Treatment of the Femoral Neck and Trochanteric Benign Lesions

Successful treatment of solitary intraosseous haemangioma of the femoral neck

“…This was despite the fact that the proximal femur is one of the most common locations for bony benign lesions. (6) Kaleem et al conducted a literature review of solitary IOH of the extremities in 2000. (2) In that review, the authors yielded a large group of cases (n = 34) in which substantial clinical, radiological and histological details were provided, but none of the cases involved the proximal femur.…”

“…(2,10) If the lesion is large and causes weakening of the bony framework (thus rendering impending or actual pathological fracture), surgical treatment is frequently indicated. (6) For lesions involving the articular surface of the femoral head, resection and reconstruction with hip endoprosthesis is often required. (7,11) If the lesion involves the femoral neck or intertrochanteric area with a risk of impending pathological fracture, but preservation of the hip articular surface is possible, curettage and bone grafting with application of an internal fixation device is preferred and has been described with excellent outcomes in previous studies.…”

“…(7,11) If the lesion involves the femoral neck or intertrochanteric area with a risk of impending pathological fracture, but preservation of the hip articular surface is possible, curettage and bone grafting with application of an internal fixation device is preferred and has been described with excellent outcomes in previous studies. (6,12,13) For bone grafting, cortical bone grafts such as fibular cortical strut grafts are favoured, as they work as a mechanical strut and biological bone graft. The choice between autogenous or allogenous cortical grafts depends on multiple factors.…”

“…Autogenous cortical grafts are superior to allografts in their rate and completeness of incorporation; this is especially the case for large solitary lesions. (6) The drawbacks include donor site morbidity and limited supply. (14) Allografts, on the other hand, offer the advantages of reduced rate of graft resorption, no donor site morbidity and wide availability; however, they may have a higher rate of infection, a reduced rate of incorporation and a small risk of disease transfer and immunogenicity.…”

“…(14,15) Augmentation with an internal fixation device can provide additional mechanical support, so as to lessen the risk of a pathological stress fracture, especially during the initial 6-12 months before significant graft incorporation. (13,15) Based on previous studies, (6,12,13) the compression hip screw appears to be the most commonly applied internal fixation device. In the case described by Chawla et al, (7) excision of the femoral head and total hip arthroplasty was unavoidable even though the patient was young, as there was involvement of the articular surface of the femoral head.…”