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Rai AK, Rathod TN, Bansal D, Hadole BS, Rahman SH, Kumar K G G, Prabhu RM. Clinicoradiological outcome of percutaneous intralesional polidocanol in Aneurysmal Bone Cysts: A prospective study of 43 patients in a single tertiary care centre. J Orthop 2022; 32:72-77. [DOI: 10.1016/j.jor.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/04/2022] [Accepted: 05/12/2022] [Indexed: 10/18/2022] Open
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Borni M, Kolsi F, Cherif I, Boudawara MZ. Spontaneous rapid regression of a juvenile primary aneurysmal bone cyst of the skull: A case report and literature review. Radiol Case Rep 2022; 17:1634-1639. [PMID: 35321267 PMCID: PMC8935339 DOI: 10.1016/j.radcr.2022.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/08/2022] [Accepted: 02/12/2022] [Indexed: 11/26/2022] Open
Abstract
Aneurysmal bone cyst (ABC) is a benign lesion that often starts off the metaphysis of long bones and which, as it grows, may blow out bone. Only 3%-6% of cases are located in the skull. Spontaneous recovery has been reported. These cases occur more often in adults and in pelvic locations. Spontaneous regression at the skull level remains a very rare entity and few cases were described in the literature. Here, the authors report another case of spontaneous rapid regression of ABC of the skull in a 7-year-old boy revealed by gradually increasing painless hard swelling in the right frontal bone region with rapid spontaneous regression within 15 days. The authors will also proceed with an overview concerning this rare entity.
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Sharma PK, Kundu ZS, Lamba A, Singh S. Diaphyseal aneurysmal bone cysts (ABCs) of long bones in extremities: Analysis of surgical management and comparison with metaphyseal lesions. J Clin Orthop Trauma 2021; 18:74-79. [PMID: 33996452 PMCID: PMC8099782 DOI: 10.1016/j.jcot.2021.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/24/2021] [Accepted: 04/10/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Aneurysmal bone cysts (ABCs) are benign lesions of long bone metaphysis affecting mostly medullary region in younger age below 20 years of life. These may be originated rarely either in the cortex or in the superficial regions of diaphysis. The study highlighted the differences of diaphyseal lesions from the usual metaphyseal ones in view of their clinical, radiological and biological behavior and also discussed their management in brief. MATERIAL AND METHODS We reviewed a total of 84 aneurysmal bone cysts over the past fourteen years (2004-2017) and evaluated their surgical outcomes retrospectively. Total ten lesions were diaphyseal cortical in location (group I), while 74 lesions were conventional metaphyseal type (group II). RESULTS We observed that cortical ABCs were occurred commonly in diaphysis of femur, humerus, tibia and radius while presentation was at an older age than metaphyseal type. Radiographically these were eccentric lesion and more prone for pathological fractures than conventional type. These are differentiated radiographically from other benign lesions but also mimicking malignant conditions including low grade surface osteosarcoma and telangiectatic osteosarcoma while resemble similar to these on histopathological examination (HPE). CONCLUSION Biological behavior of cortical lesions does not differ significantly than conventional type but these are more prone for pathological fractures so these eccentric cortical ABC lesions should be treated with adequate internal fixation along with curettage and bone grafting. Although incidence of cortical or surface variety of ABCs is rare but surgeons might evaluate its severity in view of aggressive benign or malignant lesions of diaphysis.
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Affiliation(s)
- Pankaj Kumar Sharma
- Department of Orthopaedics, All India Institute of Medical Sciences, House no 191, Model Town, Phase 3, Bathinda, Punjab, 151001, India,Corresponding author. Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, Punjab, India.
| | - Zile Singh Kundu
- Positron Multispeciality Hospital, Department of Orthopaedics, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, 124001, India
| | - Akshay Lamba
- Department of Orthopaedics, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, 124001, India
| | - Sunita Singh
- Department of Pathology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, 124001, India
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Paraskeva K, Giakoumettis D, Nikas I, Georgoulis G, Sfakianos G, Themistocleous MS. Primary Ewing sarcoma of the axis-C2: A case report and the review of the literature. Neurol Neurochir Pol 2018; 52:534-542. [DOI: 10.1016/j.pjnns.2018.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 02/23/2018] [Accepted: 02/25/2018] [Indexed: 12/12/2022]
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Abstract
PURPOSE To evaluate the long-term effectiveness of radiation therapy (RT) as an adjuvant or alternative treatment for patients with aneurysmal bone cyst (ABC). PATIENTS AND METHODS The medical records of 12 patients who received RT at the University of Florida for ABC between 1964 and 2011 were reviewed and patients were contacted, when possible, for follow-up. Follow-up duration ranged from 3 to 36 years (median, 20.5 y). Patient age at the time of RT ranged from 3 to 23 years (mean, 12.75 y), with 7 females and 5 males. Four patients were treated for recurrent ABCs. Three patients were treated with surgical interventions (intralesional curettage, subtotal resection, or selective arterial embolization) before RT, and the rest received open biopsy only. The prescribed doses ranged from 20 to 60 Gy (mean, 30.15 Gy). Ten (83.3%) patients received between 1.5 and 2.0 Gy per fraction. RESULTS All patients were doing well and free of any adverse reaction to RT as of the latest follow-up, including 1 who passed away from cardiac problems 34 years since completing RT and 3 who were lost to follow-up (at 16, 16, and 19 y) but were doing well at the last follow-up. CONCLUSIONS RT continues to result in an excellent prognosis for patients with ABC who receive either RT alone or adjuvant RT after surgery.
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Affiliation(s)
- Simeng Zhu
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL
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Bakkaly AE, Hanine MD, Amrani A, Dendane A, El Alami SZF, Madhi TE. [Aneurysmal bone cyst of the clavicle: about a case]. Pan Afr Med J 2017; 27:115. [PMID: 28819536 PMCID: PMC5554688 DOI: 10.11604/pamj.2017.27.115.11945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/30/2017] [Indexed: 11/29/2022] Open
Abstract
Le kyste osseux anévrismal est une lésion agressive et destructrice, mais bénigne, des os longs, de la colonne vertébrale ou du bassin, touchant principalement les enfants et les jeunes adultes. Il s’agit cependant d’une véritable tumeur rare. Nous rapportons un cas d’un garçon de 8 ans,présentant une localisation très rare de kyste anévrismal, claviculaire, qui s'est initialement présenté pour une fracture sur os pathologique soit une lésion kystique bénigne. L'enfant a bénéficié d'un traitement radical avec résection complète du kyste situé au niveau de la clavicule droite avec envoi de la pièce opératoire pour étude anatomo-pathologique, confirmant notre diagnostic. L'évolution a été marquée par l'absence de récidive et un bon remodelage osseux sur le plan radiologique. Le traitement radical par résection semble permettre d'éviter la récidive. A travers notre travail, nous voulons mettre le point sur cette affection orthopédique rare en comparant nos résultats avec ceux de la littérature mondiale.
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Affiliation(s)
- Achraf El Bakkaly
- Service de Chirurgie Orthopédique Pédiatrique, CHU Ibn Sina / Faculté de Médecine Mohammed V, Rabat, Maroc
| | - Moulay Dris Hanine
- Service de Chirurgie Orthopédique Pédiatrique, CHU Ibn Sina / Faculté de Médecine Mohammed V, Rabat, Maroc
| | - Abdelouahed Amrani
- Service de Chirurgie Orthopédique Pédiatrique, CHU Ibn Sina / Faculté de Médecine Mohammed V, Rabat, Maroc
| | - Anouar Dendane
- Service de Chirurgie Orthopédique Pédiatrique, CHU Ibn Sina / Faculté de Médecine Mohammed V, Rabat, Maroc
| | | | - Tarik El Madhi
- Service de Chirurgie Orthopédique Pédiatrique, CHU Ibn Sina / Faculté de Médecine Mohammed V, Rabat, Maroc
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Niemeier TE, Leddy LR, Chapin RW, Smith MT. Metachronous Aneurysmal Bone Cysts in a Fourteen-Year-Old Girl: A Case Report and Review of the Literature. JBJS Case Connect 2013; 3:e55. [PMID: 29252387 DOI: 10.2106/jbjs.cc.l.00295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Thomas E Niemeier
- College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 601, MSC 617, Charleston, SC 29425
| | - Lee R Leddy
- Department of Orthopaedic Surgery, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 622, Charleston, SC 29425
| | - Russell W Chapin
- Department of Radiology (R.W.C.) and Department of Pathology (M.T.S.), Medical University of South Carolina, 169 Ashley Avenue, MSC 322, Charleston, SC 29425
| | - M Timothy Smith
- Department of Radiology (R.W.C.) and Department of Pathology (M.T.S.), Medical University of South Carolina, 169 Ashley Avenue, MSC 322, Charleston, SC 29425
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Abstract
Aneurysmal bone cyst (ABC) is a locally aggressive, benign bone tumor that commonly affects children. Metachronous ABCs are rare, and have been described only three times in the literature. Here we present a fourth case in a 9-year-old boy who presented with an ABC of the scapula; 2½ years later he presented with a tibial ABC. We also review the literature and discuss the pathological and clinical characteristics of this lesion.
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Ozdamar Y, Acaroglu G, Kazanci B, Saka C, Kazanci B. Aneurysmal bone cyst of the ethmoid presenting with proptosis and epiphora. Orbit 2010; 29:149-151. [PMID: 20497081 DOI: 10.3109/01676830903407076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
An aneurysmal bone cyst of ethmoid is a rare and distinct clinicopathologic entity. The diagnosis is important in this localization because it requires multidisciplinary approach in its management. We report a case of a 14-year-old woman presenting to our clinic with the complaint of epiphora and proptosis in the right eye, which were the symptomatic findings of aneurysmal bone cyst of ethmoid.
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Affiliation(s)
- Yasemin Ozdamar
- Department of Retina, Ankara Ulucanlar Eye Research Hospital, Ankara, Turkey.
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Ramboaniaina S, Hoang DV, Berger M. [Aneurysmal carpal scaphoid cyst. A case report]. ACTA ACUST UNITED AC 2008; 28:46-9. [PMID: 19095484 DOI: 10.1016/j.main.2008.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Revised: 09/02/2008] [Accepted: 11/03/2008] [Indexed: 11/26/2022]
Abstract
Aneurysmal bone cyst is a rare, benign bone tumor and its location in the carpal scaphoid has never been described in the literature. We report a clinical case illustrating this location.
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Affiliation(s)
- S Ramboaniaina
- Service de chirurgie orthopédique et traumatologie, centre hospitalier de Douai, route de Cambrai, Douai cedex, France.
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Anoumou MN, Gogoua R, Kouamé M, Arame F, Koné B, Varango G. [Aneurismal bone cyst of clavicle: A case report]. ACTA ACUST UNITED AC 2006; 25:169-72. [PMID: 17175807 DOI: 10.1016/j.main.2006.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Aneurismal bone cyst is a rare tumour. The authors report an exceptional case in its clavicle localization. They review the diagnosis circumstances and treatment modalities of this pathology. The occurrence of the cyst is linked to vascular homodynamic disturbance and its discovery in a post-traumatic context has been assessed by the histology exam. Although numerous therapeutic trials, radical removal versus conservatory methods avoid relapse. Finally, resection of the clavicle leading to few functional consequences should be recommended for the cure of evoluted aneurismal bone cyst.
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Affiliation(s)
- M-N Anoumou
- Service d'orthopédie-traumatologie, CHU de Treichville, 01 BP V3, Abidjan 01, Côte-d'voire.
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Shisha T, Marton-Szucs G, Dunay M, Pap K, Kiss S, Nemeth T, Szendrõi M, Szoke G. The dangers of intraosseous fibrosing agent injection in the treatment of bone cysts. The origin of major complications shown in a rabbit model. INTERNATIONAL ORTHOPAEDICS 2006; 31:359-62. [PMID: 16821010 PMCID: PMC2267601 DOI: 10.1007/s00264-006-0177-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2006] [Revised: 05/14/2006] [Accepted: 05/15/2006] [Indexed: 11/28/2022]
Abstract
Direct intraosseous injection of fibrosing agent is widely used in the treatment of aneurysmal bone cysts. The purpose of this study was to evaluate the consequences of fibrosing agent penetrating the medulla of bones. This may be the case when, by mistake, the fibrosing agent is administered into the medulla or when the wall of the cyst ruptures and fibrosing agent is able to drift into the medulla. Twelve rabbits were injected transcutaneously with a fibrosing agent directly into the proximal metaphysis of the tibia. Prior to injection 0.5 ml of liquid-like, bloody, intraosseal tissue was aspirated, then 0.5 ml of fibrosing agent was administered. Fibrosing agent was introduced slowly (20 s) to avoid overpressure. Nine rabbits (75%) died within minutes after the introduction of fibrosing agent. A full body roentgenogram was taken of each rabbit and the animals that died underwent autopsy to find the exact cause of death. Roentgenograms of the chest showed massive multiple pulmonary emboli confirmed in all lethal cases by the autopsy. This animal model was created to draw attention to the dangers of any leakage of the fibrosing agent into the medulla of bones.
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Affiliation(s)
- T Shisha
- Department of Orthopaedic Surgery, Semmelweis University, Karolina ut 27, 1117 Budapest, Hungary.
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Abstract
OBJECTIVES The purpose of this article is to discuss the natural history, treatment, and outcomes for patients with aneurysmal bone cysts (ABC). METHODS Review of the pertinent literature. RESULTS ABCs account for 1% to 2% of all primary bone tumors, usually present in the first 2 decades of life, and exhibit a slight female preponderance. The majority of patients are treated with curettage with local control rates ranging from approximately 70% to 90%. Almost all patients with recurrences are salvaged by one or more additional operations. A small subset of patients is treated with marginal or wide excision and almost all are locally controlled. A few patients with incompletely resectable, aggressive, and/or recurrent ABCs are treated with low-dose (26-30 Gy) radiotherapy (RT) and are locally controlled in approximately 90% of cases. CONCLUSIONS The mainstay of treatment is surgery and most patients are cured with one or more operations. A small subset of patients with incompletely resectable, aggressive, and/or recurrent ABCs may be cured with low-dose RT.
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Affiliation(s)
- William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA.
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Shinde A, Mehlman CT, Collins MH. Aneurysmal bone cysts express vascular markers. Pediatr Dev Pathol 2006; 9:38-43. [PMID: 16808643 DOI: 10.2350/06-05-0070.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2005] [Accepted: 09/28/2005] [Indexed: 11/20/2022]
Abstract
Recently, clonal chromosome abnormalities have been identified in the mural spindle cells in aneurysmal bone cysts (ABCs), but the nature of the cystic spaces is unclear. Endothelial injury has been suggested as a mechanism of aneurysmal formation in these lesions, but few studies have surveyed vascular markers in ABCs. We stained 25 primary aneurysmal bone cysts with a variety of antibodies that stain vessels. Antibody to factor 8 stained the edge of ABC cavities in almost all cases, and antibodies to VEGF-C, GLUT-1, and smooth muscle actin stained the edge of the cavities in approximately half the cases. Antibodies to D2-40 and CD34 also stained the edge of the cavities in some cases. These results suggest that the cavities in ABCs are related to vasculature and support the theory that vascular injury may be important in the pathogenesis of ABCs.
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Affiliation(s)
- Anjali Shinde
- Division of Pathology and Laboratory Medicine, ML1010, B4.180, University of Cincinnati Children's Hospital Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
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Jung ST, Jeong KC. Bone Tumors Specific in Children. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2006. [DOI: 10.5124/jkma.2006.49.12.1068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Sung Taek Jung
- Department of Orthopedic Surgery, Chonnam National University College of Medicine, Korea. ,
| | - Kwang Cheul Jeong
- Department of Orthopedic Surgery, Chonnam National University College of Medicine, Korea. ,
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Vale BP, Alencar FJ, de Aguiar GB, de Almeida BR. [Vertebral aneurysmatic bone cyst: study of three cases]. ARQUIVOS DE NEURO-PSIQUIATRIA 2005; 63:1079-83. [PMID: 16400432 DOI: 10.1590/s0004-282x2005000600030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Aneurysmatic bone cyst is a hypervascularized, benign lesion locally destructive by its progressive growth with greater incidence in the second decade of life. It lodges preferably in the long bones and vertebrae. The clinical picture varies from pain to local edema and even neurological symptoms when in vertebral location. Three cases of vertebral aneurysmatic bone cyst occurring in childhood and all with neurologic deficit symptoms are described. Computerized tomography and/or magnetic resonance imaging confirmed the diagnosis. Patients underwent surgery to remove the tumor. In one of the cases, pre-operative selective arterial embolization of the lesion was performed. The three patients progressed satisfactorily with neurological improvement, which demonstrated the efficiency of the microsurgical technique for the resection of the spinal tumor. The evolution of the cases and the current treatment are discussed.
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Mankin HJ, Hornicek FJ, Ortiz-Cruz E, Villafuerte J, Gebhardt MC. Aneurysmal bone cyst: a review of 150 patients. J Clin Oncol 2005; 23:6756-62. [PMID: 16170183 DOI: 10.1200/jco.2005.15.255] [Citation(s) in RCA: 251] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We have reviewed a series of 150 aneurysmal bone cysts treated over the last 20 years. PATIENTS AND METHODS The lesions were principally located in the tibia, femur, pelvis, humerus, and spine and, in most cases, presented the imaging appearance originally described by Jaffe and Lichtenstein as a blowout with thin cortices. RESULTS Only one of the patients was believed to have an osteoblastoma of the spine with secondary development of an aneurysmal bone cyst, and none of the patients developed additional lesions. The patients were treated primarily with curettage and implantation of allograft chips or polymethylmethacrylate, but some patients were treated with insertion of autografts or allografts. The local recurrence rate was 20%, which is consistent with that reported by other centers. CONCLUSION Aneurysmal bone cysts are enigmatic lesions of unknown cause and presentation and are difficult to distinguish from other lesions. Overall, the treatment is satisfactory, but it is possible that newer approaches, such as improved magnetic resonance imaging studies, may help diagnose the lesions and allow the physicians to plan for more effective treatment protocols.
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Affiliation(s)
- Henry J Mankin
- Orthopedic Oncology Service, Orthopedic Surgery, Massachusetts General Hospital, Boston, MA 02114, USA.
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Kapoor H, Singh D, Bhatia N, Chaudhary D, Singh AK. Distal tibial aneurysmal bone cyst treatment by using a proximal fibular autologous bone graft: a case report. J Foot Ankle Surg 2004; 43:179-84. [PMID: 15181435 DOI: 10.1053/j.jfas.2004.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A case of an aneurysmal bone cyst that involved the distal tibia and medial malleolus with erosion of the medial cortex in a 22-year-old woman is presented. The patient was surgically treated by curettage and bone grafting along with reconstruction of the distal tibia by using ipsilateral proximal fibula. At the 2-year follow-up, the patient had full, painless range of motion and complete incorporation of the fibular graft. The authors discuss the different treatment options for benign tumors of the distal tibia and the advantages of using proximal fibula as an autologous bone graft in the reconstruction of medial malleolus.
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Affiliation(s)
- Harmesh Kapoor
- Central Institute of Orthopedics, Safdarjung Hospital, A-1/7, Paschim Vihar, New Delhi 110-063, India.
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Choi IH, Chung CY, Cho TJ, Kim IO, Kim CJ, Sohn YJ. Aneurysmal bone cyst arising from a fibrous metaphyseal defect in a toddler. Clin Orthop Relat Res 2002:216-20. [PMID: 11937884 DOI: 10.1097/00003086-200202000-00025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This is a case of aneurysmal bone cyst arising from a fibrous metaphyseal defect of the proximal tibia in a toddler. A 32-month-old girl presented with physiologic bowing with a small metaphyseal defect at the medial aspect of the left proximal tibia. A large aneurysmal bone cyst, occupying almost the entire metaphysis of the proximal tibia, evolved from this lesion during the following 1 year 3 months. The lesion healed uneventfully after curettage and bone grafting. This case emphasizes the importance of regular followups to observe the clinical course of a fibrous metaphyseal defect during childhood.
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Affiliation(s)
- In Ho Choi
- Department of Orthopaedic Surgery, Seoul National University, Children's Hospital and Clinical Research Institute, Seoul National University Hospital, Chongno-gu, Seoul, Republic of Korea
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