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Elastic Stable Intramedullary Nailing (ESIN), Orthoss® and Gravitational Platelet Separation--System (GPS®): an effective method of treatment for pathologic fractures of bone cysts in children.

Rapp M, Svoboda D, Wessel LM, Kaiser MM - BMC Musculoskelet Disord (2011)

Bottom Line: No peri- or postoperative complications occurred.At follow-up (20-41 months, mean 31.8 months) all patients showed very good functional results and had returned to sporting activity.No refracture occurred, no further procedure was necessary.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pediatric Surgery, University of Luebeck, Luebeck, Germany. kaier@medinf.mu-luebeck.de.

ABSTRACT

Background: The different treatment strategies for bone cysts in children are often associated with persistence and high recurrence rates of the lesions. The safety and clinical outcomes of a combined mechanical and biological treatment with elastic intramedullary nailing, artificial bone substitute and autologous platelet rich plasma are evaluated.

Methods: From 02/07 to 01/09 we offered all children with bone cysts the treatment combination of elastic intramedullary nailing (ESIN), artificial bone substitute (Orthoss®) and autologous platelet rich plasma, concentrated by the Gravitational Platelet Separation (GPS®)--System. All patients were reviewed radiologically for one year following the removal of the intramedullary nailing, which was possible because of cyst obliteration.

Results: A cohort of 12 children (4 girls, 8 boys) was recruited. The mean patient age was 11.4 years (range 7-15 years). The bone defects (ten humeral, two femoral) included eight juvenile and four aneurysmal bone cysts. Five patients suffered from persistent cysts following earlier unsuccessful treatment of humeral bone cyst after pathologic fracture; the other seven presented with acute pathologic fractures. No peri- or postoperative complications occurred. The radiographic findings showed a total resolution of the cysts in ten cases (Capanna Grade 1); in two cases a small residual cyst remained (Capanna Grade 2). The intramedullary nails were removed six to twelve months (mean 7.7) after the operation; in one case, a fourteen year old boy (Capanna Grade 2), required a further application of GPS® and Orthoss® to reach a total resolution of the cyst. At follow-up (20-41 months, mean 31.8 months) all patients showed very good functional results and had returned to sporting activity. No refracture occurred, no further procedure was necessary.

Conclusions: The combination of elastic intramedullary nailing, artificial bone substitute and autologous platelet rich plasma (GPS®) enhances the treatment of bone cysts in children, with no resulting complications.

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Related in: MedlinePlus

Complete Consolidation after a long history of failed treatment. Valgus deformity of the humerus after failed earlier treatment of juvenile bone cyst with Elastic stable intramedullary Nails and a different artificial bone substitute. After 3 years of failed treatment the result was classified as Capanna Grade 4. During removal of the nails and the combined treatment with ESIN-osteosynthesis, Orthoss® and GPS® an additional external fixation was needed due to instability. The Fixateur was removed after 4 weeks, the nails after 6 months.
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Figure 4: Complete Consolidation after a long history of failed treatment. Valgus deformity of the humerus after failed earlier treatment of juvenile bone cyst with Elastic stable intramedullary Nails and a different artificial bone substitute. After 3 years of failed treatment the result was classified as Capanna Grade 4. During removal of the nails and the combined treatment with ESIN-osteosynthesis, Orthoss® and GPS® an additional external fixation was needed due to instability. The Fixateur was removed after 4 weeks, the nails after 6 months.

Mentions: Five patients had suffered prior unsuccessful treatment of humeral bone cyst after pathologic fracture with intramedullary nailing and curettage (Figures 2, 3, 4 and 5) or artificial bone substitution in one case; the other seven presented with acute pathologic fractures (five humeral, two femoral; Figures 6, 7, 8 and 9). They all received the treatment combination of elastic intramedullary nailing (ESIN), artificial bone substitute (Orthoss®) and autologous platelet rich plasma (GPS®). None satisfied the exclusion criteria.


Elastic Stable Intramedullary Nailing (ESIN), Orthoss® and Gravitational Platelet Separation--System (GPS®): an effective method of treatment for pathologic fractures of bone cysts in children.

Rapp M, Svoboda D, Wessel LM, Kaiser MM - BMC Musculoskelet Disord (2011)

Complete Consolidation after a long history of failed treatment. Valgus deformity of the humerus after failed earlier treatment of juvenile bone cyst with Elastic stable intramedullary Nails and a different artificial bone substitute. After 3 years of failed treatment the result was classified as Capanna Grade 4. During removal of the nails and the combined treatment with ESIN-osteosynthesis, Orthoss® and GPS® an additional external fixation was needed due to instability. The Fixateur was removed after 4 weeks, the nails after 6 months.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3046000&req=5

Figure 4: Complete Consolidation after a long history of failed treatment. Valgus deformity of the humerus after failed earlier treatment of juvenile bone cyst with Elastic stable intramedullary Nails and a different artificial bone substitute. After 3 years of failed treatment the result was classified as Capanna Grade 4. During removal of the nails and the combined treatment with ESIN-osteosynthesis, Orthoss® and GPS® an additional external fixation was needed due to instability. The Fixateur was removed after 4 weeks, the nails after 6 months.
Mentions: Five patients had suffered prior unsuccessful treatment of humeral bone cyst after pathologic fracture with intramedullary nailing and curettage (Figures 2, 3, 4 and 5) or artificial bone substitution in one case; the other seven presented with acute pathologic fractures (five humeral, two femoral; Figures 6, 7, 8 and 9). They all received the treatment combination of elastic intramedullary nailing (ESIN), artificial bone substitute (Orthoss®) and autologous platelet rich plasma (GPS®). None satisfied the exclusion criteria.

Bottom Line: No peri- or postoperative complications occurred.At follow-up (20-41 months, mean 31.8 months) all patients showed very good functional results and had returned to sporting activity.No refracture occurred, no further procedure was necessary.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pediatric Surgery, University of Luebeck, Luebeck, Germany. kaier@medinf.mu-luebeck.de.

ABSTRACT

Background: The different treatment strategies for bone cysts in children are often associated with persistence and high recurrence rates of the lesions. The safety and clinical outcomes of a combined mechanical and biological treatment with elastic intramedullary nailing, artificial bone substitute and autologous platelet rich plasma are evaluated.

Methods: From 02/07 to 01/09 we offered all children with bone cysts the treatment combination of elastic intramedullary nailing (ESIN), artificial bone substitute (Orthoss®) and autologous platelet rich plasma, concentrated by the Gravitational Platelet Separation (GPS®)--System. All patients were reviewed radiologically for one year following the removal of the intramedullary nailing, which was possible because of cyst obliteration.

Results: A cohort of 12 children (4 girls, 8 boys) was recruited. The mean patient age was 11.4 years (range 7-15 years). The bone defects (ten humeral, two femoral) included eight juvenile and four aneurysmal bone cysts. Five patients suffered from persistent cysts following earlier unsuccessful treatment of humeral bone cyst after pathologic fracture; the other seven presented with acute pathologic fractures. No peri- or postoperative complications occurred. The radiographic findings showed a total resolution of the cysts in ten cases (Capanna Grade 1); in two cases a small residual cyst remained (Capanna Grade 2). The intramedullary nails were removed six to twelve months (mean 7.7) after the operation; in one case, a fourteen year old boy (Capanna Grade 2), required a further application of GPS® and Orthoss® to reach a total resolution of the cyst. At follow-up (20-41 months, mean 31.8 months) all patients showed very good functional results and had returned to sporting activity. No refracture occurred, no further procedure was necessary.

Conclusions: The combination of elastic intramedullary nailing, artificial bone substitute and autologous platelet rich plasma (GPS®) enhances the treatment of bone cysts in children, with no resulting complications.

Show MeSH
Related in: MedlinePlus