Pathological fracture of a solitary bone cyst in the calcaneus: a case series and literature review

Hoshi, Manabu; Iwai, Tadashi; Oebisu, Naoto; Shimatani, Akiyoshi; Takada, Naoki; Nakamura, Hiroaki

doi:10.1007/s00402-021-04202-6

Cited by 3 publications

(2 citation statements)

References 25 publications

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“…Primary bone tumors, whether benign or malignant, can cause pathological fractures ( 1 , 2 ). In particular, cystic bone tumors in the long bones of the extremities are prone to pathological fractures ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Oncological and functional outcomes of pathological fractures of lower extremities in patients with malignant bone tumors

Hashimoto,

Nishimura,

Ito

et al. 2024

Mol Clin Oncol

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As managing pathological fractures of the extremities can be difficult, the present study aimed to present a treatment algorithm for lower extremity bone malignancies. A total of 38 patients with impending and pathological fractures were treated at the Department of Orthopedic Surgery in Kindai University Hospital. Age, sex, fracture site, type of primary malignancy, number of metastases, pre-fracture Eastern Cooperative Oncology Group performance status (ECOG-PS) score, adjuvant therapy, treatment modality, operative time, blood loss, postoperative complications, Musculoskeletal Tumor Society (MSTS) score, outcomes, follow-up period and the MSTS scores and ECOG-PS were compared in cases of primary malignant tumors and those cases of metastatic malignant tumors were retrospectively surveyed. Post-treatment MSTS scores in cases of impending and pathological fractures were compared between intramedullary nail fixation and non-intramedullary nail fixation procedures. Disease sites included the sub-trochanteric femur in 10 patients, trochanteric femur in 8, femoral diaphysis in 7, femoral neck in 5, bilateral trochanteric femur in 3, proximal tibia in 3 and distal femur in 2 patients. A total of 10 patients had metastases between 3-20 sites. The median pre-fracture ECOG-PS score was 1. Adjuvant radiotherapy was administered to 5, chemotherapy to 8 and radiotherapy with chemotherapy to 10 patients. Surgical procedures included intramedullary nails in 18 patients, tumor arthroplasty in 4, plate fixation in 3, artificial head replacement in three, compression hip screw (CHS) in 3, conservative treatment in 2, bilateral intramedullary nail fixation in 2 and artificial bone stem with combined intramedullary nail and plate fixation, right-sided artificial head replacement and left-sided CHS in 1 patient each. The MSTS score was 19.9±8.95 for intramedullary nail fixation and 24.3±7.45 for other procedures, with a negative association between the MSTS score and pre-fracture ECOG-PS. The median follow-up period was 8 months. The outcomes were as follows: Alive with disease, 23 patients; continued disease-free, 1 patient; and dead due to disease, 14 patients. The 1-year postoperative overall survival rate was 60.5%. Moreover, the group with metastatic malignant tumors, which had significantly worse ECOG-PS, had significantly lower MSTS scores than the group with primary malignant tumors. The authors' treatment algorithm for malignant bone tumors of the lower extremity was shown to be useful.

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Section: Introductionmentioning

confidence: 99%

Oncological and functional outcomes of pathological fractures of lower extremities in patients with malignant bone tumors

Hashimoto,

Nishimura,

Ito

et al. 2024

Mol Clin Oncol

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“…However, they are diagnosed as an incidental finding in approximately 30% of cases [ 13 , 14 , 15 ]. In addition to pain, the risk of pathological fracture is another indication for surgical treatment [ 14 , 16 ]. According to the criteria established by Pogoda et al, the risk of a pathological fracture is increased when the cyst occupies 100% of the mediolateral cross-section in the coronary plane and more than 30% in the sagittal plane.…”

Section: Introductionmentioning

confidence: 99%

Allogenic Cancellous Bone versus Injectable Bone Substitute for Endoscopic Treatment of Simple Bone Cyst and Intraosseous Lipoma of the Calcaneus and Is Intraosseous Lipoma a Developmental Stage of a Simple Bone Cyst?

Toepfer

Strässle

Lenze

et al. 2023

JCM

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Simple bone cysts (SBCs) and intraosseous lipoma (IOL) of the calcaneus are rare tumor entities that are primarily diagnosed due to unspecific heel pain, incidental findings, or rarely due to pathological fractures. Compared to traditional open tumor resections, endoscopic resection of these benign tumors aims to minimize surgical morbidity and maximize surgical efficiency without compromising safety. Grafting is regularly performed to reduce the risk of recurrence and stimulate osseous consolidation of the lytic lesion. As the incidence is low and treatment strategies are heterogeneous, there is no clear consensus for the treatment of simple cysts or intraosseous lipomas of the calcaneus. The objectives of this study are (a) to present medium to long-term results after endoscopic resection and grafting with allogenic cancellous bone or bioresorbable hydroxyapatite and calcium sulfate cement, and (b) to add further evidence to the discussion of whether calcaneal SBC and IOL are the same entity at different developmental stages. Between 2012 and 2019, a total of 25 benign bone tumors consisting of 17 SBCs and 8 IOLs were treated by A.T. with endoscopic resection and grafting, comprising the largest cohort to date. For grafting, 12 patients received allogenic cancellous bone (group A) and 13 patients received injectable bone substitute (group B). Pre- and postoperative imaging using plain X-rays and MRI was retrospectively analyzed with a mean follow-up time of 24.5 months to assess tumor size, osseous consolidation (modified Neer classification), and tumor recurrence. A retrospective chart analysis focusing on adverse intra- and perioperative events and other complications associated with the surgical procedure was performed using the modified Clavien–Dindo classification (CD1-3). A total of 12/13 cases with allogenic bone grafting showed a Neer Type 1 osseous healing of the tumorous lesion after endoscopic resection, whereas only 5/11 cases with injectable bone substitute showed sufficient healing (types 1 and 2). There were three recurrent cysts (Neer 4) and two persistent cysts (Neer 3) after using injectable bone substitute. Two CD1 complications were observed in group A (prolonged wound drainage, sural neuritis) and eight complications were observed in group B (6× CD1, 2× CD3). At least two IOLs diagnosed preoperatively using MRI were ultimately identified as SBCs upon histopathologic examination. Allogenic cancellous bone grafting after endoscopic resection of calcaneal SBC or IOL showed a very low rate of complications and no tumor recurrence in our series. On the other hand, depending on the material used, injectable bone substitute showed a high rate of “white-out” (excessive drainage), resulting in multiple complications such as prolonged wound healing, insufficient permanent defect filling, recurrence, and revision surgery. Over time, calcaneal SBC may transform into IOL, exhibiting distinct features of both entities simultaneously during ossoscopy and histopathological analysis.

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Oncological and functional outcomes of pathological fractures of lower extremities in patients with malignant bone tumors

Hashimoto,

Nishimura,

Ito

et al. 2024

Preprint

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Background: Managing pathological fractures of the extremities can be difficult. We aimed to suggest our treatment algorithm for lower bone malignancies. Methods: Thirty-eight patients with impending and pathological fractures treated at our department were included. Age, sex, fracture site, type of primary malignancy, number of metastases, pre-fracture Eastern Cooperative Oncology Group performance status (ECOG-PS) score, adjuvant therapy, treatment modality, operative time, blood loss, postoperative complications, Musculoskeletal Tumor Society (MSTS) score, outcomes, and follow-up period were retrospectively surveyed. Post-treatment MSTS scores in cases of impending and pathological fractures were compared. The MSTS scores were compared between intramedullary nail fixation and surgical procedures other than intramedullary nail fixation. The postoperative 1-year survival rate was calculated using the Kaplan–Meier method. Results: The median age of the sample was 68 years. The disease sites were the subtrochanteric femur in 10 patients, the trochanteric femur in eight, the femoral diaphysis in seven, the femoral neck in five, the bilateral trochanteric femur in three, the proximal tibia in three, and the distal femur in two. Ten patients had metastases in ≤3 and 20 sites. The median pre-fracture ECOG-PS score was 1. As adjuvant chemotherapy, radiotherapy was administered to five, chemotherapy to eight, and radiotherapy and chemotherapy to 10 patients. Surgical procedures included intramedullary nails in 18 patients; tumor arthroplasty in four; plate fixation in three; artificial head replacement in three; compression hip screw (CHS) in three; conservative treatment in two; bilateral intramedullary nail fixation in two; and artificial bone stem with combined intramedullary nail and plate fixation, right-sided artificial head replacement, and left-sided CHS in one each. The operating time was 100±45.8 minutes, and blood loss was 63±153.4 mL. The MSTS score was 19.9±8.95 for intramedullary nail fixation and 24.3±7.45 for other procedures, with a negative correlation between the MSTS score and pre-fracture ECOG-PS. The median follow-up period was 8 months. The outcomes were as follows: alive with disease, 23 patients; continued disease-free, 1 patient; and dead due to disease, 14 patients. The 1-year postoperative overall survival rate was 60.5%. Conclusions: Our treatment algorithm for malignant bone tumors of the lower extremity was useful.

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Pathological fracture of a solitary bone cyst in the calcaneus: a case series and literature review

Cited by 3 publications

References 25 publications

Oncological and functional outcomes of pathological fractures of lower extremities in patients with malignant bone tumors

Oncological and functional outcomes of pathological fractures of lower extremities in patients with malignant bone tumors

Allogenic Cancellous Bone versus Injectable Bone Substitute for Endoscopic Treatment of Simple Bone Cyst and Intraosseous Lipoma of the Calcaneus and Is Intraosseous Lipoma a Developmental Stage of a Simple Bone Cyst?

Oncological and functional outcomes of pathological fractures of lower extremities in patients with malignant bone tumors

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