Grafting for bone defects after curettage of benign bone tumor - Analysis of factors influencing the bone healing.

BACKGROUND: Simple bone cyst often weaken bone properties and predispose to pathological fractures, requiring tumor excision and the filling of bone defects with grafts to prevent complications. The purpose of this study was to evaluate factors potentially affecting the quality and efficiency of graft healing. METHODS: This study retrospectively assessed 84 patients with simple bone cysts who had undergone tumor excision and filling of the bone defects with grafts between 2004 and 2014. Various patient-, tumor- and treatment-related factors that could potentially influence radiologic healing status and time to stable healing were evaluated. RESULTS: Bone healing was not related to gender and age. Graft type was not significantly correlated with both radiologic healing status or time to stable healing. Only two of all variables evaluated were significantly correlated with the prognosis: (1) Tumors location: patients with tumors located at proximal femur were significantly more likely to achieve complete healing (Neer I) (OR = 3.2; 95%CI, 1.29-8.00; p = 0.011). (2) Tumor length: patients with a tumor length less than 6.2 cm, complete healing was nearly five times more likely to occur (OR = 4.84; 95% CI, 1.83-12.84; p = 0.002). Degree of graft filling of the bone defects affected the time to stable healing. The average healing times were 4.86 months for filling degree ≥90% and 5.94 months for filling degrees <90%, respectively (p = 0.009). Postoperative re-fracture occurred in one case. CONCLUSION: Factors influencing the quality of bone healing following intralesional curettage and bone grafting are proximal femur location and tumor length. A greater degree of graft filling can contribute to higher bone healing efficiency.

Quiste óseo traumático mandibular: reporte de caso y revisión de la literatura / Mandibular traumatic bone cyst: case report and literature review

El Quiste Óseo Traumático de la mandíbula es una cavidad intraósea sin revestimiento epitelial, considerado Pseudoquiste. Ha recibido diversas denominaciones debido a su etiología y patogenia inciertas, como Quiste Óseo Traumático, Quiste Óseo Solitario, Quiste Óseo Idiopático, entre otros. Es una lesión asintomática, que a menudo se diagnostica accidentalmente durante el examen radiológico de rutina, como una radiolucencia unilocular con bordes festoneados cuando está localizado entre las raíces dentarias. Presentamos un caso raro de Quiste Óseo Traumático en la sínfisis mandíbular, identificado radiográficamente, en una paciente de 14 años sin historia clara de trauma, diagnosticado y tratado con éxito.

The Traumatic Bone Cyst of the mandible is an intraosseous cavity without an epithelial lining, considered a pseudocyst. It has received various names due to its uncertain etiology and pathogenesis, such as Traumatic Bone Cyst, Solitary Bone Cyst, Idiopathic Bone Cyst, among others. It is an asymptomatic lesion, which is often diagnosed accidentally during routine radiological examination, as a unilocular radiolucency with scalloped edges when located between the dental roots. We present a rare case of Traumatic Bone Cysts in the mandibular symphysis, identified radiologically, in a 14-year-old patient without clear history of trauma, diagnosed and successfully treated .

Treatment of large cystic medial osteochondral lesions of the talus with autologous osteoperiosteal cylinder grafts.

PURPOSE: To investigate the clinical, radiologic, and second-look arthroscopic outcomes of autologous iliac crest osteoperiosteal cylinder graft transplantation for medial osteochondral lesions of the talus (OLTs) with large subchondral cysts. METHODS: Between January 2008 and December 2010, 17 consecutive cases of medial OLT with a subchondral cyst larger than 10 mm in diameter received transplantation of autologous osteoperiosteal cylinder graft, which was harvested from the ipsilateral iliac crest. The visual analog scale score for pain during daily activities, American Orthopaedic Foot & Ankle Society hindfoot and ankle scores, and subjective satisfaction survey rating were obtained. Plain radiographs and magnetic resonance imaging of the ankle were obtained before and after surgery. In 13 cases second-look arthroscopy was performed 12 months postoperatively and the cartilage repair was assessed with the criteria of the International Cartilage Repair Society. RESULTS: Sixteen patients were available for follow-up at a mean of 32.6 months (range, 24 to 48 months). The mean visual analog scale score decreased from 5.51 ± 0.83 preoperatively to 0.98 ± 0.98 at the latest follow-up, and the median American Orthopaedic Foot & Ankle Society score improved from 75 preoperatively to 90 at the latest follow-up. Seven patients resumed sporting activities. Overall, 7 patients rated the result as excellent, 8 as good, and 1 as fair. The radiolucent area of the cysts disappeared on the plain radiographs in all cases. The mean Magnetic Resonance Observation of Cartilage Repair Tissue score was 60 ± 9.4 points, whereas subchondral bone edema persisted on the postoperative magnetic resonance images in 16 cases. The mean International Cartilage Repair Society arthroscopic score for cartilage repair at second-look arthroscopy was 9 ± 1.4 points. CONCLUSIONS: Autologous iliac crest osteoperiosteal cylinder graft transplantation with supplemental bone grafting is a simple, safe, and effective procedure for treatment of large cystic medial OLT. It can successfully fill the subchondral cyst and repair the cartilage defect. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

The role of physical medicine and rehabilitation in haemophiliac patients.

Physical medicine and rehabilitation aim to evaluate, diagnose and treat disability in haemophiliac patients, while preventing injury or deterioration. They also aim to maintain the greatest degree of functional capacity and independence in patients with haemophilia, or to return them to that state. Rehabilitation, together with clotting factor replacement therapy, has revolutionized the management of these patients in developed countries and reduced their morbidity/mortality rates. A knowledge of the musculoskeletal signs and symptoms of haemophilia is essential for providing a treatment which is suitable and customized. Physical medicine and rehabilitation techniques, which are based on physical means, are intended to reduce the impact which these injuries and their consequences or sequelae can have on the quality of life of patients with haemophilia. Under ideal haemostatic control conditions (primary prophylaxis), people with haemophilia could achieve good physical condition which will allow them to enjoy both physical activity and a daily life without limitations. Currently, children undergoing primary prophylaxis are quite close to this ideal situation. For these physical activities to be carried out, the safest possible situations must be sought.

Bilateral lunate intraosseous ganglia.

An intraosseous ganglion is a relatively uncommon, benign cystic lesion that occurs in young and middle-aged adults. Bilateral and symmetrical lesions of the wrist are rare. Intraosseous ganglia of the carpal bones are uncommon causes of chronic wrist pain. Isolated cases of intraosseous ganglion have been reported most commonly in the lunate and scaphoid. The lunate was most frequently affected, followed by the capitate, scaphoid, and triquetrum bones. Radiolucent lesions in the carpal bones are not uncommon and are often seen incidentally in asymptomatic patients. The differential diagnosis of a lytic lesion in a carpal bone includes unicameral bone cyst, degenerative cyst, fibrous developmental defect, osteomyelitis, and intraosseous ganglion cyst. This article describes a case of bilateral lunate intraosseous ganglia. A review of the literature revealed that bilateral and symmetrical intraosseous ganglia of the wrist are rare, with only 3 other reported cases of bilateral lunate lesions.

Nonoperative treatment of an interosseous ganglion cyst.

Ganglion cysts of the knee are being reported more frequently secondary to an increased rate of magnetic resonance imaging studies. Although knee pain is the impetus for imaging, ganglion cysts are often incidental findings. Nonoperative treatment is a successful therapeutic option. We report a patient with variable pain presentations over the course of her treatment. The pattern of complaints pointed to different primary etiologies about the knee, but all were common to an interosseous ganglion cyst. A stepwise assessment and expansion of the differential diagnosis allowed for appropriate utilization of modalities and limited morbidity with nonoperative therapy.

Pseudotumour in von Willebrand disease.

Pseudotumour is a rare complication of haemophilia; it has previously been reported in patients with moderate or severe haemophilia and rarely in mild disease. We report a case of a proximal pseudotumour occurring in a 36-year-old patient with mild von Willebrand disease (vWD) who made a good recovery with conservative management. Surgery has been advocated as the optimal treatment for proximal pseudotumours due to the risk of continued bleeding and progression. However, in mild haemophilia or vWD, where the risk of spontaneous bleeds is low, conservative management may be an appropriate alternative.