Which one of the benign tumors and tumor-like lesions located in long bones needs prophylactic fixation during surgery?

Abstract

In the management of benign and tumor-like lesions, bony defects have been the subject of main dispute among orthopedic surgeons for many years. Benign bone tumors or tumor-like lesions often weaken bones and predispose to pathological fractures. The goal of the surgery is to prevent tumor recurrence and to allow the restoration of bone strength. Adjuvant measures such as phenol instillation or cryotherapy with liquid nitrogen may additionally be applied due to their chemical and physical effects improving the local effect of curettage. [1][2][3][4][5] Large bone cavities have been reinforced with autologous bone grafts, allografts, polymethylmethacrylate bone cement and bone substitutes. [6] Factors affecting the biomechanics of Objectives: This study aims to define the simultaneous prophylactic fixation indications of benign tumors and tumor-like lesions located in long bones that were treated by curettage and grafting/cementing.Patients and methods: Fifty-six patients (33 males, 23 females; mean age 30.9±15.9; range, 15 to 65 years) who were treated by curettage and grafting or cementation for their benign tumors or tumor-like lesions in long bones between January 2013 and June 2016 were retrospectively analyzed. Age, sex, anamnesis and physical examination findings, histopathologic diagnosis, lesion localization, pre-and postoperative imaging results and follow-up data were all analyzed. The patients were divided into two groups as those with and without postoperative fracture. Results:The most common localization was femur (38%). The mean tumor diameter was 6.8±2.2 (range, 2.6 to 12.6) cm and volume was 58.3±45.0 (range, 6 to 177) cm 3 . Postoperative fracture occurred in 14 patients. The lesion diameter and volume of the patients in postoperative fracture group were significantly higher compared to group without postoperative fracture (p=0.034 and p=0.004, respectively). A volume value greater than 67 cm3 and ages over 35 years were found to be associated with a higher rate of fracture for all lesions. Conclusion:In the postoperative period, patients with benign tumors or tumor-like lesions of long bones had a higher fracture risk if the volume value was greater than 67 cm 3 and the age was over 35 years. Prophylactic fixation may be suggested for these patients.

Imaging Diagnosis of Primary Solitary Bone Neoplasts and Its Comparison with Tumor-like Lesions

“…Osteopolysis is obvious in tumor-like lesions, and the characteristics of iliac tumor lesions are obvious. Most tumor patients will have soft tissue mass that plays an important role in the clinical diagnosis of skeletal lesion [13].…”