DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20195812

Evaluation of curettage, synthetic bone grafting and fixation with implant in benign osteolytic and cystic lesions of long bones in children and young adults

Tapas Kumar Ghosh, Rajeeb Banik, Bijoy Bhattacharjya

Abstract


Background: Curettage is one of the most common treatment options for benign lytic bone tumors and cystic lesions. In children and young adults, the resultant defect is usually filled with synthetic bone graft, which is a natural calcium phosphate hydroxyappatite (HA) in crystalline ceramic form.

Methods: Sixteen cases of benign lytic and cystic lesions of bone were managed by simple curettage and grafting using hydroxyappatite blocks. Displaced pathological fractures or impending peritrochanteric fractures were fixed by implant. Commercially available HA was used for this purpose. Mean duration of follow up was 17.5 months (range 12 –30 months). Mean patient age was 11.2 years (range 6–20 years). Radiological staging of graft incorporation was done as per criteria of Irwin et al.

Results: Among 16 cases, 2 patients presented with non-ossifying fibroma and 2 patients with simple bone cyst, 12 cases were aneurysmal bone cyst. 5 patients had pathological fracture. Healing of lesion and graft incorporation is seen in all of the cases. At 6 months of follow up 3 cases were in Irwin stage III, 9 cases were in Irwin stage II and 4 cases were in Irwin stage I. At final follow up 10 cases were in Irwin stage III and rest was in Irwin stage II. No recurrence seen till date.

Conclusions: We conclude that meticulous curettage and filling of bone cavity by calcium phosphate hydroxyappatite and fixation with implant in displaced pathological fracture or impending fracture is the procedure of choice of management of benign lytic lesions of bone.


Keywords


Curettage, Calcium phosphate hydroxyappatite, Benign lytic, Cystic lesions

Full Text:

PDF

References


Szendröi M, Sim FH. Color Atlas of Clinical Orthopedics. 2009: 209-229.

Enneking WF. Musculoskeletal Tumor Surgery. Volume 1. New York, Churchill Livingstone; 1983; 87-89.

Teoh KH, Watts AC, Chee YH, Reid R, Porter DE. Predictive factors for recurrence of simple bone cyst of the proximal humerus. J Orthop Surg (Hong Kong). 2010;18:215-9.

Freiberg AA, Loder RT, Heidelberger KP, Hensinger RN. Aneurysmal bone cysts in young children. J Pediatr Orthop. 1994;14:86-91.

Marcove RC, Sheth DS, Takemoto S, Healey JH. The treatment of aneurysmal bone cyst. Clin Orthop. 1995;311:157-63.

Ruiter DJ, van Rijssel TG, van der Velde EA. Aneurysmal bone cysts: a clinicopathological study of 105 cases. Cancer. 1977;39:2231-9.

Kanellopoulos AD, Mavrogenis AF, Papagelopoulos PJ, Soucacos PN. Elastic intramedullary nailing and DBM bone marrow injection for the treatment of simple bone cysts. World J Surg Oncol. 2007;5:111.

Irwin RB1, Bernhard M, Biddinger A. Coralline Hydroxyapatite as bone substitute in orthopedic oncology. Am J Orthop. 2001;30:544-50.

Hirata M, Murata H, Takeshita H, Sakabe T, Tsuji Y, Kubo T. Use of purified beta‑tricalcium phosphate for filling defects after curettage of benign bone tumors. Int Orthop. 2006;30:510‑3.

Augat P, Rapp S, Claes L. A modified hip screw incorporating injected cement for the fixation of osteoporotic trochanteric fractures. J Orthop Trauma. 2002;16:311‑6.

Bini SA, Gill K, Johnston JO. Giant cell tumor of bone. Curettage and cement reconstruction. Clin Orthop Relat Res. 1995;321:245-50.

Holmes R, Mooney V, Bucholz R, Tencer A. A coralline hydroxyapatite bone graft substitute. Preliminary report. Clin Orthop Relat Res. 1984;188:252-62.

Kundu ZS, Gupta V, Sangwan SS, Rana P. Curettage of benign bone tumors and tumor like lesions: A retrospective analysis. Indian J Orthop. 2013;47:295-301.

Gupta AK, Kumar P, Keshav K, Singh A. Hydroxyapatite crystals as a bone graft substitute in benign lytic lesions of bone. Indian J Orthop. 2015;49:649-55.

Reddy R, Swamy M. The use of hydroxyapatite as a bone graft substitute in orthopaedic conditions. Indian J Orthop. 2005;39:52‑4.