Surgical treatment of benign lesions and pathologic fractures of the proximal femur in children
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ORTHOPAEDIC SURGERY
Surgical treatment of benign lesions and pathologic fractures of the proximal femur in children Ryszard Tomaszewski1,5 · Erich Rutz2,6,7 · Johannes Mayr3,6 · Jerzy Dajka4 Received: 24 June 2020 / Accepted: 15 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Benign lesions of the proximal femur region, such as simple bone cysts, aneurysmal bone cysts, and fibrous dysplasia, are common in children. Benign lesions may cause pathologic fractures, limb length inequities, and growth disturbances. Differential diagnoses, e.g., malignant bone tumors and osteomyelitis, are sometimes difficult to rule out. Objective We aimed to evaluate outcomes in children with benign lesions of the proximal femur treated with curettage, bone grafting, and plate fixation. Methods In this retrospective study, we included 30 children (median age 10.5 years; range 1.1–17.8 years) suffering from bone cysts and tumor-like lesions of the proximal femur region treated between 2002 and 2018. We analyzed plain X-ray images and CT scans in all children and obtained MRI scans in a selected group of children (63.3%). We examined histopathologic biopsy results for all bone lesions before initiating treatment. Surgical management comprised tumor curettage with adjuvant high-speed drilling and allogenic bone grafting supplemented by bone graft substitutes before plate fixation. Median follow-up interval was 87 months (range 24–156 months). We evaluated the healing of lesions according to Capanna’s classification and rated functional outcomes according to Merle d’Aubigné and Postel score. Results Overall, 25 of 30 (83.3%) patients were admitted to hospital because of a pathologic fracture. We diagnosed simple bone cysts in 15 (50.0%) patients, aneurysmal bone cysts in 7 (23.5%) patients, and fibrous dysplasia in 8 (26.5%) patients. Bone consolidation was achieved in 22 of 30 (73.3%) patients after a mean of 5 months (range 3–7 months). The main complication was recurrence of the lesion in 4 of 30 (13.3%) patients. With respect to the Merle d’Aubigné and Postel scores, 17 of 30 (56.7%) patients obtained an excellent result (18 points), while 12 (40.0%) patients had a good result (15–17 points) and only 1 (3.3%) patient had a fair result (14 points). Conclusion Surgical treatment of bone cysts and tumor-like lesions of the proximal femur by local resection or destruction of the lesion, followed by filling the defect with bone graft material and internal stabilization represents a safe and effective treatment option in children. Level of evidence Therapeutic, retrospective comparative study—Level III Keywords Children · Proximal femur · Simple bone cyst · Aneurysmal bone cyst · Fibrous dysplasia Abbreviations ABC Aneurysmal bone cyst Ryszard Tomaszewski and Erich Rutz served as co-first authors.
BCI Bone cyst index CT Computer tomography FD Fibrous dysplasia
* Erich Rutz [email protected]
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Institute of Computing, University of Silesia, Chorzów Katowice, Poland
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