Soft-tissue recurrence of giant cell tumor of bone: a case report

We report a rare complication of giant cell tumor [GCT] of bone. A soft tissue recurrence without intra-osseous involvement developed in a 35-year-old lady treated for grade III GCT with intralesional excision, local adjuvant phenol and filling the cavity with bone cement. The different imaging modalities used for work-up and staging are discussed. This report emphasizes that a soft tissue recurrence may be not recognized if a thorough clinical examination is not performed and MRI is not done. Review of relevant literature addressed different factors that influence recurrence, as well as the role of osteoinductive growth factors in stimulating the osteoblastic differentiation and metaplastic bone formation in such lesions

Management of unicameral bone cyst of proximal femur: Experience of 14 cases and review of literature

To assess the results of surgical treatment of unicameral bone cyst [UBC] involving the proximal femur Retrospective study of 14 cases of UBC of proximal femur Al-Razi Orthopedic Hospital, Kuwait Fourteen cases of UBC seen and treated at Al-Razi hospital were included in the study. Their presentation and the method of treatment were recorded. Thirteen cases were treated surgically using intra-lesional excision [ILE]. The cavity was filled with autogenous bone graft in three cases, hydroxyapatite matrix [HA] in eight cases, and combined autogenous graft and hydroxyapatite matrix in two cases. Internal fixation was carried out in six cases. External fixator was applied in one case from iliac bone to femur crossing the hip joint. Patients were followed up post-operatively for an average period of 42 months [range = 9-120 months]. They were observed for recurrence, complications and fracture healing. Recurrence was observed in one case while other cases showed healing of the cyst with consolidation and varying degrees of remodeling in one years time. A case developed mal-union and growth arrest with subsequent shortening. Avascular necrosis and coxa vara was detected in another case. All the fractures healed in the usual expected time according to age. UBC of the proximal femur exhibits unique characters and complications. Hydroxyapatite matrix is a useful and effective bone substitute. Post-excision stabilization of the cyst is recommended to avoid malunion and to facilitate post-operative rehabilitation and earlier return to normal activities

Prophylactic fixation of impending pathological fractures due to metastatic bone disease

Management of patients with metastatic bone disease [MBD] represents a true challenge to all disciplines involved in the treatment of these patients. Pathological fracture is one of the most important skeletal related events that necessitate active orthopedic intervention. Prophylactic fixation of such fractures is less traumatic to the patients and less demanding to the surgeon. Thirty four patients with 39 impending pathological fractures due to MBD were treated by prophylactic fixation of their affected bones. Thirteen were males and 21 were females. The ages ranged from 42 to 76 years with an average of 55 years. Eighty percent of the operated patients were ambulatory immediately after surgery and nearly all of them had significant pain relief. Average hospital stay was 8 days, average operative time was 70 minutes, and complications were reported in 13 cases. The survival rate was 65% at one year, 44% at 2 years and 26% at 3 years post-operatively. Prophylactic fixation of an impending pathological fracture is technically easier, has low rate of complication and protects patients from the distress of actual fracture. A multimodality approach is important to optimize care and quality of lives to this sector of patients