Limits...
Elastic intramedullary nailing and DBM-bone marrow injection for the treatment of simple bone cysts.

Kanellopoulos AD, Mavrogenis AF, Papagelopoulos PJ, Soucacos PN - World J Surg Oncol (2007)

Bottom Line: The mean follow-up was 77 months (range, 5 to 8 years).All patients were pain free and had full range of motion of the adjacent joints at 6 weeks postoperatively.Until the latest examination there was no evidence of fracture or re-fracture.

View Article: PubMed Central - HTML - PubMed

Affiliation: First Department of Orthopaedics, Athens University Medical School, Athens Greece. adkanell@yahoo.com

ABSTRACT

Background: Simple or unicameral bone cysts are common benign fluid-filled lesions usually located at the long bones of children before skeletal maturity.

Methods: We performed demineralized bone matrix and iliac crest bone marrow injection combined with elastic intramedullary nailing for the treatment of simple bone cysts in long bones of 9 children with a mean age of 12.6 years (range, 4 to 15 years).

Results: Two of the 9 patients presented with a pathological fracture. Three patients had been referred after the failure of previous treatments. Four patients had large lesions with impending pathological fractures that interfered with daily living activities. We employed a ratio to ascertain the severity of the lesion. The extent of the lesion on the longitudinal axis was divided with the normal expected diameter of the long bone at the site of the lesion. The mean follow-up was 77 months (range, 5 to 8 years). All patients were pain free and had full range of motion of the adjacent joints at 6 weeks postoperatively. Review radiographs showed that all 7 cysts had consolidated completely (Neer stage I) and 2 cysts had consolidated partially (Neer stage II). Until the latest examination there was no evidence of fracture or re-fracture.

Conclusion: Elastic intramedullary nailing has the twofold benefits of continuous cyst decompression, and early immediate stability to the involved bone segment, which permits early mobilization and return to the normal activities of the pre-teen patients.

Show MeSH

Related in: MedlinePlus

(A) A cystogram was performed and tissue was obtained for histological examination. (B) Under image-intensifier control, kirschner wires were drilled in appropriate positions on both medial and lateral cortices. (C) The entry holes of the nails were created with cannulated drills over the kirschner wires, and the nails were directed to pass through the bone cyst, one at a time. (D) Iliac crest bone marrow was mixed with demineralized bone matrix and the mixture was injected at the cyst.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2117015&req=5

Figure 2: (A) A cystogram was performed and tissue was obtained for histological examination. (B) Under image-intensifier control, kirschner wires were drilled in appropriate positions on both medial and lateral cortices. (C) The entry holes of the nails were created with cannulated drills over the kirschner wires, and the nails were directed to pass through the bone cyst, one at a time. (D) Iliac crest bone marrow was mixed with demineralized bone matrix and the mixture was injected at the cyst.

Mentions: With the child under general anesthesia without the use of a tourniquet, fluoroscopy is used to locate the cyst and the physis. After full skin preparation and draping, a thin trocar is used to perforate the bone cortex and evacuate the cyst by aspiration of fluid. A cystogram was performed; a venous drainage was not observed in any of the patients in this study. The cysts would not have been injected with bone marrow and demineralized bone matrix if a large venous drainage was observed. Using a thin curette under fluoroscopic guidance tissue was obtained for histology (Figure 2A). Histology sections showed a unicameral bone cyst in all the patients.


Elastic intramedullary nailing and DBM-bone marrow injection for the treatment of simple bone cysts.

Kanellopoulos AD, Mavrogenis AF, Papagelopoulos PJ, Soucacos PN - World J Surg Oncol (2007)

(A) A cystogram was performed and tissue was obtained for histological examination. (B) Under image-intensifier control, kirschner wires were drilled in appropriate positions on both medial and lateral cortices. (C) The entry holes of the nails were created with cannulated drills over the kirschner wires, and the nails were directed to pass through the bone cyst, one at a time. (D) Iliac crest bone marrow was mixed with demineralized bone matrix and the mixture was injected at the cyst.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2117015&req=5

Figure 2: (A) A cystogram was performed and tissue was obtained for histological examination. (B) Under image-intensifier control, kirschner wires were drilled in appropriate positions on both medial and lateral cortices. (C) The entry holes of the nails were created with cannulated drills over the kirschner wires, and the nails were directed to pass through the bone cyst, one at a time. (D) Iliac crest bone marrow was mixed with demineralized bone matrix and the mixture was injected at the cyst.
Mentions: With the child under general anesthesia without the use of a tourniquet, fluoroscopy is used to locate the cyst and the physis. After full skin preparation and draping, a thin trocar is used to perforate the bone cortex and evacuate the cyst by aspiration of fluid. A cystogram was performed; a venous drainage was not observed in any of the patients in this study. The cysts would not have been injected with bone marrow and demineralized bone matrix if a large venous drainage was observed. Using a thin curette under fluoroscopic guidance tissue was obtained for histology (Figure 2A). Histology sections showed a unicameral bone cyst in all the patients.

Bottom Line: The mean follow-up was 77 months (range, 5 to 8 years).All patients were pain free and had full range of motion of the adjacent joints at 6 weeks postoperatively.Until the latest examination there was no evidence of fracture or re-fracture.

View Article: PubMed Central - HTML - PubMed

Affiliation: First Department of Orthopaedics, Athens University Medical School, Athens Greece. adkanell@yahoo.com

ABSTRACT

Background: Simple or unicameral bone cysts are common benign fluid-filled lesions usually located at the long bones of children before skeletal maturity.

Methods: We performed demineralized bone matrix and iliac crest bone marrow injection combined with elastic intramedullary nailing for the treatment of simple bone cysts in long bones of 9 children with a mean age of 12.6 years (range, 4 to 15 years).

Results: Two of the 9 patients presented with a pathological fracture. Three patients had been referred after the failure of previous treatments. Four patients had large lesions with impending pathological fractures that interfered with daily living activities. We employed a ratio to ascertain the severity of the lesion. The extent of the lesion on the longitudinal axis was divided with the normal expected diameter of the long bone at the site of the lesion. The mean follow-up was 77 months (range, 5 to 8 years). All patients were pain free and had full range of motion of the adjacent joints at 6 weeks postoperatively. Review radiographs showed that all 7 cysts had consolidated completely (Neer stage I) and 2 cysts had consolidated partially (Neer stage II). Until the latest examination there was no evidence of fracture or re-fracture.

Conclusion: Elastic intramedullary nailing has the twofold benefits of continuous cyst decompression, and early immediate stability to the involved bone segment, which permits early mobilization and return to the normal activities of the pre-teen patients.

Show MeSH
Related in: MedlinePlus