Treatment of bone cysts by percutaneous injection of demineralized bone matrix mixed with bone marrow.

Bone cysts whether aneurysmal or simple, are known for their tendency to recur. To replace the classical aggressive surgeries, minimally invasive techniques were developed giving differing results based on variable radiographic criteria. No unique percutaneous treatment has proven effective on both types of cysts. The purpose of this study was to evaluate with volumetric MRI calculations the benefit of percutaneous injection of demineralized bone matrix mixed with autogenous bone marrow on both types of cysts. Twenty-seven cysts; 6 aggressive aneurysmal bone cysts (ABCs) and 21 active simple bone cysts (SBCs) were treated with our percutaneous treatment in this case series. Regular MRIs were performed to calculate their volumetric evolution starting before treatment and with a minimal two-year follow-up. A cyst was considered healed when its final residual volume shrank to less than 50%. To allow statistical comparison between both types of cysts, 13 previously reported ABCs treated with the same protocol in our institution were joined to the 6 present ABCs. Four ABCs healed with a single injection while the 2 others recurred. Five SBCs healed with a single injection, 9 others after a second injection and 2 others after a third injection. Five SBCs were considered non-healed. The present healing rate in 67% of ABCs is consistent with the previous series as there was no significant difference (p=0.37). The better global healing rate for ABC (79%) was not statistically different from the SBC healing rate (76%) (p=0.83). The percutaneous injection of demineralized bone matrix mixed with bone marrow is an effective treatment for both types of cysts.

Painless osteoid osteoma of the distal phalanx of a toe.

Osteoid osteoma is a benign bone tumor, found in young subjects with typical intense focal pain, nocturnal exacerbation and favorable response to salicylates. Painless osteoid osteomas are rare and their diagnosis is difficult, especially whether their imaging appearance is not typical. We report the case of a 13-year-old boy with a spontaneous painless lesion of the distal phalanx of a toe. The main symptom was a swelling of the distal portion of the toe with an enlargement of its nail. The radiological aspect was not typical. A computed tomography showed a small lucent bone area within a focal hypertrophy of the phalangeal tuft and an osteoid osteoma was proposed as main diagnosis. The tumor was completely removed and the histopathological examination confirmed the diagnosis of osteoid osteoma. This clinical case shows that painless swelling of a toe may be indicative of an osteoid osteoma.

Natural history of shelf gap and paleo-acetabular depth after shelf acetabuloplasty for Perthes disease.

The purpose of this study was to evaluate the morphologic evolution of the shelf gap, acetabulum and femoral head after shelf acetabuloplasty in patients affected by Perthes disease. 54 patients operated for Perthes disease with shelf acetabuloplasty were retrospectively reviewed regarding the radiographic results. Three pelvic antero-posterior radiographs have been studied for each patient, one at 2 postoperative months, one at 1 postoperative year and one at the latest clinical follow up (mean 76 postoperative months). The shelf gap decreased from 108% at 2 months to 104% at the last follow-up (p<0.001). There was an increase of the total acetabular depth to 168% by the presence of the shelf graft (p<0.001). The acetabular index of the operated side related to the contralateral side was 68% at 2 months due to the effect of the graft (p<0.001). The migration index of the shelf side was in mean -24% at 2 months and -3% at last follow- up (p<0.001). According to the Stulberg classification, there were 9 type 1 (17%), 20 type 2 (37%), 19 type 3 (35%), 5 type 4 (9%) and 1 type 5 (2%). A progressive remodeling with shelf gap reduction was occurring during the following months after the surgery. An increase of the total acetabular depth and a decrease of the migration index without a lateral overgrowth of the paleo-acetabulum was observed. Shelf acetabuloplasty is a good procedure to prevent early osteoarthritis by a better femoral head coverage.

Surgical management of rickets-like bone deformities (knock-knee and bow-leg) in children in sub-Saharan Africa.

Rickets-like deformities of the lower limb (knock- knee or bow-leg) are very frequent in sub-Saharan Africa. A prospective study was carried out over a period of 5 years. Forty-eight children were treated surgically for rickets-like deformities. The surgical technique was guided growth using a tension-band plate (eight plate). One patient was lost to follow- up. The technique failed in two cases (absence of correction in one case and hypercorrection in one case). Five patients are still under follow-up with progressive correction and were excluded from the study. A full correction was achieved in 40 patients (73 knees). There were 33 bilateral and 7 unilateral deformities. The deformities were knock-knees in 20 cases, bowlegs in 18 cases and there were 2 windswept deformities Good correction was obtained after a mean time of 11.4 months for genu varum and after a mean time of 12.4 months. The two windswept deformities were corrected after 8 and 9 months respectively. The guided growth technique using eight plate is effective as well in Africa. The needed material is not expensive if a two-hole tubular plate is used with two 3.5 screws.