Review of 16 cases of aneurysmal bone cyst in the proximal femur treated by extended curettage and cryosurgery with reconstruction using autogenous nonvascularized fibula graft

Abstract

Background: Aneurysmal bone cyst (ABC) is an aggressive benign lesion that may sometimes be difficult to treat. Lesions that occur in the proximal femur require to be addressed aggressively because of the high rate of local recurrence and the risk of fracture. Few articles report the experience of management of ABC in the proximal femur. This location presents a surgical challenge due to its anatomical and biomechanical peculiarity. Methods: We retrospectively reviewed 16 cases with ABC in the proximal femur that were treated in our institution between 2005 and 2014, utilizing extended curettage and liquid nitrogen as adjuvant therapy and reconstruction using nonvascularized autogenous fibular strut graft. The mean follow-up period was 50.5 months. Five cases presented as recurrent cases, while four cases presented with pathological fractures. Results: The functional score ranged from 70 to 90 on modified Musculoskeletal Tumor Society score with a mean score of 81.25, which is considered to be excellent function. Time for graft incorporation ranged from 10 to 12 weeks. One case got local recurrence, and one case got early surgical site infection. Conclusions: Extended curettage and cryotherapy represent a recommended approach for management of ABC in the proximal femur with favorable results.

Efficacy of treatment interventions for primary aneurysmal bone cysts: a systematic review

“…Four retrospective cohort studies investigating differences between alternative surgical approaches 17 , 18 , 30 , 31 and one RCT comparing curettage to percutaneous sclerotherapy were included. 20 A total of 18 studies reported on surgical treatment methods 11 , 13 , 16 - 18 , 20 , 30 - 41 and 12 studies reported on percutaneous injection-based therapies. 8 , 19 , 20 , 42 - 50 One included study reported outcomes for two subjects treated with radiation therapy.…”

“…Surgical treatment mostly consisted of curettage with or without mechanical burring, 11 , 13 , 16 - 18 , 20 , 30 , 33 , 35 , 37 , 41 bone/bone substitute grafting, 11 , 13 , 16 - 18 , 20 , 30 , 31 , 33 , 34 , 36 - 39 , 41 cauterization, 31 , 38 argon beam coagulation, 16 , 33 , 34 phenol, 16 , 17 , 33 , 38 polymethyl methacrylate (PMMA), 11 , 17 , 31 cryosurgery, 13 , 41 hydrogen peroxide, 33 , 38 preoperative embolization, 11 , 38 and internal fixation. 11 , 13 , 30 , 35 Treatment heterogeneity was often observed with a variety of different adjuvant treatments being used within a single series.…”

Clinical observation of mineralized collagen bone grafting after curettage of benign bone tumors

“…However, the donor sites of children and adolescents with benign bone tumors are very limited, excessive bone removal can lead to fracture of the donor site [ 21 ]. Besides common donor site complications, bone extraction of children and adolescents may damage epiphysis, thereby affecting physiological growth and development of the bone [ 22 ]. Adding new surgical sites, prolonging operation time, increasing bleeding, increasing operation risk and complications of the donor site are also the shortcomings of the autogenous bone.…”

Aggressive lytic lesion of lesser trochanter proximal femur in an eighteen year old male - A case report

“…Although first described in 1942 by Jaffe and Lichtenstein, the true aetiology and optimum line of treatment is still unknown. [1][2][3] The incidence in the general population is 0.14/100,000 inhabitants with the peak incidence recorded in the second decade of life typically affecting the metaphysis of long bones. [1][2][3] Although considered benign, radiologically it can be locally aggressive.…”

“…[1][2][3] The incidence in the general population is 0.14/100,000 inhabitants with the peak incidence recorded in the second decade of life typically affecting the metaphysis of long bones. [1][2][3] Although considered benign, radiologically it can be locally aggressive. 2,4 ABC can be either primary or secondary to other underlying pathologies which adds to the challenge in ABC diagnosis.…”