractures or to correct deformities. Case presentation A 19-year-old Chinese woman presented with non-traumatic, nonspecific left hip pain during basketball training. X-rays demonstrated a ground glass lesion, 10 cm in length, in her left femoral neck, which is a classic sign of fibrous dysplasia. No other deformities were noted. She was managed conservatively with analgesia for 6 months; however, her condition did not improve and a decision was made for surgical intervention. The lesion was a type 1 lesion according to the Ippolito radiological classification of fibrous dysplasia, which is a lesion with mild deformities. Therefore, we performed minimal curettage and insertion of a free autologous fibula strut harvested from her left leg, for structural stability. No implants were used. The operation was successful and her postoperative course was uneventful. Histology confirmed the diagnosis of fibrous dysplasia. She achieved partial weight bearing at 4 weeks postoperation, and full weight bearing at 8 weeks, and returned to basketball at 12 weeks. At 1-year follow-up, she returned to competitive basketball and remained pain free with no complications. Conclusions Fibrous dysplasia is a rare and benign fibrous tumor of the bone that presents mostly in a young patient population. From our case, we have shown that it is possible to treat young patients with uncomplicated Ippolito type 1 fibrous dysplasia with a minimally invasive approach of using a cortical bone graft for structural augmentation of the affected area, without the use of implants. They are able to fully return to an active and vigorous lifestyle without restriction of activities or long-term risks of orthopedic implant complications.
Collapse
Affiliation(s)
- David Yung
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, 160-8582, Japan.,Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
| | - Kazutaka Kikuta
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Tetsuya Sekita
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Naofumi Asano
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Robert Nakayama
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, 160-8582, Japan
| |
Collapse
|
13
|
Individualized approach to the surgical management of fibrous dysplasia of the proximal femur. Orphanet J Rare Dis 2018; 13:72. [PMID: 29720212 PMCID: PMC5932767 DOI: 10.1186/s13023-018-0805-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 04/10/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Fibrous dysplasia of the proximal femur presents with heterogeneous clinical manifestations dictating different surgical approaches. However, to date there are no clear recommendations to guide the choice of surgical approach and no general guidelines for the optimal orthopedic management of these lesions. The objective of this study was to evaluate treatment outcomes of angled blade plates and intramedullary nails, using as outcome indicators revision-free survival, pain, function and femoral neck-shaft-angle. Based on a review of published literature and our study findings, we propose a treatment algorithm, taking into account different factors, which may play a role in the selection of one surgical approach over another. METHODS Data were evaluated in thirty-two patients (18 male) from a combined cohort from the Netherlands and Austria, who had a surgical intervention using an angled blade plate (n = 27) or an intramedullary nail (n = 5) between 1985 and 2015, and who had a minimal follow-up of one year. The primary outcome was success of the procedure according to the revised Henderson classification. Secondary outcomes, which were assessed at one year and at the end of follow-up included: function (as measured by walking ability), pain and change in femoral neck-shaft angle over time. RESULTS Analysis of data showed that revision-free survival was 72% after a median follow-up of 4.1 years. Revision was necessary in two patients for structural failure due to a fracture distal to an angled blade plate and in 7 patients due to angled blade plate-induced iliotibial tract pain. At the end of follow-up 91% of all patients had good walking ability and 91% were pain free. There was no significant postoperative change in femoral neck shaft angle. CONCLUSION Our data show that fibrous dysplasia of the proximal femur can be adequately and safely treated with angled blade plates or intramedullary nails, providing these are used according to specific characteristics of the individual patient. Based on published literature and our own experience, we propose an individualized, patient-tailored approach for the surgical management of fibrous dysplasia of the proximal femur.
Collapse
|
14
|
Lin J, Chen R, Yan W, Zhang Y, Chen D. [Treatment of benign bone lesions of proximal femur using dynamic hip screw and intralesional curettage via Watson-Jones approach]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:31-35. [PMID: 29806361 DOI: 10.7507/1002-0179.201707092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Objective To explore the effectiveness of dynamic hip screw (DHS) and intralesional curettage via Watson-Jones approach in treatment of benign bone lesions of the proximal femur. Methods Between March 2012 and December 2016, 20 patients (21 lesions) with benign bone tumors or tumor like conditions of proximal femurs were treated with DHS and intralesional curettage via Watson-Jones approach. Their average age was 27.8 years (range, 11-51 years), including 13 males and 7 females. The pathological diagnosis were fibrous dysplasia in 11 cases, simple bone cyst in 2 cases, aneurysmal bone cyst in 2 cases, benign fibrous histocytoma in 2 cases, giant cell tumor in 2 cases, and chondroblastoma in 1 case, including 3 pathological fractures. According to the Enneking staging system, 18 patients were in stage S1, 3 patients with pathological fractures in stage S2. There was no varus deformity or valgus deformity. The operation time, intraoperative blood loss, and time of full weight-bearing were recorded. X-ray film and CT were used to observe the bone graft fusion and location of DHS. Complications were recorded. Visual analogue scale (VAS) and Musculoskeletal Tumor Society (MSTS) scoring were used to evaluate function of lower limbs. Results The average operation time was 177.1 minutes (range, 110-265 minutes). The average intraoperative blood loss was 828.6 mL (range, 200-2 300 mL). There was superficial incision infection in 1 case, deep incision infection in 1 case, and hip discomfort in 1 case, respectively. All patients were followed up 6-63 months (mean, 27.4 months). The time of full weight-bearing was 2 days in 2 patients with giant cell tumor and 2 to 13 weeks with an average of 7.2 weeks in the other patients. At last follow-up, VAS and MSTS were 0.19±0.51 and 29.62±0.97 respectively, showing significant differences when compared with the values before operation (3.52±2.62 and 23.71±8.77) ( t=5.565, P=0.000; t=-3.020, P=0.007 ). X-ray film showed the all bone grafts fusion with mean time of 8.2 months (range, 5-12 months). There was no pathological fracture of the femur, local tumor recurrence, chronic hip pain, dislocation, or femoral head necrosis during follow-up. Conclusion The treatment of benign bone lesion of the proximal femur using DHS and intralesional curettage via Watson-Jones approach is a safe and effective method.
Collapse
Affiliation(s)
- Jiasheng Lin
- Department of Musculoskeletal Tumor, the Second Hospital of Fuzhou Affiliated to Xiamen University, Fuzhou Fujian, 350007, P.R.China
| | - Rong Chen
- Department of Musculoskeletal Tumor, the Second Hospital of Fuzhou Affiliated to Xiamen University, Fuzhou Fujian, 350007,
| | - Wei Yan
- Department of Musculoskeletal Tumor, the Second Hospital of Fuzhou Affiliated to Xiamen University, Fuzhou Fujian, 350007, P.R.China
| | - Yiyuan Zhang
- Department of Musculoskeletal Tumor, the Second Hospital of Fuzhou Affiliated to Xiamen University, Fuzhou Fujian, 350007, P.R.China
| | - Dongdong Chen
- Department of Musculoskeletal Tumor, the Second Hospital of Fuzhou Affiliated to Xiamen University, Fuzhou Fujian, 350007, P.R.China
| |
Collapse
|
15
|
Abstract
BACKGROUND Benign aggressive bone lesions of the femoral head and neck are mostly seen in young adults and warrant treatment for pain, impending fracture or established fracture, and disease clearance. It becomes challenging to treat them effectively while attempting salvage of the femoral head and yet achieving long term disease control with minimum complications. We describe our technique and experience in dealing with these lesions which can achieve the above-mentioned goals and can be easily replicated. MATERIALS AND METHODS We analyzed 15 cases of surgically treated, biopsy-proven benign, locally aggressive lesions affecting the femoral head and neck in skeletally mature individuals. All cases were treated with extended curettage through anterolateral modified Smith-Petersen approach along with tricortical iliac crest bone graft (combined with fibular graft in some cases) reconstruction with or without suitable internal fixation. RESULTS All, except one, patients were available for follow up. The age ranged from 18 to 43 years and the follow up ranged between 24 and 124 months (average 78 months). These included aneurysmal bone cysts (9), giant cell tumors (4), and fibrous dysplasia (2). The indication was pain (8), with impending (2) or established pathological neck femur fracture (5). In all cases, there was satisfactory healing of lesion and timely rehabilitation. Nonunion, avascular necrosis or local recurrences were not seen. The MSTS functional score was good or excellent in all (range 26-29, average 28). CONCLUSION Benign aggressive lesions affecting femoral head and neck in young and middle-aged adults pose a treatment challenge. A sturdy, lasting reconstruct with acceptable functional outcome and minimal recurrence rate can be achieved by salvaging the femoral head and neck using curettage and reconstruction, obviating the need for replacement at such an early age.
Collapse
Affiliation(s)
- Yogesh Panchwagh
- Department of Orthopaedic Oncology, Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India,Department of Orthopaedic Oncology, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India,Address for correspondence: Dr. Yogesh Panchwagh, 101, Vasant, Plot 29, Bharat Kunj Soc. No. 2, Erandwana, Pune - 411 038, Maharashtra, India. E-mail:
| | - Sujit K Joshi
- Department of Pathology, Deenanath Mangeshkar Hospital and Research Centre, Sancheti Institute for Orthopedics and Rehabilitation, Pune, Maharashtra, India
| | - Parag K Sancheti
- Department of Orthopaedic Oncology, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India
| |
Collapse
|
16
|
Locking plate and fibular strut-graft augmentation in the reconstruction of unicameral bone cyst of proximal femur in the paediatric population. INTERNATIONAL ORTHOPAEDICS 2017; 42:169-174. [PMID: 28963665 DOI: 10.1007/s00264-017-3648-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/20/2017] [Indexed: 01/27/2023]
Abstract
PURPOSE Several therapeutic strategies have been used for managing unicameral bone cyst (UBC) of the proximal femur. However, there is insufficient evidence to support one treatment over another, and the optimal treatment is controversial. This study aims at describing our experience with surgical reconstruction of paediatric UBCs of the proximal femur using a proximal locking plate and fibular strut allograft. METHODS In total, 14 consecutive paediatric patients with Dormans types IB (four cases) and IIB (10 cases) UBC were assessed. Mean patient age was 8.6 ± 2.3 years, and mean follow-up period was 41.7 ± 29.8 months. Six patients (42.8%) were referred with a pathologic fracture. Clinical/radiological outcome and complication rates were evaluated at the final follow-up session. RESULTS No cysts were Capanna's class III (recurrence) or IV (no response). Complete healing (Capanna's class I) was seen in ten cysts, while four other cysts healed with residual radiolucent areas (Capanna's class II). Mean healing period was 14.1 ± 5.1 (9-24 months). One patient had superficial infection, one heterotopic ossification, and one mild coxa vara, and mean Musculoskeletal Tumor Society (MSTS) score was 99.5%. CONCLUSION According to our results, locking plate and fibular strut graft in Dormans classification types IB and IIB results in a favorable outcome in managing UBC of the proximal femur in the paediatric population.
Collapse
|
17
|
Lenze U, Kasal S, Hefti F, Krieg AH. Non-vascularised fibula grafts for reconstruction of segmental and hemicortical bone defects following meta- /diaphyseal tumour resection at the extremities. BMC Musculoskelet Disord 2017; 18:289. [PMID: 28679368 PMCID: PMC5499012 DOI: 10.1186/s12891-017-1640-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 06/26/2017] [Indexed: 12/23/2022] Open
Abstract
Background The reconstruction of meta−/diaphyseal bone defects following bone tumour resection is challenging, and biological treatment options should be applied whenever possible, especially in benign lesions and early stage sarcomas. We aimed to evaluate the results of segmental (SR) and hemicortical reconstructions (HR) at the extremities using non-vascularised fibula grafts. Methods We retrospectively enrolled 36 patients who were treated with non-vascularised fibula reconstructions (15 SR, 21 HR) after bone tumour resection (15 malignant, 21 benign). All cases were evaluated regarding consolidation, hypertrophy at the graft-host junctions, and complications; moreover, the functional and oncological results were assessed. The mean follow-up was 8.3 years (2.1–26.6 years). Results Primary union was achieved in 94% (SR 87%, HR 100%) of patients, and 85% (SR 81%, HR 88%) showed hypertrophy at the graft-host junction. The overall complication rate was 36% with 4 patients (11%) developing local recurrence. There was a significant correlation between the development of mechanical complications (fracture, delayed-/non-union) and a defect size of ≥12 cm (p = 0.013), segmental defects (p = 0.013) and additional required treatment (p = 0.008). The functional outcome was highly satisfactory (mean MSTS score 86%). Conclusions Due to encouraging results and advantages (such as their remodelling capacity at the donor site), non-vascularised fibula reconstructions should be considered a valuable alternative treatment option for patients with hemicortical defects or segmental reconstructions of less than 12 cm in which no additional neo-/adjuvant treatment is necessary.
Collapse
Affiliation(s)
- Ulrich Lenze
- Department of Orthopaedics, University Children's Hospital of both Basel (UKBB), Spitalstrasse 33, CH-4056, Basel, Switzerland.
| | - Stefanie Kasal
- Department of Orthopaedics, University Children's Hospital of both Basel (UKBB), Spitalstrasse 33, CH-4056, Basel, Switzerland
| | - Fritz Hefti
- Department of Orthopaedics, University Children's Hospital of both Basel (UKBB), Spitalstrasse 33, CH-4056, Basel, Switzerland
| | - Andreas Heinrich Krieg
- Department of Orthopaedics, University Children's Hospital of both Basel (UKBB), Spitalstrasse 33, CH-4056, Basel, Switzerland
| |
Collapse
|
18
|
Kaewpornsawan K, Eamsobhana P. Free non-vascularized fibular graft for treatment of large bone defect around the elbow in pediatric patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:895-900. [PMID: 28393309 DOI: 10.1007/s00590-017-1955-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/23/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Large bone defect is a challenging problem in orthopedics practice. Several methods are available for bridging of these bone defects, including cancellous bone graft, free vascularized fibula graft, and bone transport with external ring fixator. The aim of this study was to describe our experience in nine pediatric cases of free non-vascularized autogenous fibular strut bone graft in which large bone defect and bone loss of >7 cm was caused by open fracture and infective nonunion around the elbow joint. OBJECTIVE To describe our experience in nine pediatric cases of free non-vascularized autogenous fibular strut bone graft in which large bone defect and bone loss of >7 cm was caused by open fracture and infective nonunion around the elbow joint. METHOD This retrospective review was conducted in patients with large bone defect with bony gap >7 cm. Time to union, range of motion, complications, Mayo Elbow Performance Score, and Foot and Ankle Disability Index (FADI) were recorded. RESULT The large bone defects included in this study were managed by free non-vascularized fibular strut bone grafts (FNVFG) that were harvested subperiosteally. Nine patients with a mean age of 11 years (range: 6-17) underwent this procedure. Nine grafts (100%) united at both ends within an average of 9 weeks (range: 8-14). Mean length of defect was 9.3 cm (range: 8-13 cm). Mean postoperative Mayo Elbow Performance Score was significantly higher than the mean preoperative score (98.33 vs. 64.44, respectively; p < 0.001). Three fibulae were observed for hypertrophy. Mean Foot and Ankle Disability Index score was 100 both preoperatively and postoperatively in all patients. CONCLUSION Free non-vascularized fibular graft is a simple procedure and a reliable method for bridging large bone defect or loss caused by open fracture and/or infection around the elbow in pediatric patients.
Collapse
Affiliation(s)
- Kamolporn Kaewpornsawan
- Department of Orthopedics Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglung Road Bangkoknoi, Bangkok, Thailand
| | - Perajit Eamsobhana
- Department of Orthopedics Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglung Road Bangkoknoi, Bangkok, Thailand.
| |
Collapse
|
19
|
What Is the Role of Allogeneic Cortical Strut Grafts in the Treatment of Fibrous Dysplasia of the Proximal Femur? Clin Orthop Relat Res 2017; 475:786-795. [PMID: 27020436 PMCID: PMC5289171 DOI: 10.1007/s11999-016-4806-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Fibrous dysplasia of the proximal femur is a progressive, often recurrent condition of bone that can cause skeletal deformity, fractures, and pain [corrected]. Allogeneic cortical strut grafting to minimize the risk of fracture or as part of fracture treatment is a promising treatment option, but evidence is scarce on the intermediate- to long-term results of this procedure and there are no data on factors associated with graft failure. QUESTIONS/PURPOSES The purposes of this study were (1) to evaluate the revision-free survivorship; (2) radiographic findings; (3) factors associated with failure; and (4) complications associated with cortical strut allograft to prevent or treat fractures of the proximal femur in patients with fibrous dysplasia. METHODS Between 1980 and 2013 we performed cortical strut allografting in 30 patients for impending or actual fractures of the proximal femur, of whom 28 (93%) were available for followup at a minimum of 2 years (mean, 13 years; range, 4-37 years) and of whom 22 (73%) had also been evaluated within the last 5 years. During that time, the indications for cortical strut allografting were an impending fracture of the proximal femur, persistent pain, or an actual nondisplaced femoral fracture. In patients who presented with a diaphyseal fracture, a fracture with severe dislocation of severe varus deformity, which required an osteotomy, placement of a blade plate was instead performed and these patients are not included here. During that time, for patients with diaphyseal fractures, and in patients with a displaced femoral fracture of the proximal femur, placement of a blade plate without strut grafting was instead performed; these patients are not included here. The primary outcome was the success rate of allogeneic cortical strut grafting surgery as assessed by the absence of revision surgery for a newly sustained fracture, resorption of the graft, or progressive deformity of the proximal femur. The association of possible contributing factors to graft failure such as gender, age at surgery, preoperative fracture, and anchoring distances of the graft in healthy bone was also evaluated using Cox regression analysis. RESULTS Revision surgery was performed in 13 patients, resulting in a mean survival time of 13 years (Kaplan-Meier 95% confidence interval [CI], 10-16). Radiological resorption of the graft was observed in 15 of 28 patients (54%). However, revision surgery was not performed in all patients who developed graft resorption, because of the absence of a risk for fracture on the basis of the anatomical site of resorption. Identified risk factors for graft failure included preoperative fractures (hazard ratio [HR], 4.5; 95% CI, 1.2-17.2; p = 0.028) and insufficient proximal anchoring of the graft in healthy bone (HR, 6.02; 95% CI, 1.3-27; p = 0.02). One patient sustained a refracture after surgery resulting from an in-hospital fall. The fracture was treated without further surgery, and it healed. CONCLUSIONS Our findings from this study suggest that cortical strut allografting may be a viable option for treatment of fibrous dysplasia of the proximal femur a without previous pathological fracture. Surgeons should pay particular attention to the proximal fixation point of the allograft to decrease the risk of failure. Patients with a fracture have an increased risk of failure and reoperation and so should be treated with an osteosynthesis. LEVEL OF EVIDENCE Level IV, therapeutic study.
Collapse
|
20
|
Laitinen MK, Parry MC, Albergo JI, Grimer RJ, Jeys LM. Is computer navigation when used in the surgery of iliosacral pelvic bone tumours safer for the patient? Bone Joint J 2017; 99-B:261-266. [DOI: 10.1302/0301-620x.99b2.bjj-2016-0149.r2] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 10/03/2016] [Indexed: 11/05/2022]
Abstract
Aims Due to the complex anatomy of the pelvis, limb-sparing resections of pelvic tumours achieving adequate surgical margins, can often be difficult. The advent of computer navigation has improved the precision of resection of these lesions, though there is little evidence comparing resection with or without the assistance of navigation. Our aim was to evaluate the efficacy of navigation-assisted surgery for the resection of pelvic bone tumours involving the posterior ilium and sacrum. Patients and Methods Using our prospectively updated institutional database, we conducted a retrospective case control study of 21 patients who underwent resection of the posterior ilium and sacrum, for the treatment of a primary sarcoma of bone, between 1987 and 2015. The resection was performed with the assistance of navigation in nine patients and without navigation in 12. We assessed the accuracy of navigation-assisted surgery, as defined by the surgical margin and how this affects the rate of local recurrence, the disease-free survival and the effects on peri-and post-operative morbidity. Results The mean age of the patients was 36.4 years (15 to 66). The mean size of the tumour was 10.9 cm. In the navigation-assisted group, the margin was wide in two patients (16.7%), marginal in six (66.7%) and wide-contaminated in one (11.1%) with no intralesional margin. In the non-navigated-assisted group; the margin was wide in two patients (16.7%), marginal in five (41.7%), intralesional in three (25.0%) and wide-contaminated in two (16.7%). Local recurrence occurred in two patients in the navigation-assisted group (22.2%) and six in the non-navigation-assisted group (50.0%). The disease-free survival was significantly better when operated with navigation-assistance (p = 0.048). The blood loss and operating time were less in the navigated-assisted group, as was the risk of a foot drop post-operatively. Conclusion The introduction of navigation-assisted surgery for the resection of tumours of the posterior ilium and sacrum has increased the safety for the patients and allows for a better oncological outcome. Cite this article: Bone Joint J 2017;99-B:261–6.
Collapse
Affiliation(s)
- M. K. Laitinen
- Royal Orthopaedic Hospital NHS Foundation
Trust, and Tampere University Hospital, Department
of Orthopaedics, Unit of Musculoskeletal Surgery, Tampere, Finland
| | - M. C. Parry
- Royal Orthopaedic Hospital NHS Foundation
Trust, Birmingham, UK
| | - J. I. Albergo
- Hospital Italiano de Buenos Aires, Juan
D Peron 4190, C1181ACH Buenos Aires, Argentina
| | - R. J. Grimer
- Royal Orthopaedic Hospital NHS Foundation
Trust, Birmingham, UK
| | - L. M. Jeys
- Royal Orthopaedic Hospital NHS Foundation
Trust, Birmingham, UK
| |
Collapse
|
21
|
Qi D, Hu T, Zhang G. Evaluation of the use of fluoroscopy guided needle biopsies for diagnosing cases of suspected pathological fractures. Asia Pac J Clin Oncol 2016; 12:235-41. [PMID: 26996135 DOI: 10.1111/ajco.12488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 10/31/2015] [Accepted: 01/16/2016] [Indexed: 01/01/2023]
Abstract
AIM Establishing an early and accurate diagnosis in cases of suspected pathological fractures is crucial to initiate optimal treatment without delay. The use of percutaneous biopsy has become popular over the past few years. However, there is a paucity of information regarding the efficacy and safety of percutaneous biopsy procedures guided by fluoroscopy. METHODS A total of 137 percutaneous C-arm fluoroscopy-guided core needle biopsy (CNB) procedures were performed in 135 patients with suspected pathological fractures. The sensitivity, specificity, accuracy, and overall prognostic value of these procedures were evaluated. Complications, if any, were documented for all cases. RESULTS The overall sensitivity, specificity, and accuracy were 82.0%, 100%, and 83.2%, respectively. The positive and negative predictive value was 100% and 28.1%, respectively. There were 23 "false negative" cases in our study, of which 15 were benign lesions and eight were malignant tumors. No "false-positives" were found. Major procedure-related complications occurred in three patients (2.2%). These complications, however, did not alter the prognosis of these patients. CONCLUSION Percutaneous C-arm fluoroscopy-guided biopsy procedures are both effective and safe for diagnosis of suspected pathological fractures in the appendicular skeleton.
Collapse
Affiliation(s)
- Dianwen Qi
- Department of Musculoskeletal Tumor, Third Hospital of Hebei Medical University, Hebei, China
| | - Tongyu Hu
- Department of Musculoskeletal Tumor, Third Hospital of Hebei Medical University, Hebei, China
| | - Guochuan Zhang
- Department of Musculoskeletal Tumor, Third Hospital of Hebei Medical University, Hebei, China
| |
Collapse
|
22
|
Leet AI, Boyce AM, Ibrahim KA, Wientroub S, Kushner H, Collins MT. Bone-Grafting in Polyostotic Fibrous Dysplasia. J Bone Joint Surg Am 2016; 98:211-9. [PMID: 26842411 PMCID: PMC4732545 DOI: 10.2106/jbjs.o.00547] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Polyostotic fibrous dysplasia is a skeletal disease that results from somatic activating mutations in the gene GNAS in skeletal stem cells, leading to proliferation of immature osteogenic cells with replacement of normal marrow and bone with fibro-osseous tissue. Lesions may cause bone deformity or fracture. In the surgical care of polyostotic fibrous dysplasia, the role of grafting and the optimal grafting material are not clear. The purpose of this study was to evaluate the long-term survival of bone-grafting procedures in subjects with polyostotic fibrous dysplasia over time. METHODS The operative reports and radiographs of a cohort of subjects with polyostotic fibrous dysplasia followed in a natural history study were reviewed. Twenty-three subjects (mean age at the time of enrollment, thirteen years [range, two to forty years]) with fifty-two bone-grafting procedures had a mean follow-up time of 19.6 years (range, twenty-nine months to forty-seven years). Kaplan-Meier life table estimates, Cox proportional hazard models, and t tests comparing means were performed to assess various aspects of graft survival. RESULTS Kaplan-Meier curves showed a 50% estimate of survival of 14.5 years. Cox proportional hazards models showed no advantage comparing allograft with autograft or structural with nonstructural graft materials. The mean age of the patients was significantly greater (p < 0.001) in the subgroup of subjects in whom grafts were maintained over time (20.9 years) compared with the subgroup of patients whose grafts were resorbed over time (9.8 years). CONCLUSIONS Bone-grafting, including both allograft and autograft, is of limited value in ablating the lesions of fibrous dysplasia. The expectations of patients and surgeons should include the high probability of graft resorption over time with return of bone characteristics of fibrous dysplasia, particularly in younger patients. This suggests the maintenance of normal bone mechanics with implant support should be the priority of any surgical intervention.
Collapse
Affiliation(s)
| | - Alison M. Boyce
- Skeletal Clinical Studies Unit, Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland,Division of Endocrinology and Diabetes, Children’s National Health System, Washington, D.C.,Bone Health Program, Division of Orthopaedics and Sports Medicine, Children’s National Health System, Washington, D.C
| | - Khalda A. Ibrahim
- Department of Orthopedics, Johns Hopkins University, Baltimore, Maryland
| | - Shlomo Wientroub
- Department of Pediatric Orthopedics, Dana Children’s Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Harvey Kushner
- Biomedical Computer Research Institute, Philadelphia, Pennsylvania
| | - Michael T. Collins
- Skeletal Clinical Studies Unit, Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland,E-mail address for M.T. Collins:
| |
Collapse
|
23
|
Xia Z, Sittampalam K, Howe TS, Lo NN. Successful treatment of solitary intraosseous haemangioma of the femoral neck. Singapore Med J 2015; 56:e65-70. [PMID: 25917479 DOI: 10.11622/smedj.2014200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Intraosseous haemangiomas (IOHs) are benign vascular bone tumours that account for 1% of all primary bone tumours. They are most frequently seen in the vertebrae and skull, and are rarely found in long bones. Herein, we present an uncommon case of a 25-year-old woman with a solitary IOH that occupied the left femoral neck. We describe the clinical, radiological and histological details of the case, as well as the three-year outcome of the surgical treatment, which successfully preserved the femoral head. We also conducted a review of the literature on this uncommon entity.
Collapse
Affiliation(s)
- Zhan Xia
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore 169608.
| | | | | | | |
Collapse
|
24
|
Zhang X, Chen C, Duan H, Tu C. Radiographic classification and treatment of fibrous dysplasia of the proximal femur: 227 femurs with a mean follow-up of 6 years. J Orthop Surg Res 2015; 10:171. [PMID: 26567848 PMCID: PMC4645476 DOI: 10.1186/s13018-015-0313-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 10/30/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Research into the optimal treatment of fibrous dysplasia has been limited by the lack of an established classification system for the disease. The purposes of this study were to develop a radiographic classification for fibrous dysplasia of the proximal femur and to test this classification's intra- and interobserver reliability as well as the effectiveness of our treatments. METHODS We retrospectively reviewed radiographs and computed tomography (CT) of 227 femurs from 206 patients with fibrous dysplasia. The radiographs were evaluated in the coronal plane for neck-shaft angle, varus deformity in the proximal femoral shaft, and distal juxtaarticular valgus deformity. CT was evaluated in the axial plane for destruction of cortex. Reduction of bone strength was defined as the thickness of the remaining cortex less than 50 % of the original on axial CT. Two senior orthopedists evaluated each radiograph and CT twice at 8-week intervals. Intra- and interobserver reliability testing was performed using the kappa statistic. Treatments were assessed through mid-term follow-up. RESULTS The 227 femurs were classified into five reproducible types: type 1 (33 %), normal bone strength without angular deformity; type 2 (30 %), decreased bone strength without angular deformity; type 3 (12 %), isolated coxa vara with neck-shaft angle <120°; type 4 (11 %), isolated varus deformity in the proximal femoral shaft; and type 5 (14 %), coxa vara with varus deformity in the proximal femoral shaft. Intra- and interobserver kappa values were excellent, ranging from 0.85 to 0.88. Good clinical outcomes were achieved. CONCLUSIONS This radiographic classification of fibrous dysplasia is reproducible and useful for describing and assessing this disease. The treatments based on this classification were effective.
Collapse
Affiliation(s)
- Xuelei Zhang
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guo Xue Lane, Wuhou District, 610041, Chengdu, Sichuan, China.
| | - Chunyu Chen
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guo Xue Lane, Wuhou District, 610041, Chengdu, Sichuan, China.
| | - Hong Duan
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guo Xue Lane, Wuhou District, 610041, Chengdu, Sichuan, China.
| | - Chongqi Tu
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guo Xue Lane, Wuhou District, 610041, Chengdu, Sichuan, China.
| |
Collapse
|
25
|
Nakamura T, Matsumine A, Asanuma K, Matsubara T, Sudo A. Treatment of bone defect with calcium phosphate cement subsequent to tumor curettage in pediatric patients. Oncol Lett 2015; 11:247-252. [PMID: 26870197 DOI: 10.3892/ol.2015.3855] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 09/17/2015] [Indexed: 12/23/2022] Open
Abstract
The aim of the present study was to investigate the mid- to long-term clinical performance of calcium phosphate cement (CPC) in the treatment of benign bone tumors in pediatric patients with a follow-up of at least 2-years. The cases of 33 patients with benign bone tumors treated by curettage and subsequent implantation of CPC were retrospectively reviewed. The patients consisted of 13 males and 20 females, with a median age of 13 years and median follow-up time of 79 months. All patients were alive at the time of review. No toxicity was detected in routine blood tests. Radiography was used to confirm that CPC was well adapted to the surrounding host bone, although the resorbability of CPC was not obtained for all patients at the final follow-up. Local tumor recurrence occurred in 4 patients. None of the patients reported post-operative fractures. In total, 6 patients required a second surgical procedure, as follows: 4 patients in whom local tumor recurrence occurred; 1 patient with post-operative superficial wound infection, who underwent wound debridement; and 1 patient that required the removal of CPC due to deep infection at the proximal humerus. All patients had regained full physical function without any pain at the final follow-up. The present study recommends that the properties of CPC should be taken into consideration and applied to the reconstruction of bone defects subsequent to curettage of bone tumors.
Collapse
Affiliation(s)
- Tomoki Nakamura
- Department of Orthopaedic Surgery, Mie University Hospital, Tsu, Mie 514-8507, Japan
| | - Akihiko Matsumine
- Department of Orthopaedic Surgery, Mie University Hospital, Tsu, Mie 514-8507, Japan
| | - Kunihiro Asanuma
- Department of Orthopaedic Surgery, Mie University Hospital, Tsu, Mie 514-8507, Japan
| | - Takao Matsubara
- Department of Orthopaedic Surgery, Mie University Hospital, Tsu, Mie 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Hospital, Tsu, Mie 514-8507, Japan
| |
Collapse
|
26
|
Nakamura T, Matsumine A, Asanuma K, Matsubara T, Sudo A. Treatment of the benign bone tumors including femoral neck lesion using compression hip screw and synthetic bone graft. SICOT J 2015; 1:15. [PMID: 27163071 PMCID: PMC4849251 DOI: 10.1051/sicotj/2015009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The proximal femur is one of the most common locations for benign bone tumors and tumor like conditions. We describe the clinical outcomes of the surgical treatment of benign lesions of the proximal femur including femoral neck using compression hip screw and synthetic bone graft. METHODS Thirteen patients with benign bone tumors or tumor like conditions of the proximal femur including femoral neck were surgically treated. Their average age at the time of presentation was 35 years and the average follow-up time was 76 months. RESULTS The average intraoperative blood loss was 1088 mL and intraoperative blood transfusion was required in eight patients. The average operative time was 167 minutes. All patients required one week and 12 weeks after surgery before full weight-bearing was allowed. All patients had regained full physical function without pain by the final follow-up. No patient sustained a pathological fracture of the femur following the procedure. All patients achieved partial or complete radiographic consolidation of the lesion within one year except one patient who developed a local tumor recurrence in 11 months. Post-operative superficial wound infection was observed in one patient, which resolved with intravenous antibiotics. Chronic hip pain was observed in one patient due to the irritation of tensor fascia lata muscle by the tube plate. CONCLUSION We suggest that the treatment of benign bone lesion of the proximal femur using compression hip screw and synthetic bone graft is a safe and effective method.
Collapse
Affiliation(s)
- Tomoki Nakamura
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine Tsu Japan
| | - Akihiko Matsumine
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine Tsu Japan
| | - Kunihiro Asanuma
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine Tsu Japan
| | - Takao Matsubara
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine Tsu Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine Tsu Japan
| |
Collapse
|
27
|
Xia Z, Sittampalam K, Howe TS, Lo NN. Successful treatment of solitary intraosseous haemangioma of the femoral neck. Singapore Med J 2015; 56:e65-e70. [PMID: 25917479 PMCID: PMC4415109 DOI: 10.11622/smedj.2015064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Intraosseous haemangiomas (IOHs) are benign vascular bone tumours that account for 1% of all primary bone tumours. They are most frequently seen in the vertebrae and skull, and are rarely found in long bones. Herein, we present an uncommon case of a 25-year-old woman with a solitary IOH that occupied the left femoral neck. We describe the clinical, radiological and histological details of the case, as well as the three-year outcome of the surgical treatment, which successfully preserved the femoral head. We also conducted a review of the literature on this uncommon entity.
Collapse
Affiliation(s)
- Zhan Xia
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore 169608.
| | | | | | | |
Collapse
|
28
|
Gaston CL, Puls F, Grimer RJ. The dilemma of denosumab: Salvage of a femoral head giant cell tumour. Int J Surg Case Rep 2014; 5:783-6. [PMID: 25290381 PMCID: PMC4245664 DOI: 10.1016/j.ijscr.2014.09.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 09/10/2014] [Accepted: 09/11/2014] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Denosumab is a monoclonal RANKL antibody which has been shown to be highly effective in treating giant cell tumour (GCT) of bone. We report on its use as a neo-adjuvant agent to avoid morbid surgery for an adolescent. PRESENTATION OF CASE We report a case of a15-year old female with a Campanacci 3 GCT involving the femoral head and neck. DISCUSSION To preserve bone stock and avoid an outright hip replacement, the patient was given denosumab pre-operatively to consolidate the tumour. After receiving 6 months of treatment, a rim of cortical bone had developed to allow an extended curettage of the tumour to be performed without fear of collapse of the articular surface. CONCLUSION This is the first reported case of the use of denosumab in GCT of the femoral head and neck. We describe our experience in the neo-adjuvant use of denosumab and offer suggestions for future use. Further studies will be needed to see if denosumab has a role in conventional GCT and whether it can lead to a lowering of local recurrence rates.
Collapse
Affiliation(s)
- Czar Louie Gaston
- Oncology Unit, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham B31 2AP, UK.
| | - Florian Puls
- Oncology Unit, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham B31 2AP, UK
| | - Robert John Grimer
- Oncology Unit, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham B31 2AP, UK
| |
Collapse
|
29
|
Free non-vascularized fibular strut bone graft for treatment of post-traumatic lower extremity large bone loss. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:599-605. [DOI: 10.1007/s00590-013-1342-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 10/14/2013] [Indexed: 10/26/2022]
|
30
|
Shin SH, Yeo I, Seo SW. Can certain benign lesions of the proximal femur be treated without surgery? Clin Orthop Relat Res 2013; 471:3319-25. [PMID: 23670674 PMCID: PMC3773140 DOI: 10.1007/s11999-013-3048-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 05/01/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Benign lesions in the proximal femur can cause pathologic fractures. To avoid fracture, benign tumors and tumor-like lesions in this region often are treated surgically, yet there have been few reports regarding the decision-making processes or protocols for nonsurgical treatment of these lesions. QUESTIONS/PURPOSES In this study, we asked (1) whether some benign lesions of the proximal femur can be managed safely using a conservative protocol, and (2) if observed according to such a protocol, what are the outcomes of such lesions at this anatomic site? METHODS Fifty-four consecutive patients who had been followed for at least 12 months were enrolled in this study. The mean age of the patients at first visit was 38 years (range, 13-70 years), and the minimum followup was 12 months (mean, 25 months; range, 12-59 months). After ruling out malignancy, lesions were categorized as aggressive benign tumors or nonaggressive benign lesions using a standardized approach. We used conservative treatment for most patients with nonaggressive, benign lesions. Surgery was performed only for patients with nonaggressive lesions who met our fracture risk criteria: pain on initiating hip movement, progressively worsening pain, cortical thinning, and the absence of a sclerotic margin. RESULTS Of the 47 patients with a nonaggressive, benign lesion without fracture at presentation, 83% were treated conservatively and only 10% of these patients had progression of the lesion. No new pathologic fractures developed during followup. In 88% of patients who presented with pain that was managed conservatively, pain improved either partially or completely at final followup. CONCLUSIONS Most nonaggressive, benign lesions in the proximal femur can be treated conservatively, and our protocol appears to be a useful outpatient guideline. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Seung Han Shin
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710 Korea
| | - Ingwon Yeo
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710 Korea
| | - Sung Wook Seo
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710 Korea
| |
Collapse
|
31
|
Tong Z, Zhang W, Jiao N, Wang K, Chen B, Yang T. Surgical treatment of fibrous dysplasia in the proximal femur. Exp Ther Med 2013; 5:1355-1358. [PMID: 23737878 PMCID: PMC3671783 DOI: 10.3892/etm.2013.987] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 02/11/2013] [Indexed: 12/16/2022] Open
Abstract
The aim of this study was to summarize oncological and functional results and to investigate surgical treatment methods and efficacies by conducting a retrospective study of patients with fibrous dysplasia (FD) in the proximal femur. A total of 15 patients with FD in the proximal femur were selected. Among them, 12 cases were monostotic and 3 cases were polyostotic. In addition, 2 cases were accompanied by shepherd’s crook deformity. All cases received internal fixation following focus curettage and impaction grafting. Among them, valgus osteotomy was conducted for 2 cases of shepherd’s crook deformity. All patients were followed up for 12–32 months. For 2 patients with shepherd’s crook deformity in the proximal femur, the collodiaphysial angle was recovered after an orthopedic procedure following osteotomy. In addition, no patient presented with postoperative recurrent lesions. At 3 months following surgery, local bone resorption was visible in the bone grafting area. Between 8 and 12 months after surgery, the bones in the bone grafting area had healed, pain had disappeared and gaits were nearly normal. An effective internal fixation following thorough focus curettage and allograft bone transplantation is an effective method of treating FD in the proximal femur. For patients with shepherd’s crook deformity, it is also necessary to perform valgus osteotomy to recover hip joint function.
Collapse
Affiliation(s)
- Zhichao Tong
- Department of Osteopathy, Xi'an Red Cross Hospital, Xi'an, Shaanxi 710054
| | | | | | | | | | | |
Collapse
|
32
|
Bielecki T, Cieslik-Bielecka A, Żelawski M, Mikusek W. A side-effect induced by the combination of a demineralized freeze-dried bone allograft and leucocyte and platelet-rich plasma during treatment for large bone cysts: A 4-year follow-up clinical study. Transfus Apher Sci 2012; 47:133-8. [DOI: 10.1016/j.transci.2012.06.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Revised: 05/23/2012] [Accepted: 06/29/2012] [Indexed: 01/21/2023]
|
33
|
Ruggieri P, Mavrogenis AF, Casadei R, Errani C, Angelini A, Calabrò T, Pala E, Mercuri M. Protocol of surgical treatment of long bone pathological fractures. Injury 2010; 41:1161-7. [PMID: 20947077 DOI: 10.1016/j.injury.2010.09.018] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Long bone pathological fractures in patients with primary and metastatic bone tumours are difficult to treat and their management may alter the prognosis of the disease and jeopardize survival. The aim of this article was to review the relevant studies reporting on the management of tumour patients with pathological fractures of the long bones, to discuss the most suitable approach in these patients, to highlight specific treatment recommendations, and finally based on this analysis and our clinical practice, to propose a treatment algorithm for decision making and treatment.
Collapse
Affiliation(s)
- Pietro Ruggieri
- Department of Orthopaedics, Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Abuhassan FO, Shannak A. Non-vascularized fibular graft reconstruction after resection of giant aneurysmal bone cyst (ABC). Strategies Trauma Limb Reconstr 2010; 5:149-54. [PMID: 21286360 PMCID: PMC2987204 DOI: 10.1007/s11751-010-0093-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Accepted: 08/03/2010] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to present the results of non-vascularized fibular graft for reconstruction of bone defects after en block resection of giant aneurysmal bone cyst (ABC) of the extremities. Between 1998 and 2006, three patients, aged 6, 8 and 23 years, with giant aneurysmal bone cysts were treated. The cysts were located in the humerus, proximal femur and metatarsal. All patients were given en bloc resection of the cyst followed by non-vascularized fibular bone graft, with the graft length ranging from 6 to 18 cm. All patients needed supplementary fixation with a single Kirschner wire or plate and screws. At the final follow-up, bony union was achieved in each case, and there was no recurrence, limitation of range of motion or disability. In addition, complete regeneration of the fibula at the donor site was seen in the two children. We propose a criterion for giant ABC, when the transverse diameter of the cyst is up to three times or more of the transverse diameter of the nearby bone, it is then called a giant ABC. Non-vascularized fibular graft is an optimal and valuable method for the reconstruction of bone defects after resection of giant ABC in the extremities.
Collapse
Affiliation(s)
- Freih Odeh Abuhassan
- The Department of Orthopaedic Surgery, Jordan University, P.O. Box 73, Jubaiha, Amman, 11941 Jordan
| | | |
Collapse
|
35
|
Pathologic proximal femoral fracture complicating aneurysmal bone cyst: management and alternatives of fixation in eight patients. CURRENT ORTHOPAEDIC PRACTICE 2010. [DOI: 10.1097/bco.0b013e3181dade5a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
36
|
Ruggieri P, Angelini A, Montalti M, Pala E, Calabrò T, Ussia G, Abati CN, Mercuri M. Tumours and tumour-like lesions of the hip in the paediatric age: a review of the Rizzoli experience. Hip Int 2009; 19 Suppl 6:S35-45. [PMID: 19306246 DOI: 10.1177/112070000901906s07] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Bone tumours and tumour-like lesions of the hip in children are rare. Signs and symptoms of these tumours are generally nonspecific. Delay of diagnosis is not uncommon. A high index of suspicion in young patients presenting with persistent pain and without history of trauma, that is unresolved with conservative therapy should prompt further investigation, including radiographs or computed tomography scan of the pelvis. In the experience of the Istituto Rizzoli, in patients less than 14 years (mean 9 years, ranged from 6 months to 14 years), 752 tumours and tumours-like lesions occurred in the pelvis or proximal femur, involving the hip. Tumour-like lesions accounted for 322 cases (simple bone cyst in 255, eosinophilic granuloma in 43, aneurismal bone cyst in 34), benign tumours for 340 cases (osteoid osteoma in 229, fibrous dysplasia in 63, exostosis in 48) and malignant tumours for 80 cases (Ewing's sarcoma in 53 and osteosarcoma in 27). The epidemiology, pathology, clinical presentation, and radiograph findings are discussed for each of these tumours.Treatment of these tumours differs from observation or minimally invasive treatment for most pseudotumoural lesions, intralesional excision or termoablation for benign bone tumours and wide resection for malignant bone tumours. In this latter group, chemotherapy is required and often administered pre- and postoperatively.
Collapse
Affiliation(s)
- P Ruggieri
- Department of Orthopedics, University of Bologna, Istituto Ortopedico Rizzoli, Via Pupilli, 1, Bologna 40136, Italy.
| | | | | | | | | | | | | | | |
Collapse
|