Complications of Albizzia femoral lengthening nail: an analysis of 36 cases.

Thirty-six cases of femoral lengthening using the Albizzia nail were performed. The indication for lengthening was a congenital malformation, sequellae of trauma, of infection, of radiation therapy, short stature, and vascular malformation. The mean age of the patients was 16 years, the average lengthening achieved was 4.7 cm, and the follow-up period averaged 5.8 years. We found that bone consolidation was achieved faster than with external fixation. The patient's comfort during lengthening as well as the speed of functional restoration also improved. In three cases, the program failed, in six the lengthening was achieved with a second procedure, and eight patients required one ratcheting or more under general anesthesia. In our experience, the Albizzia nail is a simple and effective solution for uncomplicated femoral lengthening.

Active aneurysmal bone cysts in children: possible evolution after biopsy.

PURPOSE: The active or aggressive character in certain localisations of aneurysmal bone cysts in children requires either curettage with a considerable recurrence rate or a radical segmental excision, raising complex reconstructive challenges. Cyst maturation with subsequent ossification may be observed either spontaneously or after incisional biopsy. PATIENTS: Five new cases of active aneurysmal bone cysts (ABCs) with healing of the cyst after biopsy alone are reported. All patients had no treatment of the cyst after the biopsy. RESULTS: In two cases, the lesion initially increases in size immediately after the biopsy, and it is only secondarily that the lesion decreases in size. Four out of five cases of the spontaneous healing occurred in pelvic bone. The cysts healed after, respectively, 36, 24, 12, 32 and 12 months. CONCLUSIONS: The emergence of these new cases of spontaneous healing encourages promoting clinical and radiological supervision after biopsy in selected cases. Unfortunately, it is impossible to predict a possible aggressive behaviour in ABCs. Then, if the lesion is quickly aggressive with clinically and radiologically increasing size after biopsy, it would be illogical and dangerous to let this ABC evolve. It would be necessary to treat it without delay. On the other hand, if the lesion moderately increased after the biopsy, it is possible to wait and observe the patient during a period of 5 months for a possible healing, if the ABC localisation is not dangerous. Of course, if the lesion does not increase in size after biopsy, there is no delay to treat it.

Intercalary segmental reconstruction of long bones after malignant bone tumor resection using primary methyl methacrylate cement spacer interposition and secondary bone grafting: the induced membrane technique.

BACKGROUND: Bone reconstruction after surgical resection of malignant bone tumor in children remains a difficult challenge and various techniques exist. Induced membrane reconstruction as described by Masquelet et al has been reported in traumatic large bone defects. We have been using this 2-stage technique after primary malignant bone tumors resection in children since 2000. METHODS: We retrospectively studied 12 cases: 6 Ewing sarcomas and 6 osteosarcomas. Mean age of the patients was 9 years old (range, 3 to 15.5 y). Surgical treatment consisted of wide resection and insertion of a cement spacer then secondary bone grafting. All patients had neoadjuvant and adjuvant chemotherapy and 2 patients had adjuvant radiotherapy. RESULTS: Surgical excision was complete in all cases. There was no local recurrence at 6.2 years (range, 4.6 to 9.1 y) follow-up. Three patients had pulmonary metastasis (of whom 1 deceased) and 1 had a metastasis on the contralateral limb. The 11 patients operated on the lower limb achieved weight bearing 4.1 months (range, 0.2 to 14.2 mo) after the second stage of the procedure. Complications were numerous with 7 nonunions (4 unifocal and 3 bifocal), 5 fractures (in 4 patients), 5 protruding wires (in 4 patients), and 2 femoral varus deformities. There was no infection. CONCLUSIONS: Induced membrane reconstruction seems to be a simple and reliable technique in pediatric bone tumors and these results are promising. Extended use of locking nails could reduce the high rate of nonunion though it is not always possible in skeletally immature patients. LEVEL OF EVIDENCE: IV (case series).