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Daoulas T, Bozon O, Chammas M, Coulet B, Lazerges C. Management of advanced metacarpal aneurysmal cysts: Surgical technique. Hand Surg Rehabil 2023; 42:482-487. [PMID: 37625544 DOI: 10.1016/j.hansur.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023]
Abstract
The hand is a rare site for aneurysmal bone cysts (ABCs). Depending on their degree of invasiveness, treatment of ABCs ranges from medical therapy to surgical curettage and bone filling. In the most advanced cases, bone resection and reconstruction, with or without adjuvant or neoadjuvant treatment, are indicated. We describe a technique involving segmental bone resection and structural iliac graft reconstruction with carpo-metacarpal plate arthrodesis, for the management of advanced ABC involving the base of the metacarpals. The radio-clinical results of two patients operated on using this technique are presented, at 18 and 36 months. At the last follow-up, the results showed a QDASH of 15 and 10, and a PRWE of 9 and 11. Satisfaction was 10/10 in both cases. Grasp strength was 25 kg and 42 kg versus 28 kg and 40 kg on the opposite side. Pinch strength was 6 kg and 11 kg versus 7 kg and 10 kg. Metacarpophalangeal flexion was 80° and 90°. Extension was complete in both cases. Radiographs showed good graft fusion, with no lysis or signs of ABC recurrence at the last follow-up. Segmental bone resection and iliac autograft reconstruction with carpo-metacarpal plate arthrodesis represents a therapeutic option in the management of advanced ABCs of the metacarpal base.
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Affiliation(s)
- Thomas Daoulas
- Département de chirurgie orthopédique, Unité de chirurgie du membre supérieur, de la main et des nerfs périphériques, CHU Lapeyronie, Montpellier, France.
| | - Olivier Bozon
- Département de chirurgie orthopédique, Unité de chirurgie du membre supérieur, de la main et des nerfs périphériques, CHU Lapeyronie, Montpellier, France
| | - Michel Chammas
- Département de chirurgie orthopédique, Unité de chirurgie du membre supérieur, de la main et des nerfs périphériques, CHU Lapeyronie, Montpellier, France
| | - Bertrand Coulet
- Département de chirurgie orthopédique, Unité de chirurgie du membre supérieur, de la main et des nerfs périphériques, CHU Lapeyronie, Montpellier, France
| | - Cyril Lazerges
- Département de chirurgie orthopédique, Unité de chirurgie du membre supérieur, de la main et des nerfs périphériques, CHU Lapeyronie, Montpellier, France
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Muran A, Fallon J, Jung B, Dzaugis P, Zhang A, Fitzgerald M, Goodman HJ, Kenan S, Kenan S. Treatment trends of benign bone lesions in a suburban New York healthcare system. J Family Med Prim Care 2023; 12:1979-1983. [PMID: 38024888 PMCID: PMC10657113 DOI: 10.4103/jfmpc.jfmpc_5_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 04/26/2023] [Accepted: 06/09/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The management of benign bone lesions is controversial as it is dependent on a multitude of factors such as age, anatomic location, comorbidities, lesion metabolic activity, surgeon preferences, and goals of care, among others. Thus far, many studies have attempted to report on these lesions; however, most are heterogeneous compilations of benign and malignant lesions with nearly all failing to report patient treatment and none of which have originated from a suburban area of the United States. The goal of this study was to establish a modern database dedicated solely to benign bone tumors to reflect current diagnosis and treatment trends in suburban New York. Materials and Methods This was a multicenter retrospective observational study with inclusion criteria limited to benign bone lesions of all ages. Malignant lesions were excluded. Patients were drawn from both primary care provider and surgeon records, with documentation of their associated management. Results A total of 689 patients met inclusion criteria. The overall operative rate for this cohort was 71.6%. In agreement with current literature, aneurysmal bone cysts, giant cell tumors, and osteochondromas underwent surgery more frequently than enchondromas; older patients underwent surgery less frequently; benign bone lesions were more commonly found in younger males, and the distal femur and proximal tibia were the most common locations for lesions (P < .05 for all findings). Conclusion This study demonstrates the management of a globally representative variety of benign bone lesions in a diverse suburban population of New York and should facilitate future research on how lesion type, location, management, and other factors relate to patient outcomes.
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Affiliation(s)
- Andrew Muran
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - John Fallon
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - Byeongho Jung
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - Peter Dzaugis
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - Aaron Zhang
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - Michael Fitzgerald
- Department of Orthopaedic Surgery, Northwell Health, Long Island Jewish Medical Center, New York, USA
| | - Howard J. Goodman
- Department of Orthopaedic Surgery, Northwell Health, Long Island Jewish Medical Center, New York, USA
| | - Samuel Kenan
- Department of Orthopaedic Surgery, Northwell Health, Long Island Jewish Medical Center, New York, USA
| | - Shachar Kenan
- Department of Orthopaedic Surgery, Northwell Health, Long Island Jewish Medical Center, New York, USA
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3
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Putro YAP, Magetsari R, Taroeno-Hariadi KW, Dwianingsih EK, Pribadi AW, Sukotjo KK. Classic and rare manifestations of multiple osteoma: A case report. Int J Surg Case Rep 2023; 110:108713. [PMID: 37634429 PMCID: PMC10509817 DOI: 10.1016/j.ijscr.2023.108713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 08/29/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Osteoma is a benign tumor that can arise from compact or cancellous bone and is more commonly found in the face or skull. The incidence of osteoma believed to be underreported as most are asymptomatic. To date, the best modality to diagnose osteoma is CT scan. We report a unique case of osteoma presenting with cranial and extracranial manifestations and highlight the importance of bone survey in evaluating patients with osteoma. CASE PRESENTATION A 26-year-old female complained of bilateral pain in the jawbone and several areas of her head. On physical examination, there were several masses in the head with the largest on the left mandible measuring 5.6 × 6.0 × 4.5 cm from MSCT examination. Hemi-mandibulectomy, histopathological and cytopathology examination were performed on the tissue obtained from the left mandible which concluded osteoma. Post-operative bone survey was performed and found osteoma on left ulna and bilateral fibula. Suspected Gardner syndrome with multiple osteoma manifestation was excluded from normal results of colon in-loop examination. We conservatively monitored the patient and most recent 6-month follow-up found no complaint nor changes in the extracranial osteoma manifestation on left ulna and both fibulas. CLINICAL DISCUSSION The benign tumor osteoma is incredibly uncommon to present both intra and extracranially. We suggest thorough skeletal studies such as bone survey to be performed as they are crucial in the full evaluation of patients with multiple osteomas. Osteoma treatment is based on the patient's symptoms, surgery for patients with symptoms and periodic monitoring for asymptomatic patients. CONCLUSION It is necessary to consider radiological modality for diagnosing osteoma patients. The majority of osteomas are asymptomatic and the choice of radiological examination sometimes still misses the lesion. It is important to evaluate histologically if the lesion difficult to diagnose.
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Affiliation(s)
- Yuni Artha Prabowo Putro
- Department of Orthopedics and Traumatology, RSUP Dr. Sardjito Hospital, Jl. Kesehatan Sendowo No.1, Sleman 55281, D.I.Yogyakarta, Indonesia; Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Farmako, Sendowo, Sekip Utara, Sleman 55281, D.I.Yogyakarta, Indonesia.
| | - Rahadyan Magetsari
- Department of Orthopedics and Traumatology, RSUP Dr. Sardjito Hospital, Jl. Kesehatan Sendowo No.1, Sleman 55281, D.I.Yogyakarta, Indonesia; Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Farmako, Sendowo, Sekip Utara, Sleman 55281, D.I.Yogyakarta, Indonesia
| | - Kartika W Taroeno-Hariadi
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Farmako, Sendowo, Sekip Utara, Sleman 55281, D.I.Yogyakarta, Indonesia; Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito General Hospital, Jl. Farmako, Sendowo, Sekip Utara, Sleman 55281, D.I.Yogyakarta, Indonesia
| | - Ery Kus Dwianingsih
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Farmako, Sendowo, Sekip Utara, Sleman 55281, D.I.Yogyakarta, Indonesia; Department of Anatomical Pathology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito General Hospital, Jl. Farmako, Sendowo, Sekip Utara, Sleman 55281, D.I.Yogyakarta, Indonesia
| | - Amri Wicaksono Pribadi
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Farmako, Sendowo, Sekip Utara, Sleman 55281, D.I.Yogyakarta, Indonesia; Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Farmako, Sendowo, Sekip Utara, Sleman 55281, D.I.Yogyakarta, Indonesia
| | - Karisa Kartika Sukotjo
- Department of Orthopedics and Traumatology, RSUP Dr. Sardjito Hospital, Jl. Kesehatan Sendowo No.1, Sleman 55281, D.I.Yogyakarta, Indonesia; Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Farmako, Sendowo, Sekip Utara, Sleman 55281, D.I.Yogyakarta, Indonesia
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Moghamis IS, Elramadi A, Radi M, Hejleh HA, Mudawi A, Elsayed AM. Vanishing solitary osteochondroma of humerus following trauma: A case report. Trauma Case Rep 2023; 46:100874. [PMID: 37396115 PMCID: PMC10310942 DOI: 10.1016/j.tcr.2023.100874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 07/04/2023] Open
Abstract
Osteochondromas are the most common benign tumors of the bone. Mainly these lesions affect the long-bone metaphysis and usually are asymptomatic. When complications develop from these lesions, then they become symptomatic and surgical resection may become indicated. Spontaneous resolution of osteochondroma is rare. There have been fewer case reports about this condition. We are reporting 16 years old, male, who sustained direct trauma to his shoulder and presented with fracture at the base of a solitary osteochondroma. Complete resolution of the lesion occurred without any surgical intervention 18 months following the fracture.
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Affiliation(s)
- Isam Sami Moghamis
- Corresponding author at: Hamad Medical Corporation, P.O. BOX 3050, Doha, Qatar.
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Tan Y, Zhang S, Zhang J, Huang T, Li X, Zhou X, Zhang J. Denosumab treatment for progressive Enneking stage II cervical giant-cell tumor conservatively. Funct Integr Genomics 2023; 23:76. [PMID: 36867323 DOI: 10.1007/s10142-023-01004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 03/04/2023]
Abstract
Cervical giant cell tumor of the bone (GCTB) is a rare, primary benign bone tumor in pediatric patients. Surgery remains the primary choice for treating resectable cervical GCTB. Additional adjuvant therapeutic options are available for patients with unresectable cervical GCTB, including the anti-RANKL monoclonal antibody, denosumab. We represented a case incidentally found in a 7-year-old female, who complained severe craniocervical pain, grade 2-3 dysphagia, dysphonia, hypesthesia, and extremity weakness. The patient showed an impressive clinical response to denosumab, both clinically and radiologically, without adverse events or recurrence. To date, this is the youngest patient ever reported to have a progressive Enneking stage II C3 GCTB treated with denosumab alone. Denosumab can be administered as a single and conservative therapy for pediatric patients with unresectable upper cervical GCTB, avoiding the risks and morbidity of surgical and radiative treatment.
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Affiliation(s)
- YiXuan Tan
- Department of Orthopedics, Shanghai Changzheng Hospital, Shanghai, China
| | - Shuhan Zhang
- Department of Anesthesia, Shanghai Changzheng Hospital, Shanghai, China
| | - Jinling Zhang
- Medical School of Nanjing University, Nanjing, China
| | - Tao Huang
- Huzhou University, Huzhou, Zhejiang, China
| | - Xiaoming Li
- Department of Orthopaedics, 72nd Group Army Hospital, Huzhou University, Huzhou, Zhejiang, China.
| | - Xuhui Zhou
- Department of Orthopedics, Shanghai Changzheng Hospital, Shanghai, China.
| | - Jiefeng Zhang
- Department of Orthopaedics, 72nd Group Army Hospital, Huzhou University, Huzhou, Zhejiang, China.
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Panagopoulos I, Andersen K, Gorunova L, Lund-Iversen M, Lobmaier I, Heim S. Recurrent Fusion of the Genes for High-mobility Group AT-hook 2 ( HMGA2) and Nuclear Receptor Co-repressor 2 ( NCOR2) in Osteoclastic Giant Cell-rich Tumors of Bone. Cancer Genomics Proteomics 2022; 19:163-177. [PMID: 35181586 DOI: 10.21873/cgp.20312] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/AIM Chimeras involving the high-mobility group AT-hook 2 gene (HMGA2 in 12q14.3) have been found in lipomas and other benign mesenchymal tumors. We report here a fusion of HMGA2 with the nuclear receptor co-repressor 2 gene (NCOR2 in 12q24.31) repeatedly found in tumors of bone and the first cytogenetic investigation of this fusion. MATERIALS AND METHODS Six osteoclastic giant cell-rich tumors were investigated using G-banding, RNA sequencing, reverse transcription polymerase chain reaction, Sanger sequencing, and fluorescence in situ hybridization. RESULTS Four tumors had structural chromosomal aberrations of 12q. The pathogenic variant c.103_104GG>AT (p.Gly35Met) in the H3.3 histone A gene was found in a tumor without 12q aberration. In-frame HMGA2-NCOR2 fusion transcripts were found in all tumors. In two cases, the presence of an HMGA2-NCOR2 fusion gene was confirmed by FISH on metaphase spreads. CONCLUSION Our results demonstrate that a subset of osteoclastic giant cell-rich tumors of bone are characterized by an HMGA2-NCOR2 fusion gene.
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Affiliation(s)
- Ioannis Panagopoulos
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway;
| | - Kristin Andersen
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Ludmila Gorunova
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Marius Lund-Iversen
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Ingvild Lobmaier
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Sverre Heim
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Abstract
Fibrous dysplasia is a benign intraosseous tumor, which can occur as a monostotic or polyostotic disease. As a combination of dermatological and endocrinological features it is known as McCune-Albright syndrome, in conjunction with intramuscular myxoma as Mazabraud's syndrome. Fibrous dysplasia originates from a genetic defect, a postzygotic mutation of the GNAS gene, leading to incorrect regulation of the osteogenesis of the affected area of the bone. The weakening of the bone causes a variety of symptoms ranging from isolated local pain, acute fractures up to severe deformation of the bones. In the latter case the patients may lose the capability of walking. The orthopedic treatment provides suitable methods to set and stabilize fractures, to strengthen weakened bones and to straighten out and stabilize deformed long bones. This can help many patients return to a high level of pain-free mobility and even allow the most badly affected patients to lead a better life with a restricted mobility.
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Affiliation(s)
- Thomas Wirth
- Klinik für Orthopädie, Klinikum Stuttgart, Olgahospital, Kriegsbergstr. 62, 70176, Stuttgart, Deutschland.
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Khalaf A, Hirmas N, Anwer F, Al-Ibraheem A. 68Ga DOTA-TOC Uptake in Non-ossifying Fibroma: a Case Report. Nucl Med Mol Imaging 2020; 54:199-203. [PMID: 32831966 DOI: 10.1007/s13139-020-00650-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 05/29/2020] [Accepted: 06/26/2020] [Indexed: 10/23/2022] Open
Abstract
Non-ossifying fibroma (NOF) is a common benign bone tumor with a high probability of occurrence in children and adolescents. It is commonly seen in the metaphysis of long bones, eccentrically located, and can coexist with other malignant tumors such as neuroendocrine tumors (NET). To date, plain radiographs play a major role in the diagnosis of these benign bone tumors. Herein, we report the case of a 13-year-old male patient who was diagnosed with pulmonary NET and underwent right lung lobectomy for a hilar mass which later revealed a well-differentiated NET. The follow-up 68Ga DOTA-TOC PET/CT showed a focal somatostatin receptor expression in the left distal femur, with corresponding CT component findings of a well-defined osteolytic bone lesion located within the medial aspect of the left distal femoral metaphysis, strongly indicative of NOF. To the best of our knowledge, this is the first reported case of such an occurrence.
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Galanis V, Georgiadi K, Balomenos V, Tsoucalas G, Thomaidis V, Fiska A. Osteochondroma of the talus in a 19-year-old female: A case report and review of the literature. Foot (Edinb) 2020; 42:101635. [PMID: 31739169 DOI: 10.1016/j.foot.2019.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/05/2019] [Accepted: 08/18/2019] [Indexed: 02/04/2023]
Abstract
CASE Osteochondroma is a benign bone tumor usually affecting areas around the knee, pelvis, neck and tibia. This disease rarely affects the talus. A case of a 19-years-old female with anteromedial ankle impingement with 8 years follow-up is reported. Surgery removal was the treatment of choice and histopathology examination revealed a benign solitary osteochondroma. CONCLUSION Osteochondromas in the anterior and anteromedial side of talus are rarer and can cause multiple clinical manifestations including important ones such as limitation of ankle movement and pain. Different locations of solitary osteochondromas can influence both patients' symptoms and clinical examination findings.
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Affiliation(s)
- Vasilios Galanis
- Anatomy Department, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Kyriaki Georgiadi
- Anatomy Department, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
| | - Vassilios Balomenos
- Anatomy Department, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Gregory Tsoucalas
- Anatomy Department, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Vasilios Thomaidis
- Anatomy Department, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Aliki Fiska
- Anatomy Department, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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10
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de Ga K, Bateni C, Darrow M, McGahan J, Randall RL, Chen D. Polyostotic osteoid osteoma: A case report. Radiol Case Rep 2020; 15:411-415. [PMID: 32071661 PMCID: PMC7015827 DOI: 10.1016/j.radcr.2020.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/03/2020] [Accepted: 01/07/2020] [Indexed: 11/29/2022] Open
Abstract
Osteoid osteomas are common, benign osteoblastic tumors that can occur in any bone in the body. They are almost always solitary, with only rare reports of multiple tumors in the same patient. When multiple, they typically are found within the same bone. We present a unique case of a young female athlete who presented initially at 16 years old with a right tibial osteoid osteoma and later at 18 years old with a right acetabular osteoid osteoma. Our case demonstrates the rare entity of polyostotic osteoid osteoma, the potential limitations of MRI in the diagnosis of osteoid osteoma, and the utility of radiofrequency ablation in the treatment of osteoid osteoma.
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Affiliation(s)
- Kristopher de Ga
- Department of Radiology, University of California Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA 95817, USA
| | - Cyrus Bateni
- Department of Radiology, University of California Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA 95817, USA
| | - Morgan Darrow
- Department of Pathology, University of California Davis Medical Center, 4400 V Street, Sacramento, CA 95817, USA
| | - John McGahan
- Department of Radiology, University of California Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA 95817, USA
| | - R Lor Randall
- Department of Orthopedic Surgery, University of California Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA 95817, USA
| | - Dillon Chen
- Department of Radiology, University of California Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA 95817, USA
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11
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Vaish A, Patel J, Vaishya R. Reconstruction of hand in aggressive benign bone tumors by mini JESS fixator. J Clin Orthop Trauma 2020; 11:686-689. [PMID: 32684713 PMCID: PMC7355068 DOI: 10.1016/j.jcot.2020.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/01/2020] [Accepted: 05/03/2020] [Indexed: 11/29/2022] Open
Abstract
We present two cases of young females with aggressive benign bone tumors of the bone (Enchondroma and Giant Cell Tumor). Giant cell tumors and Enchondromas in hand are commonly found benign tumors, which may be locally aggressive. The primary treatment of these lesions is surgical. The two reported cases were treated successfully by extended curettage, bone grafting, and spanning JESS fixator. There was no recurrence in either case at one year follow-up and good hand function and complete healing of the lesion.
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12
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Abstract
Background Curettage is widely used in orthopedic oncology; the defect created frequently requires filling for mechanical and functional stability for the bones and adjacent joint. Allograft, bone graft substitute, and polymethyl methacrylate (PMMA) are the most common substances used each with their benefits and drawbacks. The aim of the study is to show that good functional result can be achieved with curettage and bone filler, regardless of type. Methods A series of 267 cases were reviewed between 1994 and 2015 who received curettage treatment and placement of a bone filler. Endpoints included fracture, infection, cellulitis, pulmonary embolism, and paresthesia. Complication rates at our single institution were compared against literature values for three study cohorts: allograft, bone graft substitute, and PMMA bone fillers. Friedman test, Wilcoxon test, and Z-score for two populations were used to compare our subset against literature values and between different bone filling types. Results Our cases included 18 autografts, 74 allografts, 121 bone graft substitute, and 54 PMMA of which the bulk of complications occurred. Our overall complication rate was 3.37%. Allograft has a complication rate of 1.35%, bone graft substitute of 4.13%, and PMMA of 5.56%. Other techniques did not yield any complications. Combination filling techniques PMMA + allograft and PMMA + bone graft substitute had sample sizes too small for statistical comparison. Statistical comparison yielded no significant difference between complications in any of the filling groups (P = 0.411). Conclusions Some has even argued that bone defects following curettage do not require bone filling for good outcome. However, many structural or biologic benefits that aid in earlier return to functionality can be conferred by filling large bone defects. There was no significant difference in postoperative complication rates between allograft, bone graft substitute, and PMMA when compared at our institution and with literature values. Nevertheless, one complication with a large defect filled with allograft, requiring a subsequent reconstruction using vascularized fibular graft. Taking everything into account, we see bone graft substitute as a suitable alternative to other bone filling modalities.
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Affiliation(s)
- Clark J Chen
- Miller School of Medicine, University of Miami, Miami, FL, 33136, USA.
| | - Earl W Brien
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA, 90048, USA
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Balbouzis T, Alexopoulos T, Grigoris P. Os calcis lipoma: To graft or not to graft? - A case report and literature review. World J Orthop 2019; 10:292-298. [PMID: 31360644 PMCID: PMC6650635 DOI: 10.5312/wjo.v10.i7.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/25/2019] [Accepted: 07/08/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intraosseous lipoma is a rare benign lesion, commonly affecting the os calcis. Its pathogenesis and natural history are not fully understood, and its management remains controversial.
CASE SUMMARY A 56-year-old male complaining of heel pain was diagnosed with an os calcis lipoma. The lesion was treated with curettage and it was filled with impacted allograft and demineralized bone matrix. Histological examination confirmed the above diagnosis. Six months postoperatively, the patient returned to recreational long-distance running. Repeated computed tomography scanning, up to five years postoperatively, showed almost complete resorption of the graft over time.
CONCLUSION The treatment of an os calcis lipoma should be individualized, depending on the symptoms, the location and size of the lesion. Surgeons, electing to proceed with bone grafting, should consider the probability of bone graft resorption.
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Affiliation(s)
- Theodoros Balbouzis
- Department of Orthopaedics, Metropolitan General Hospital, Holargos, Athens 15562, Greece
| | | | - Peter Grigoris
- Department of Orthopaedics, Metropolitan General Hospital, Holargos, Athens 15562, Greece
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Abuhejleh H, Wunder JS, Ferguson PC, Isler MH, Mottard S, Werier JA, Griffin AM, Turcotte RE. Extended intralesional curettage preferred over resection-arthrodesis for giant cell tumour of the distal radius. Eur J Orthop Surg Traumatol 2020; 30:11-7. [PMID: 31297594 DOI: 10.1007/s00590-019-02496-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 07/06/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Distal radius giant cell tumour (GCT) is known to be associated with distinct management difficulties, including high rates of local recurrence and lung metastases compared to other anatomic locations. Multiple treatment options exist, each with different outcomes and complications. QUESTIONS/PURPOSES To compare oncological and functional outcomes and complications following treatment of patients with distal radius GCT by extended intralesional curettage (EIC) or resection-arthrodesis. METHODS Patients operated on for distal radius GCT were identified from prospectively collected databases at four Canadian musculoskeletal oncology specialty centres. There were 57 patients with a mean age of 35.4 years (range 17-57). Thirteen tumours were Campanacci grade 2, and 40 were Grade 3 (4 unknown). Twenty patients presented with an associated pathologic fracture. There were 34 patients treated by EIC and 23 by en bloc resection and wrist arthrodesis. All resections were performed for grade 3 tumours. The mean follow-up was 86 months (range 1-280). RESULTS There were a total of 11 (19%) local recurrences: 10 of 34 (29%) in the EIC group compared to only 1 of 23 (4%) in the resection-arthrodesis group (p = 0.028). For the 10 patients with local recurrence following initial treatment by EIC, 7 underwent repeat EIC, while 3 required resection-arthrodesis. The one local recurrence following initial resection was managed with repeat resection-arthrodesis. Six of the 11 local recurrences followed treatment of Campanacci grade 3 tumours, while 4 were in grade 2 lesions and in one case of recurrence the grade was unknown. There were no post-operative complications after EIC, whereas 7 patients (30%) had post-operative complications following resection-arthrodesis including 4 infections, one malunion, one non-union and one fracture (p = 0.001). The mean post-operative Musculoskeletal Tumor Society score was 33.5 in the curettage group compared to 27 in the resection group (p = 0.001). The mean Toronto Extremity Salvage Score was 98.3% following curettage compared to 91.5% after resection (p = 0.006). No patients experienced lung metastasis or death. CONCLUSIONS EIC is an effective alternative to wide resection-arthrodesis following treatment of distal radius GCT, with the advantage of preserving the distal radius and wrist joint function, but with a higher risk of local recurrence. Most local recurrences following initial treatment by EIC could be managed with iterative curettage and joint preservation. Wide excision and arthrodesis were associated with a significantly lower risk of tumour recurrence but was technically challenging and associated with more frequent post-operative complications. EIC was associated with better functional scores. Resection should be reserved for the most severe grade 3 tumours and recurrent and complex cases not amenable to treatment with EIC and joint salvage. LEVEL OF EVIDENCE III, retrospective comparative trial.
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Ikumi A, Funayama T, Tsukanishi T, Noguchi H, Yamazaki M. Novel Unidirectional Porous β-Tricalcium Phosphate Used as a Bone Substitute after Excision of Benign Bone Tumors of the Hand: A Case Series. J Hand Surg Asian Pac Vol 2018; 23:424-429. [PMID: 30282534 DOI: 10.1142/s2424835518720293] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Unidirectional porous β-tricalcium phosphate (UDPTCP; Affinos®, Kuraray, Tokyo, Japan) has been in clinical use since 2015. Animal studies have confirmed the excellent potential of UDPTCP with regard to bone formation and material absorption. We present the first three clinical cases using UDPTCP as a bone substitute after curettage of benign bone tumors of the hand. All three patients were males, 29-, 30- and 81-years-old, two having a diagnosis of enchondroma and the other, a bone ganglion, with a pathological fracture identified in one case. Over a mean follow-up of 10 months, all patients achieved satisfactory clinical result, with no adverse events of UDPTCP noted. Radiographic evidence of good bone formation and material absorption was observable over the postoperative course. UDPTCP provided satisfactory clinical results, with good biocompatibility and fast resorption characteristics. Therefore, UDPTCP could provide a safe and reliable filling substitute for bone defects following curettage of small bone tumors.
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Affiliation(s)
- Akira Ikumi
- * Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Toru Funayama
- * Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | | | - Hiroshi Noguchi
- * Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masashi Yamazaki
- * Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Thibaut A, Bouhamama A, Boespflug A, Vaz G, Cuinet M, Kalenderian AC, Menassel B, Ricoeur A, Mastier C, Pilleul F. Percutaneous Cryotherapy for Treatment of Chondroblastoma: Early Experience. Cardiovasc Intervent Radiol 2018; 42:304-307. [PMID: 30327928 DOI: 10.1007/s00270-018-2085-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/26/2018] [Indexed: 11/25/2022]
Abstract
Surgical curettage is currently the standard of care for the chondroblastoma, but in peri-articular tumors it is limited by its morbidity. In this preliminary report, we evaluate the feasibility of percutaneous cryotherapy as an alternative ablative treatment for chondroblastoma. Three patients with a chondroblastoma treated by CT scan-guided cryotherapy are presented in this article. Pain permanently disappeared 2 days after the procedure. No local tumor recurrence or cartilage damage was observed by MRI performed 1 year after the intervention. This preliminary case report suggests that percutaneous cryotherapy may be a possible alternative to the current standard of care in chondroblastoma. Further studies are needed to evaluate if this technique offers similar anti-tumoral efficacy while providing better pain relief and less morbidity than curettage.
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Affiliation(s)
- Antoine Thibaut
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008, Lyon, France.
| | - Amine Bouhamama
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008, Lyon, France
| | - Amélie Boespflug
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008, Lyon, France
| | - Gualter Vaz
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008, Lyon, France
| | - Marie Cuinet
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008, Lyon, France
| | - Anne-Charlotte Kalenderian
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008, Lyon, France
| | - Badis Menassel
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008, Lyon, France
| | - Alexis Ricoeur
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008, Lyon, France
| | - Charles Mastier
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008, Lyon, France
| | - Frank Pilleul
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008, Lyon, France
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Horstmann PF, Hettwer WH, Petersen MM. Natural Course of Local Bone Mineralization After Treatment of Benign or Borderline Bone Tumors and Cysts With a Composite Ceramic Bone Graft Substitute. J Clin Densitom 2018; 21:472-479. [PMID: 29661685 DOI: 10.1016/j.jocd.2017.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 12/12/2017] [Indexed: 01/17/2023]
Abstract
After surgical bone tumor removal, filling of the bone defect is frequently performed using a bone graft or bone graft substitute. During follow-up, precise quantification of changes in bone mineral density, within the treated bone defect, is very difficult using conventional X-ray examinations. The objectives of this study were to characterize the pattern of resorption/biodegradation of a composite calcium sulfate/hydroxyapatite bone graft substitute and to quantify the bone defect healing with repeated dual-energy X-ray absorptiometry (DXA) measurements. Seventeen patients treated for 18 benign bone lesions, with subsequent defect filling using 2 variants of a composite ceramic bone graft substitute (CERAMENT™|BONE VOID FILLER or CERMAMENT™|G, BONESUPPORT AB, Lund, Sweden), were scanned postoperatively and after 2, 6, 12, 26, and 52 wk using DXA. After an initial increase in bone mineral density after implantation of the bone graft substitute, bone mineral density decreased in the bone defect region throughout the 52 wk: rapidly in the first 12 wk and slower in the remaining weeks. Despite this continuous decrease, bone mineral density remained, on average, 25% higher in the operated extremity, compared with the nonoperated extremity, after 52 wk. The observed pattern of reduction in bone mineral density is consistent with the anticipated resorption of calcium sulfate within the bone graft substitute during the first 12 wk after surgery. We believe the DXA technique provides a precise method for quantification of bone graft resorption, but for evaluation of new bone formation, 3-dimensional imaging is needed.
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Affiliation(s)
- Peter Frederik Horstmann
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Werner Herbert Hettwer
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Michael Mørk Petersen
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Wu PK, Chen CF, Chen CM, Tsai SW, Cheng YC, Chang MC, Chen WM. Grafting for bone defects after curettage of benign bone tumor - Analysis of factors influencing the bone healing. J Chin Med Assoc 2018; 81:643-648. [PMID: 29789225 DOI: 10.1016/j.jcma.2017.08.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 08/02/2017] [Accepted: 08/11/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Simple bone cyst often weaken bone properties and predispose to pathological fractures, requiring tumor excision and the filling of bone defects with grafts to prevent complications. The purpose of this study was to evaluate factors potentially affecting the quality and efficiency of graft healing. METHODS This study retrospectively assessed 84 patients with simple bone cysts who had undergone tumor excision and filling of the bone defects with grafts between 2004 and 2014. Various patient-, tumor- and treatment-related factors that could potentially influence radiologic healing status and time to stable healing were evaluated. RESULTS Bone healing was not related to gender and age. Graft type was not significantly correlated with both radiologic healing status or time to stable healing. Only two of all variables evaluated were significantly correlated with the prognosis: (1) Tumors location: patients with tumors located at proximal femur were significantly more likely to achieve complete healing (Neer I) (OR = 3.2; 95%CI, 1.29-8.00; p = 0.011). (2) Tumor length: patients with a tumor length less than 6.2 cm, complete healing was nearly five times more likely to occur (OR = 4.84; 95% CI, 1.83-12.84; p = 0.002). Degree of graft filling of the bone defects affected the time to stable healing. The average healing times were 4.86 months for filling degree ≥90% and 5.94 months for filling degrees <90%, respectively (p = 0.009). Postoperative re-fracture occurred in one case. CONCLUSION Factors influencing the quality of bone healing following intralesional curettage and bone grafting are proximal femur location and tumor length. A greater degree of graft filling can contribute to higher bone healing efficiency.
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Affiliation(s)
- Po-Kuei Wu
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Orthopaedic Department, School of Medicine, National Yang- Ming University, Taipei, Taiwan, ROC
| | - Cheng-Fong Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Orthopaedic Department, School of Medicine, National Yang- Ming University, Taipei, Taiwan, ROC
| | - Chao-Ming Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Shang-Wen Tsai
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yu-Chi Cheng
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Ming-Chau Chang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Orthopaedic Department, School of Medicine, National Yang- Ming University, Taipei, Taiwan, ROC
| | - Wei-Ming Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Orthopaedic Department, School of Medicine, National Yang- Ming University, Taipei, Taiwan, ROC.
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Errani C, Tsukamoto S, Leone G, Akahane M, Cevolani L, Tanzi P, Kido A, Honoki K, Tanaka Y, Donati DM. Higher local recurrence rates after intralesional surgery for giant cell tumor of the proximal femur compared to other sites. Eur J Orthop Surg Traumatol 2017; 27:813-819. [PMID: 28589498 DOI: 10.1007/s00590-017-1983-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 05/19/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The treatment of giant cell tumor (GCT) of bone remains controversial. Intralesional surgery (curettage) results in a higher rate of local recurrence, but better functional results compared to resection. The aim of this study was to assess whether the use of curettage was successful in the treatment of GCT of long bones. We evaluated the influence of adjuvant treatment, local tumor presentation, and demographic factors on the risk of recurrence. METHODS We retrospectively reviewed the records of patients treated for GCT of long bones between 1990 and 2013, using curettage. No patient had any treatment other than surgery. After detailed curettage, the bone cavity was filled with bone allografts and/or cement. Recurrence rates, risk factors for recurrence and the development of pulmonary metastases were determined. The minimum follow-up was 24 months. RESULTS We enrolled 210 patients with GCT of long bones treated by curettage. The rate of local recurrence was 16.2% (34/210 patients). The median follow-up was 89.2 months. In the multivariate analysis, no significant statistical effect on the local recurrence rate could be identified for gender, patient's age, Campanacci's grading, or cement versus bone allografts. The only independent risk factor related to the local recurrence was the site, with a statistically significant higher risk for patients with GCT of the proximal femur. CONCLUSIONS Our observation on the correlation of tumor location and risk of local recurrence is new. We suggest that patients with GCT of bone in the proximal femur should be followed closely soon after surgery to identify any possible recurrence.
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Affiliation(s)
- Costantino Errani
- Department of Orthopaedic Surgery, Rizzoli Institute, Bologna, Italy. .,Musculoskeletal Oncology Department, Istituto Ortopedico Rizzoli, via Pupilli n1, 40136, Bologna, Italy.
| | - Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Giulio Leone
- Department of Orthopaedic Surgery, Rizzoli Institute, Bologna, Italy
| | - Manabu Akahane
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara, Japan
| | - Luca Cevolani
- Department of Orthopaedic Surgery, Rizzoli Institute, Bologna, Italy
| | | | - Akira Kido
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Kanya Honoki
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
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Gali RS, Devireddy SK, Mohan Rao N, Kishore Kumar RV, Kanubaddy SR, Dasari M, Sowjanya K, Pathapati RM. Autogenous Bone Marrow Aspirate Coated Synthetic Hydroxyapatite for Reconstruction of Maxillo-Mandibular Osseous Defects: A Prospective Study. J Maxillofac Oral Surg 2017; 16:71-78. [PMID: 28286388 DOI: 10.1007/s12663-016-0924-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 05/21/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE This prospective study was conducted to evaluate the bone regeneration capacity of synthetic hydroxyapatite mixed with autogenous bone marrow aspirate when used as a bone graft substitute in maxillo-mandibular osseous defects. METHODS This study included nine patients with histopathalogically proven benign osteolytic lesions in maxilla and mandible that were treated with enucleation or marginal resection followed by bone marrow aspirate coated synthetic biphasic hydroxyapatite (hydroxyapatite and beta tricalcium phosphate) graft placement. Incorporation of graft was assessed based on Irwin's radiologic staging. The efficacy of graft to form new bone was radiologically evaluated by observing the sequential changes of density at grafted site using gray scale level histogram which was processed in adobe photoshop 7.0 elements. Clinical assessment of recipient and donor sites was done. RESULTS Based on Irwin's radiologic staging, at 6 month follow up period, obvious incorporation of graft with new bone was observed. Sequential changes in bone density measured by gray scale histogram revealed initial resorption followed by replacement of BMA coated hydroxyapatite with new bone formation. None of the patients eventually had complications like infection, wound dehiscence, graft loss at recipient sites at 6 months follow up period. CONCLUSION Autogenous bone marrow aspirate in combination with synthetic hydroxyapatite is an effective option for accelerating bone regeneration in small to moderate sized jaw bone defects. This mixture provides all the three critical elements needed for bone regeneration (osteogenesis, osteoinduction and osteoconduction) with an added advantage of obviating donor site morbidity.
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Affiliation(s)
- Raja Sekhar Gali
- Deprtment of Oral and Maxillofacial Surgery, Narayana Dental College & Hospital, Nellore, Andhra Pradesh 524003 India
| | - Sathya Kumar Devireddy
- Deprtment of Oral and Maxillofacial Surgery, Narayana Dental College & Hospital, Nellore, Andhra Pradesh 524003 India
| | - N Mohan Rao
- Department of Pathology, Narayana Dental College & Hospital, Nellore, Andhra Pradesh 524003 India
| | - R V Kishore Kumar
- Deprtment of Oral and Maxillofacial Surgery, Narayana Dental College & Hospital, Nellore, Andhra Pradesh 524003 India
| | - Sridhar Reddy Kanubaddy
- Deprtment of Oral and Maxillofacial Surgery, Narayana Dental College & Hospital, Nellore, Andhra Pradesh 524003 India
| | - Mallikarjuna Dasari
- Deprtment of Oral and Maxillofacial Surgery, Narayana Dental College & Hospital, Nellore, Andhra Pradesh 524003 India
| | - K Sowjanya
- Deprtment of Oral and Maxillofacial Surgery, Narayana Dental College & Hospital, Nellore, Andhra Pradesh 524003 India
| | - Rama Mohan Pathapati
- Department of Clinical Pharmacology, Narayana Dental College & Hospital, Nellore, Andhra Pradesh 524003 India
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Abstract
Aneurysmal bone cysts (ABCs) are benign bone lesions arising predominantly in the pediatric population that can cause local pain, swelling, and pathologic fracture. Primary lesions, which constitute roughly two thirds of all ABCs, are thought to be neoplastic in nature, with one third of ABCs arising secondary to other tumors. Diagnosis is made with various imaging modalities, which exhibit characteristic features such as "fluid-fluid levels," although biopsy is critical, as telangiectatic osteosarcoma cannot be excluded based on imaging alone. Currently, the standard of care and most widely employed treatment is intralesional curettage. However, tumor recurrence with curettage alone is common and has driven some to propose a multitude of adjuvants with varying efficacy and risk profiles. Historically, therapies such as en bloc resection or radiation therapy were utilized as an alternative to decrease the recurrence rate, but these therapies imposed high morbidity. As a result, modern techniques now seek to simultaneously reduce morbidity and recurrence, the pursuit of which has produced preliminary study into minimally invasive percutaneous treatments and medical management.
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Erol B, Topkar MO, Aydemir AN, Okay E, Caliskan E, Sofulu O. A treatment strategy for proximal femoral benign bone lesions in children and recommended surgical procedures: retrospective analysis of 62 patients. Arch Orthop Trauma Surg 2016; 136:1051-61. [PMID: 27317344 DOI: 10.1007/s00402-016-2486-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Indexed: 01/28/2023]
Abstract
PURPOSE We aimed to develop a surgical treatment strategy for benign bone lesions of the proximal femur based upon retrospective review of our data in 62 children. METHODS Sixty-two children [38 male, 24 female; median age 9 years (range 5-18 years)] with proximal femoral benign bone lesions were surgically treated between 2005 and 2013. Histopathological diagnoses were simple (31) or aneurysmal (27) bone cysts, and nonossifying fibromas (4). The pathological fracture rate was 77.4 %. Surgical treatment was determined due to four criteria, including patient's skeletal maturity, localization and initial diagnosis of lesion, and amount of bone loss in the femoral neck and lateral proximal femur. Surgical procedure consisted of biopsy, curettage, bone grafting, and internal fixation when required. The median follow-up was 45 months (range 25-89 months). RESULTS Complete clinical recovery was achieved in 56 (90.3 %) patients between 4 and 8 months postoperatively; full weight-bearing and mobilization, without pain and limping, was possible. The median preoperative and postoperative last follow-up Musculoskeletal Tumor Society (MSTS) scores were 13.3 % (range 10-23.3 %) and 96.6 % (range 90-100 %), respectively (p < 0.0001). The pathological fractures were healed in 10 weeks on average (range 8-12 weeks). Fifty-seven (92 %) patients demonstrated complete or significant partial radiographic healing between 5 and 7 months that maintained throughout follow-up. Local recurrence was not observed, and only 1 (1.6 %) patient required reoperation for partial cyst healing. There were 5 (8 %) complications, 1 (1.6 %) of which required reoperation. CONCLUSIONS This treatment strategy can provide good local control and excellent functional and radiological results in the management of benign bone lesions of the proximal femur in children.
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Affiliation(s)
- Bulent Erol
- Orthopedics and Traumatology Department, Marmara University Hospital, Fevzi Cakmak Mh. Muhsin Yazicioglu Cd. No:10 34899 Ust Kaynarca, Pendik, Istanbul, Turkey
| | - Mert Osman Topkar
- Orthopedics and Traumatology Department, Marmara University Hospital, Fevzi Cakmak Mh. Muhsin Yazicioglu Cd. No:10 34899 Ust Kaynarca, Pendik, Istanbul, Turkey.
| | - Ahmet Nadir Aydemir
- Orthopedics and Traumatology Department, Marmara University Hospital, Fevzi Cakmak Mh. Muhsin Yazicioglu Cd. No:10 34899 Ust Kaynarca, Pendik, Istanbul, Turkey
| | - Erhan Okay
- Orthopedics and Traumatology Department, Marmara University Hospital, Fevzi Cakmak Mh. Muhsin Yazicioglu Cd. No:10 34899 Ust Kaynarca, Pendik, Istanbul, Turkey
| | - Emrah Caliskan
- Orthopedics and Traumatology Department, Marmara University Hospital, Fevzi Cakmak Mh. Muhsin Yazicioglu Cd. No:10 34899 Ust Kaynarca, Pendik, Istanbul, Turkey
| | - Omer Sofulu
- Orthopedics and Traumatology Department, Marmara University Hospital, Fevzi Cakmak Mh. Muhsin Yazicioglu Cd. No:10 34899 Ust Kaynarca, Pendik, Istanbul, Turkey
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Yang Y, Niu X, Zhang Q, Li Y. [EFFICACY OF BIOACTIVE GLASS AND ALLOGENIC BONE IN REPAIR OF BONE DEFECT AFTER BENIGN BONE TUMOR CURETTAGE]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2016; 30:675-679. [PMID: 29786274 DOI: 10.7507/1002-1892.20160137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare the healing process and clinical results of bioactive glass and allogenic bone in the repair of bone defects after benign bone tumor curettage. METHODS Between November 2011 and December 2012, 20 patients with benign bone tumor received bioactive glass and allogenic bone for repair of bone defects after benign bone tumor curettage. There were 17 males and 3 females, aged 9-68 years (median, 18.5 years). The mean course of disease was 3.3 months (range, 1-9 months). Pathological examination revealed that there were 7 cases of chondroblastoma, 5 cases of bone cyst, 2 cases of non-ossifying fibroma, 2 cases of enchondroma, 1 case of vascular tumor of bone, 1 case of lipoma of bone, 1 case of osteoid osteoma, and 1 case of chondromyxoid fibroma. The lesion located at the femur in 5 cases, at the tibia in 11 cases, at the humerus in 1 case, at the calcaneus in 2 cases, and at the talus in 1 case. The bioactive glass and allogenic cancellous bone were implanted in the cavity at the same time. The Musculoskeletal Tumor Society (MSTS) function evaluation score was used for evaluation of postoperative limb function. According to the imaging and clinical benefit, the healing processes of two kinds of implants were evaluated. The healing rate and healing time were compared. The distribution of the bioactive glass was divided into two layers: the layer close to host bone and the layer close to allogenic bone. The bone ingrowth time and bone resorption time in different layers were evaluated and compared. RESULTS All cases were followed up 12-42 months (mean, 34.5 months). All incisions healed by first intention. There were no complications of wound infection or deep infection, rejection, nonunion of bone, fracture at bone graft site, and collapsing of articular surface. There was no tumor recurrence during follow-up. The mean MSTS functional score was 29.5 (range, 28-30) at last follow-up. Complete healing was observed in 11 cases and healing in 9 cases. The healing rates of two kinds of implants were both 100%. The healing time of bioactive glass and allogenic bone was (4.7±1.3) months and (5.2±1.6) months, respectively, showing no significant difference (t=-1.240, P=0.244). The bone ingrowth time and the bone absorption time were (3.6±0.9) months and (3.7±1.0) months in the layer close to host bone and were (4.2±1.3) months and (4.2±1.3) months in the layer close to allogenic bone, all showing no significant difference (t=1.785, P=0.097; t=1.476, P=0.172). CONCLUSIONS For the repair of bone defects after benign bone tumor curettage, bioactive glass can achieve satisfactory healing result and has good safety.
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Affiliation(s)
- Yongkun Yang
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Beijing, 100035, P.R.China
| | - Xiaohui Niu
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Beijing, 100035, P.R.China
| | - Qing Zhang
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Beijing, 100035, P.R.China
| | - Yuan Li
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Beijing, 100035, P.R.China
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Tiefenboeck TM, Stockhammer V, Panotopoulos J, Lang S, Sulzbacher I, Windhager R, Funovics PT. Complete local tumor control after curettage of chondroblastoma-a retrospective analysis. Orthop Traumatol Surg Res 2016; 102:473-8. [PMID: 27067177 DOI: 10.1016/j.otsr.2016.01.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 01/20/2016] [Accepted: 01/28/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Chondroblastoma is an uncommon benign bone tumor with an incidence of 1 to 2% among all primary bone tumors. In the past, treatment for chondroblastoma has been highly variable leading to different rates of recurrences. Therefore we aimed to determine: (1) the rate of recurrence, (2) the complication rate, (3) and functional outcome after intralesional curettage of chondroblastoma. HYPOTHESES Intralesional curettage with high speed burring and packing can avoid local recurrences. PATIENTS AND METHODS Experiences of 22 patients with chondroblastoma of the bone were retrospectively reviewed. The patient group consisted of 16 men; 6 women; mean age 24years (range; 12-58years) affecting in 15 the lower- (68%) and in seven the upper extremity (32%). RESULTS There was no local recurrence or malignant transformation. All patients underwent intralesional curettage, followed by defect filling presenting in 19 patients (87%) excellent clinical and oncological results (mean MSTS 98.9). Complications were seen in two patients. Pain was the main revealing symptom of the chondroblastoma (n=16, 73%). Mean follow-up of all patients was 114months (range, 25 to 480months). DISCUSSION Aggressive curettage and packing provided excellent local tumor control and functional results in our patients with chondroblastoma. Malignant transformation is extremely rare, however, present in literature but was not seen in any of our patients. LEVEL OF EVIDENCE Level IV, retrospective study.
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Bumpass DB, Park A, Hill KT, Huang J, Friedman MV, Zebala LP. Eosinophilic granuloma of the sacrum treated with radiation therapy: a case report. Spine J 2016; 16:e53-7. [PMID: 26386170 DOI: 10.1016/j.spinee.2015.09.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 09/11/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Eosinophilic granulomas (EGs) of the sacrum have been reported in fewer than 10 patients. Treatment algorithms for these tumors remain poorly defined; there are no reports of treating solitary sacral EG with radiation therapy (RT). PURPOSE This study aimed to describe the presentation, treatment, and outcome of sacral EG in an adult patient with intractable pain and radiculopathy, treated in a novel fashion with RT. STUDY DESIGN/SETTING The study design was a case report from a tertiary cancer referral center. METHODS Patient records, imaging, and pathology were reviewed. RESULTS A 35-year-old man received 20 Gy of radiation to his S1 EG lesion. He subsequently developed vertebra plana of S1 causing symptomatic L5-S1 stenosis, but 15 months after RT treatment was free of pain or tumor recurrence. CONCLUSION Radiation therapy is an effective treatment option for sacral EG causing severe axial pain and neural impingement.
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Affiliation(s)
- David B Bumpass
- Department of Orthopaedic Surgery, Washington University, 660 S. Euclid Ave, Campus Box 8233, St. Louis, MO 63110, USA.
| | - Andrew Park
- Department of Orthopaedic Surgery, Washington University, 660 S. Euclid Ave, Campus Box 8233, St. Louis, MO 63110, USA
| | - Kirk T Hill
- Department of Pathology, Washington University, 660 S. Euclid Ave, Campus Box 8118, St. Louis, MO 63110, USA
| | - Jiayi Huang
- Department of Radiation Oncology, Washington University, 660 S. Euclid Ave, Campus Box 8224, St. Louis, MO 63110, USA
| | - Michael V Friedman
- Mallinckrodt Institute of Radiology, Washington University, 660 S. Euclid Ave, Campus Box 8131, St. Louis, MO 63110, USA
| | - Lukas P Zebala
- Department of Orthopaedic Surgery, Washington University, 660 S. Euclid Ave, Campus Box 8233, St. Louis, MO 63110, USA
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Shin DH, Oh CS, Kim YS, Kim Y, Oh SW, Park JB, Lee IS, Kim MJ. Bone tumors in pre-modern skulls from human skeletal series of Joseon Dynasty. Anat Cell Biol 2015; 48:213-7. [PMID: 26417482 PMCID: PMC4582165 DOI: 10.5115/acb.2015.48.3.213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 05/01/2015] [Accepted: 05/26/2015] [Indexed: 11/27/2022] Open
Abstract
To date, there are still very few reports on benign-tumor cases based on East Asian skeletal series, even though other regions and continents have been well represented. In our study on the Joseon Human Skeletal Series, we identified benign bone tumors in two skeletons (cases Nos. 75 and 96). Our radiological analyses showed both cases to be homogeneous sclerotic bone masses aligned with the cranial vault suture. In a subsequent series of differential diagnoses, we determined both cases to be osteoma, the most common bone-tumor type reported for archaeological samples. Our study is the osteoarchaeological basis for this, the first-ever report on benign bone neoplasm in a pre-modern East Asian population.
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Affiliation(s)
- Dong Hoon Shin
- Bioanthropology and Paleopathology Laboratory, Department of Anatomy, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Seok Oh
- Bioanthropology and Paleopathology Laboratory, Department of Anatomy, Seoul National University College of Medicine, Seoul, Korea
| | - Yi-Suk Kim
- Department of Anatomy, Ewha Womans University School of Medicine, Seoul, Korea
| | - Yusu Kim
- Bioanthropology and Paleopathology Laboratory, Department of Anatomy, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Whan Oh
- Hangang Institute of Cultural Heritage, Seoul, Korea
| | - Jun Bum Park
- Special Duty Professor for Archaeology, Industry Academic Cooperation Foundation of Sangmyung University, Cheonan, Korea
| | - In Sun Lee
- Department of Radiology, Seoul National University Hospital, Seongnam, Korea
| | - Myeung Ju Kim
- Paleopathology Laboratory, Department of Anatomy, Dankook University College of Medicine, Cheonan, Korea
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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.
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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
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Mors M, Cervantes SS, Hinni M. Bizarre parosteal osteochondromatous proliferation presenting in the nasal dorsum. J Oral Maxillofac Pathol 2015; 19:109. [PMID: 26097325 PMCID: PMC4451655 DOI: 10.4103/0973-029x.157225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 03/21/2015] [Indexed: 11/21/2022] Open
Abstract
We present the first bizarre parosteal osteochondromatous proliferation (BPOP) in the nasal dorsum. These lesions have been described since 1983; however, the vast majority of these lesions do not present in the head and neck, although five cases exist in the literature. An understanding of the potential sites for bizarre paraosteal osteochondromatous proliferations will help lead to successful diagnosis and proper treatment.
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Affiliation(s)
- Matthew Mors
- Department of Otolanryngolog-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Santino S Cervantes
- Department of Otolanryngolog-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Michael Hinni
- Department of Otolanryngolog-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
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Inai R, Shinya T, Tada A, Sato S, Fujiwara T, Takeda K, Kunisada T, Yanai H, Ozaki T, Kanazawa S. Diagnostic value of Thallium-201 scintigraphy in differentiating malignant bone tumors from benign bone lesions. Ann Nucl Med 2015; 29:674-81. [PMID: 26036991 DOI: 10.1007/s12149-015-0990-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 05/24/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This retrospective study aims to evaluate the diagnostic capacity of thallium-201 (201Tl) scintigraphy for differentiating malignant bone tumors from benign bone lesions. METHODS Between January 2006 and December 2012, 279 patients with bone lesions (51 malignant and 228 benign) underwent 201Tl scintigraphy before treatment. To evaluate 201Tl uptake, we investigated tumor-to-background contrast (TBC) as well as TBC washout rate (WR). The differences of TBC on early and delayed images and WR were estimated by the Mann-Whitney U test. Receiver operating characteristic (ROC) analyses were used to determine the cut-off TBC values for differentiating malignant bone tumors from benign bone lesions. RESULTS There were statistically significant differences in median TBC between malignant tumors and benign lesions. These differences occurred for early imaging (1.57 vs. 0.09, p < 0.001) as well as for delayed imaging (0.83 vs. 0.07, p < 0.001). However, there was no statistical difference in WR between malignant tumors and benign lesions (44 vs. 43 %, NS). The chosen TBC cut-off value was 0.68 for early imaging and 0.38 for delayed imaging. Using these cut-off values, the prediction of malignancy had a 77 % sensitivity, 74 % specificity, and 75 % accuracy for early imaging and an 80 % sensitivity, 76 % specificity, and 77 % accuracy for delayed imaging. CONCLUSIONS 201Tl scintigraphy may have the ability to distinguish malignant bone tumors from benign bone lesions.
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Affiliation(s)
- Ryota Inai
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikatacho, Kita-ku, Okayama, Okayama, 700-8558, Japan.
| | - Takayoshi Shinya
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikatacho, Kita-ku, Okayama, Okayama, 700-8558, Japan
| | - Akihiro Tada
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikatacho, Kita-ku, Okayama, Okayama, 700-8558, Japan
| | - Shuhei Sato
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikatacho, Kita-ku, Okayama, Okayama, 700-8558, Japan
| | - Tomohiro Fujiwara
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Ken Takeda
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Toshiyuki Kunisada
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Hiroyuki Yanai
- Department of Pathology, Okayama University Hospital, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikatacho, Kita-ku, Okayama, Okayama, 700-8558, Japan
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Abstract
BACKGROUND The commonly used reconstructive options after post resection defects in bone tumors like megaprosthesis, autograft, allograft, bone graft substitutes and recycled bone have their own demerits on a long term. Bone transport that regenerates patient's own bone is a less explored option of reconstruction after resection of benign bone tumors and reports on this are limited. This technique is very much relevant in tibia where Ilizarov fixator is surgeon and patient friendly. We report our experience. MATERIALS AND METHODS This is a retrospective series of resection and bone transport in 38 patients with benign tumor of tibia. There were 14 males and 24 females with mean age of 23.40 years (range 9-40 years). Lesion was located in proximal third tibia in 27, middle third in two and distal third in nine patients. The diagnosis was giant cell tumor in 32, chondroblastoma in three, chondromyxoid fibroma, enchondroma and desmoplasic fibroma in one patient each. The resection was intercalary in 28 and transarticular in 10 patients. Osteosynthesis was monofocal in three, bifocal in 31 and polyfocal in four cases. RESULTS Mean followup was 7.22 years (range 1.5-15 years). Mean resection length was 10.21 cm (range 3-22 cm). The mean duration of external fixator was 308.03 days (range 89-677 days) and mean external fixator index was 36.14 days/cm (range 16.84-97.43 days/cm). Twelve patients had difficulties in the form of 11 problems and five obstacles that were successfully managed. None of the patients had local recurrence of tumor or any long term complication. Mean Musculo-skeletal Tumour Society score at final followup was 27.18 (90.60%). CONCLUSIONS Bone transport is an excellent option after resection of benign tumors of tibia with good local control and functional outcome, despite minor difficulties that need timely management.
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Affiliation(s)
- Dmitry Y Borzunov
- Department No. 4, Russian Ilizarov Scientific Centre “Restorative Traumatology and Orthopaedics”, 6, Kurgan, 640014, Russia,Address for correspondence: Dr. Dmitry Y Borzunov, Russian Ilizarov Scientific Centre, No. 6, M. Ulianova Street, Kurgan - 640 014, Russia. E-mail:
| | - Pavel I Balaev
- Department of No. 15, Russian Ilizarov Scientific Centre “Restorative Traumatology and Orthopaedics”, 6, Kurgan, 640014, Russia
| | - Koushik N Subramanyam
- Department of Orthopaedics, Sri Sathya Sai Institute of Higher Medical Sciences, Prasanthigram, Puttaparthi, Andhra Pradesh, India
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Raux S, Abelin-Genevois K, Canterino I, Chotel F, Kohler R. Osteoid osteoma of the proximal femur: treatment by percutaneous bone resection and drilling (PBRD). A report of 44 cases. Orthop Traumatol Surg Res 2014; 100:641-5. [PMID: 25217029 DOI: 10.1016/j.otsr.2014.05.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 04/09/2014] [Accepted: 05/02/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Osteoid osteoma is a benign osteogenic tumor that is mainly located in the lower limbs. According to Campanacci the proximal femur is involved in 25% of cases. We present a series of 44 cases of osteoid osteoma located in the neck of the femur or the lesser trochanter treated by the minimally invasive method, CT-guided percutaneous bone resection and drilling (PBRD). MATERIALS AND METHODS This series included 44 patients, 20 girls and 24 boys, treated between 1987 and 2012. The average age at surgery was 12.7 years old (range 4-34). The diagnosis was based on the "association" of scintigraphy (hyperfixation) - CT scan (nidus located on the femoral neck or near the lesser trochanter). These patients underwent CT-guided PBRD under general anesthesia. Specific ancillary material was used to reach and remove the nidus and a cylinder of bone was sent to the pathologist for assessment. A lateral or anterior approach was used in all cases except one in which a posterior incision was made. Histological confirmation was obtained in 23 cases (the bone fragment was damaged in 21 cases). RESULTS Forty-two patients were reviewed after a minimum follow-up of one year (12-56 months). Two patients were lost to follow-up. Results were evaluated clinically and on CT scan 1 year after surgery: there were 35 cures with complete and permanent pain relief. There were 5 failures and 1 case of recurrence requiring a second CT-guided PBRD procedure as well 2 complications involving femoral fracture (one associated with failure). DISCUSSION The proximal femur is a common location of osteoid osteoma. Treatment requires careful preoperative planning to determine the surgical approach for safe removal. PBRD is a minimally invasive technique, allowing complete resection with suitable ancillary equipment. This method should be compared with thermoablation, which is a similar technique. CONCLUSION CT-guided PBRD is a therapeutic option in case of osteoid osteoma of the proximal femur. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- S Raux
- Service d'orthopédie pédiatrique, hôpital Femme Mère Enfant, hospices civils de Lyon, université Lyon 1, 59, boulevard Pinel, 69677 Bron cedex, France
| | - K Abelin-Genevois
- Service d'orthopédie pédiatrique, hôpital Femme Mère Enfant, hospices civils de Lyon, université Lyon 1, 59, boulevard Pinel, 69677 Bron cedex, France
| | - I Canterino
- Service d'imagerie pédiatrique, hôpital Femme Mère Enfant, hospices civils de Lyon, université Lyon 1, 59, boulevard Pinel, 69677 Bron cedex, France
| | - F Chotel
- Service d'orthopédie pédiatrique, hôpital Femme Mère Enfant, hospices civils de Lyon, université Lyon 1, 59, boulevard Pinel, 69677 Bron cedex, France
| | - R Kohler
- Service d'orthopédie pédiatrique, hôpital Femme Mère Enfant, hospices civils de Lyon, université Lyon 1, 59, boulevard Pinel, 69677 Bron cedex, France.
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Abstract
Background This study was conducted to examine the clinical usefulness and efficacy of endoscopic curettage on benign bone tumor. Methods Thirty-two patients (20 men and 12 women) with benign bone tumor were included in the study. The patients were aged between five and 76 years; the mean follow-up period was 27.05 months (range, 9.6 to 39.9 months). The primary sites include simple bone cyst (9 cases), fibrous dysplasia (6 cases), enchondroma (5 cases), non-ossifying fibroma (4 cases), bone infarct (3 cases), aneurysmal bone cyst (1 case), chondroblastoma (1 case), osteoblastoma (1 case), intraosseous lipoma (1 case), and Brodie abscess (1 case). A plain radiography was performed to assess the radiological recovery. Radiological outcomes, including local recurrence and bone union, were evaluated as excellent, good, poor, and recurred. Results In our series, there were 27 cases (84.4%) of good or better outcomes, six cases (18.8%) of complications (4 local recurrence, 1 wound infection, and 1 pathologic fracture). Conclusions Our results showed that endoscopic curettage and bone graft had a lower rate of recurrence and a higher cure rate in cases of benign bone tumor. It can, therefore, be concluded that endoscopic curettage and bone graft might be good treatment modalities for benign bone tumors.
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Affiliation(s)
- Young Choi
- Department of Orthopaedic Surgery, Kosin University Gospel Hospital, Busan, Korea
| | - Jae Man Kwak
- Department of Orthopaedic Surgery, Kosin University Gospel Hospital, Busan, Korea
| | - So Hak Chung
- Department of Orthopaedic Surgery, Kosin University Gospel Hospital, Busan, Korea
| | - Gu Hee Jung
- Department of Orthopaedic Surgery, Kosin University Gospel Hospital, Busan, Korea
| | - Jae Do Kim
- Department of Orthopaedic Surgery, Kosin University Gospel Hospital, Busan, Korea
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Gouin F, Dumaine V. Local recurrence after curettage treatment of giant cell tumors in peripheral bones: retrospective study by the GSF-GETO (French Sarcoma and Bone Tumor Study Groups). Orthop Traumatol Surg Res 2013; 99:S313-8. [PMID: 23978709 DOI: 10.1016/j.otsr.2013.07.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Curettage is a well-established treatment modality for giant cell tumors of bone. The purpose of this retrospective study by the French Sarcoma and Bone Tumor Study Groups (GSF-GETO) was to analyze various tumor-specific and surgery-specific factors that could influence the rate of local recurrence. PATIENTS AND METHOD Data was collected from patients with giant cells tumors of the appendicular skeletal who were treated by intralesional curettage. The hazard ratio for tumor recurrence was calculated for the different variables collected and a multifactorial analysis carried out. RESULTS One hundred and ninety-three surgical procedures were included from nine centers. One hundred and seventy-one (89%) were primary tumors and 22 had been referred after one or more recurrences. The mean follow-up was 6 years and 11 months. The distal femur and proximal tibia were the most common locations: 42.5 and 34.2% of cases, respectively. The bone defect after curettage was filled in 176 cases (91.2%) and left empty in 16 cases. Local adjuvant treatment (phenol, alcohol, cryotherapy or combination treatment) was used in 39 cases (20.2%) and systemic adjuvant treatment used in 24 cases (calcitonin 11 and zoledronic acid 13). Local recurrence occurred in 71 cases (36.8%). Risk factors for local recurrence were an empty defect, a defect filled with autograft, and patients treated before 2005. Multivariate analysis showed that the only risk factors for local recurrence were a surgical procedure before 2005 (odds ratio 3.6 (95% CI: 1.2, 7.9) P=0.017) and a bone defect filled with autograft (odds ratio 3.9 [95% CI: 1.3, 11.6] P=0.013) CONCLUSION: Neither tumor-specific nor surgery-specific factors such as adjuvant treatment were found to be as risk factors for local recurrence after curettage of giant cell tumors in the appendicular skeleton. As recently reported, high-quality local curettage is probably the most effective technique to prevent local recurrence. The current study suggests that two factors associated with more recent management of these tumors in France, high-speed burring and centralization to skilled surgical teams, can improve the quality of curettage. LEVEL OF EVIDENCE 4, retrospective cohort study.
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Affiliation(s)
- F Gouin
- Clinique chirurgicale orthopédique et traumatologique, CHU Hôtel-Dieu, Nantes, France; Inserm UI 957, laboratoire de la résorption osseuse et des tumeurs osseuses primitives (LROP), faculté de médecine de Nantes, Nantes, France.
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Abstract
BACKGROUND Synthetic bio-inert materials are currently used as an alternative to autogenous bone graft. Calcium hydroxyapatite (HA) and Beta tri-calcium phosphate (beta-TCP), which belong to the calcium phosphate ceramics group, are biocompatible and osteo-conductive. The purpose of this study is to analyse the use of HA and beta-TCP in their ceramic forms as a bone graft substitute in filling bone voids after curettage of benign bone tumors. MATERIALS AND METHODS Twenty-four patients in the age range of 3.5-55 years (mean 14.3 years) having benign bone tumors with bone defects were filled with bone graft substitute following curettage. In 20 patients bone defects were filled with block/granules of HA ceramic and in four with beta-TCP. Fibular strut graft was packed with HA in four patients. The patients were followed up for an average of 18 months (range 12-36 months). RESULTS The functional status of the patients at follow-up was evaluated and compared with preoperative functional status. Early incorporation of graft substitutes became evident radiologically between 6 and 10 weeks (Stage I). Complete incorporation (Stage III) was observed in an average of nine months (6-18 months). Clinical healing was observed before radiological healing. The average time taken to return to preoperative function was 14 weeks. There was no recurrence of lesion or growth retardation. CONCLUSION Calcium hydroxyapatite and beta-TCP are excellent bone graft substitutes for autogenous bone graft in filling voids after curettage of benign bone tumors.
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Affiliation(s)
- KC Saikia
- Department of Orthopedics, Guwahati Medical College and Hospital, Guwahati, Assam, India,Correspondence: Dr. KC Saikia, Rajgarh Link Road, Anil Nagar, Bylane-5, House No.7, Guwahati - 781 007, Assam, India. E-mail:
| | - TD Bhattacharya
- Department of Orthopedics, Guwahati Medical College and Hospital, Guwahati, Assam, India
| | - SK Bhuyan
- Department of Orthopedics, Guwahati Medical College and Hospital, Guwahati, Assam, India
| | - DJ Talukdar
- Department of Orthopedics, Guwahati Medical College and Hospital, Guwahati, Assam, India
| | - SP Saikia
- Department of Orthopedics, Guwahati Medical College and Hospital, Guwahati, Assam, India
| | - P Jitesh
- Department of Orthopedics, Guwahati Medical College and Hospital, Guwahati, Assam, India
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