Cross-beam Non-vascular Fibular Graft Reconstruction in the Management of Long Bone Giant Aneurysmal Bone Cyst – A Case Series

Abstract

Introduction: Aneurysmal bone cyst (ABC) is a benign expansile osteolytic lesion, characterized by a blood-filled cavity in the bone. Giant ABC (GABC) is an uncommon condition due to the delayed presentation of an ABC that is difficult to handle when it occurs in long weight-bearing bones due to its aggressive nature. The common treatment relies on total resection of tumor with reconstruction of the resultant defect. Case Report: We present the results of 5 cases of GABCs of long bones managed with non-vascularized fibular graft in a cross-beam fashion along with internal fixation. All patients achieved complete consolidation of the lesion by 12 months along with full incorporation of the graft with good-excellent musculoskeletal tumor society scores. None of the patients had recurrence/pathological fracture till 2 years of follow-up. Conclusion: We suggest the method of using a non-vascularized fibula graft in a cross-beam fashion to reconstruct the void from the resection of long-bone GABC as a safe, reliable technique with excellent functional and radiological results. Keywords: Giant Aneurysmal Bone Cyst, Fibular Graft, Resection, Recurrence, Reconstruction

Pathological Fractures in Aneurysmal Bone Cysts: A Systematic Review

“…In our analysis, we reported similar percentages, with the exception of spine localization being less frequent compared to the literature. They typically manifest with pain and swelling, while, to a lesser extent, they may be associated with pathological fractures in about 8% of cases [5].…”

“…ABCs represent 9.1% of all bone tumors [4]. The most frequent localizations are lower limbs (50-60%), with tibia representing almost 40% of the cases [5], the spine is involved in almost 15% of the cases and the pelvis in 9% [1]. Typically, ABCs are located near the metaphysis, adjacent to the physis region, and eccentrically [6].…”

“…Pathologic fracture occurs in about 8% of ABCs, but the incidence may be as high as 21% in ABCs that have spinal involvement [5]. A pathological fracture is caused by minor trauma that typically cannot cause a bone fracture in healthy bone.…”