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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.

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(A) Plain radiograph and (B) magnetic resonance imaging of the right humerus of a 7 year-old boy with a simple bone cyst. The patient had previous steroid injections. (C) Anteroposterior and (D) lateral radiographs after intramedullary nailing and injection of demineralized bone matrix and autologous bone marrow from the ipsilateral iliac crest. (E) Anteroposterior and (F) lateral radiographs at 31 months after the operation show complete healing of the cyst (Neer stage I).
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Figure 3: (A) Plain radiograph and (B) magnetic resonance imaging of the right humerus of a 7 year-old boy with a simple bone cyst. The patient had previous steroid injections. (C) Anteroposterior and (D) lateral radiographs after intramedullary nailing and injection of demineralized bone matrix and autologous bone marrow from the ipsilateral iliac crest. (E) Anteroposterior and (F) lateral radiographs at 31 months after the operation show complete healing of the cyst (Neer stage I).

Mentions: According to the classification system of Neer, there are 4 stages of cyst healing. Stage I include complete cyst filing; stage II include partial cyst filling with thickening of the cyst wall and small lucencies of less than 3 cm; stage III include recurrence of the cyst and lucencies of more than 3 cm; and stage IV include no response of the cyst [3]. In the present series, review radiographs showed that all 9 cysts had consolidated completely or partially (Neer stages I and II); 7 cysts were graded as Neer I, and 2 cysts were graded as Neer II (Figures 3 and 4).


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) Plain radiograph and (B) magnetic resonance imaging of the right humerus of a 7 year-old boy with a simple bone cyst. The patient had previous steroid injections. (C) Anteroposterior and (D) lateral radiographs after intramedullary nailing and injection of demineralized bone matrix and autologous bone marrow from the ipsilateral iliac crest. (E) Anteroposterior and (F) lateral radiographs at 31 months after the operation show complete healing of the cyst (Neer stage I).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: (A) Plain radiograph and (B) magnetic resonance imaging of the right humerus of a 7 year-old boy with a simple bone cyst. The patient had previous steroid injections. (C) Anteroposterior and (D) lateral radiographs after intramedullary nailing and injection of demineralized bone matrix and autologous bone marrow from the ipsilateral iliac crest. (E) Anteroposterior and (F) lateral radiographs at 31 months after the operation show complete healing of the cyst (Neer stage I).
Mentions: According to the classification system of Neer, there are 4 stages of cyst healing. Stage I include complete cyst filing; stage II include partial cyst filling with thickening of the cyst wall and small lucencies of less than 3 cm; stage III include recurrence of the cyst and lucencies of more than 3 cm; and stage IV include no response of the cyst [3]. In the present series, review radiographs showed that all 9 cysts had consolidated completely or partially (Neer stages I and II); 7 cysts were graded as Neer I, and 2 cysts were graded as Neer II (Figures 3 and 4).

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