Treatment of pathological fractures due to simple bone cysts by extended curettage grafting and intramedullary decompression

Abstract

Objective: Effectiveness and morbidity of curettage grafting and intramedullary decompression in the treatment of pathological fractures due to simple bone cysts (SBCs) were evaluated.
Methods: Between 2005 and 2012, 34 children with SBCs were treated with extended curettage grafting and intramedullary decompression. Average age of the patients (23 male, 11 female) at surgery was 11.7 years (range: 6–21 years). The lesions were localized in the humerus (19), femur (12), tibia (2), and ulna (1). Pathological micro- or displaced fractures occurred in 31 patients. Surgical procedure included extended curettage by using cauterization and high-speed burring, bone grafting, and intramedullary decompression with elastic nails. Six patients had been treated conservatively or surgically in other institutions previously. Radiographic and functional results were evaluated by Capanna criteria and MSTS scores respectively. Early and late complications and additional surgical procedures were recorded.
Results: The average follow-up was 37 months (range: 18–89 months). The average time to heal for pathological fractures was 8 weeks (range: 6–12 weeks). Radiographic evaluation revealed Grade 1 healing in 28 patients (82%) and Grade 2 healing in 6 patients (18%). The average MSTS score based on final follow-up was 28.5 (range: 17–30); excellent (32 patients; 94%) and good (2 patients; 6%) functional results were obtained. There was no early or late infection, refracture or implant failure. Malunion developed following treatment of 2 humeral and 2 femoral lesions. With the exception of 2 implant removals, no patients required additional surgical intervention.
Conclusion: Complete cyst healing and satisfactory functional results can be obtained by curettage grafting and intramedullary decompression. This technique restores bone integrity by allowing early motion and prevents refracture and subsequent deformity in the majority of patients.

Keywords

• Curettage and grafting
• intramedullary decompression
• intramedullary nailing
• simple bone cyst

Basit kemik kistlerine bağlı patolojik kırıklarınküretaj-grefonaj ve intramedüllerdekompresyon ile tedavisi

Öz

Amaç: Basit kemik kistine bağlı patolojik kırıkların tedavisinde küretaj-grefonaj ve intramedüller dekompresyonun etkinliği ve morbiditesi değerlendirildi.

Çalışma planı: 2005–2012 yılları arasında basit kemik kisti tanısıyla genişletilmiş küretaj-grefonaj ve intramedüller dekompresyon uygulanan 34 çocuk retrospektif değerlendirildi. Hastaların (23 erkek/11 kadın) cerrahi sırasındaki ortalama yaşları 11.7 yıldı (aralık, 6–21). Humerus (19), femur (12), tibia (2) ve ulna (1) yerleşimli lezyonlara, 31 hastada patolojik kırık eşlik etti. Cerrahi işlem, koterizasyon ve burrlama ile genişletilmiş küretaj, grefonaj ve elastik çivilerle intramedüller dekompresyonu içerdi. Altı hastaya önceden konservatif veya cerrahi tedavi uygulanmıştı. Radyolojik ve fonksiyonel sonuçlar sırasıyla Capanna kriterleri ve MSTS skorlaması ile değerlendirildi. Erken ve geç dönem komplikasyonlar ve bunlara yönelik ilave cerrahi girişim ihtiyacı araştırıldı.

Bulgular: Hastalar ortalama 37 ay (aralık, 18–89) takip edildi. Patolojik kırıkların tümü ortalama sekiz haftada (aralık, 6–12 hafta) sorunsuz kaynadı. Yirmi sekiz (%82) hastada Grad 1, altı (%18) hastada Grad 2 radyolojik iyileşme sağlandı. Son takip ortalama MSTS skoru 28.5 (aralık, 17–30) hesaplandı; 32 (%94) hastada mükemmel, iki (%6) hastada iyi sonuç elde edildi. Hiçbir hastada erken veya geç enfeksiyon, refraktür veya implant yetmezliği görülmedi. İki humerus ve iki femur olgusunda tedavi sonrası malunion gelişti, sadece biri hafif klinik bulgu verdi. Uzun takipli iki çocukta çivilerin çıkartılması dışında hiçbir hastada ilave cerrahi girişim yapılmadı.

Çıkarımlar: Küretaj-grefonaj ve elastik çivilerle intramedüller dekompresyon genellikle tam kist iyileşmesi ve iyi fonksiyonel sonuçlarla seyreder. Patolojik kırık varlığında kemik bütünlüğünü sağlayarak erken harekete izin veren bu yöntem, uzun vadede re-fraktür ve deformite gelişimini engeller.

 

DOI: 10.3944/AOTT.2015.14.0108

Bu özet, makalenin henüz redaksiyonu tamamlanmamış haline aittir ve bilgi verme amaçlıdır. Yayın aşamasında değişiklik gösterebilir.

Anahtar Kelimeler

• Basit kemik kisti; intrameduller çivileme; küretaj ve grefonaj.

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