Aneurysmal bone cyst of the thumb metacarpal: en-block resection and free toe phalanx transplantation

Hand's aneurysmal bone cyst: A rare localization. Case report and systematic literature review

Aneurysmal bone cysts are benign, rare bony tumours frequently observed among children and young adults principally located in the long bones, pelvis, and spine and rarely in other anatomical district such as the hand. We report the case of a 12-year-old girl with an aneurysmal bone cyst, in active stage, involving the still-open epiphysis of the fourth metacarpal of the right hand, which was in a first time treated by curettage, and 3 months later, occurring a recurrence, by a radically excision of the bone and reconstruction with a graft from the iliac crest. At 10-year follow-up the patient had good cosmetic results and a functioning hand. We also performed a systematic Literature review in order to retrieve the key information regarding: the diagnosis, the clinical features and the treatment.

Bipolar electric cauterization as adjuvant treatment after curettage of aneurysmal bone cysts of the hand

Almost all aneurysmal bone cysts of the hand were managed with either simple curettage plus or minus bone graft or en block excision and autograft reconstruction. The high recurrence rate is a major disadvantage of the former technique, whereas complexity/donor-site morbidities are known disadvantages of the latter technique. In the long bones of the lower limbs, adjuvant therapy after curettage is known to reduce the recurrence rate. This article introduces adjuvant bipolar electrical cauterization after curettage of aneurysmal bone cysts of the hands. This technique was used in 6 cases including 1 case with a recurrent lesion after curettage done elsewhere. Complications have been minimal and there was no recurrence at a mean follow-up of 3 years. Although the number of cases in this series is small, the favorable results warrant trying the technique in a multicenter comparative study.

Aneurysmal bone cyst of the fifth metacarpal

Aneurysmal bone cyst is a rare, rapidly growing, and destructive benign bone tumor that even more rarely involves the bones of the hand. Various treatment options for aneurysmal bone cyst have been reported in the literature, but controversy exists regarding optimal treatment. Due to its rarity in the hand, no evidence-based treatment regimen has been established. A 21-year-old man presented with a history of pain and local swelling over his fifth metacarpal of 5 months' duration. Physical and radiographic examination of the hand was consistent with aneurysmal bone cyst. After biopsy, pathologic examination confirmed the diagnosis of aneurysmal bone cyst. En-block resection of the tumor and autologous bicortical strut graft fixation with Kirschner wires was performed. The hand was immobilized in a short arm cast for 3 weeks after the patient received 3 weeks of physiotherapy. Kirschner wires were removed 6 weeks postoperatively. Excellent clinical and functional results were obtained with no recurrence after 3 years of follow-up with en-block resection and reconstruction with iliac crest graft. Radiographic examination demonstrated the osseous integration of the graft with no signs of recurrence. Although treatment should be planned individually according to lesion site and size and to patient age, we suggest en-block resection to prevent recurrence and secondary surgical interventions particularly in cases with no articular involvement.