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van Geloven TPG, van der Heijden L, Laitinen MK, Campanacci DA, Döring K, Dammerer D, Badr IT, Haara M, Beltrami G, Hobusch GM, Kraus T, Scheider P, Soto-Montoya C, Umer M, Saeed J, Funovics PT, Fiocco M, van de Sande MAJ, de Witte PB. As simple as it sounds? The treatment of simple bone cysts in the proximal femur in children and adolescents: Retrospective multicenter EPOS study of 74 patients. J Child Orthop 2024; 18:85-95. [PMID: 38348433 PMCID: PMC10859114 DOI: 10.1177/18632521231221553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/03/2023] [Indexed: 02/15/2024] Open
Abstract
Purpose Simple bone cysts are among the most prevalent benign cystic tumor-like lesions in children. Proximal femoral simple bone cysts may require specific treatment because of increased fracture risk. With limited literature available on this specific localization, consensus regarding optimal treatment is lacking. We present a large international multicenter retrospective cohort study on proximal femoral simple bone cysts. Methods All consecutive pediatric patients with proximal femoral simple bone cyst from 10 tertiary referral centers for musculoskeletal oncology were included (2000-2021). Demographics, primary treatment, complications, and re-operations were evaluated. Primary outcomes were time until full weight-bearing and failure-free survival. Results Overall, 74 simple bone cyst patients were included (median age 9 years (range = 2-16), 56 (76%) male). Median follow-up was 2.9 years (range = 0.5-21). Index procedure was watchful waiting (n = 6), percutaneous procedure (n = 12), open procedure (n = 50), or osteosynthesis alone (n = 6). Median time until full weight-bearing was 8 weeks (95% confidence interval = 0.1-15.9) for watchful waiting, 9.5 (95% confidence interval = 3.7-15.3) for percutaneous procedure, 11 (95% confidence interval = -0.7 to 13.7) for open procedure, and 6.5 (95% confidence interval = 5.9-16.1) for osteosynthesis alone (p = 0.58). Failure rates were 33%, 58%, 29%, and 0%, respectively (p = 0.069). Overall failure-free survival at 1, 2, and 5 years was 77.8% (95% confidence interval = 68.2-87.4), 69.5% (95% confidence interval = 58.5-80.5), and 62.0% (95% confidence interval = 47.9-76.1), respectively. Conclusion A preferred treatment for proximal femoral simple bone cysts remains unclear, with comparable failure rates and times until full weight-bearing. Watchful waiting may be successful in certain cases. If not feasible, osteosynthesis alone can be considered. Treatment goals should be cyst control, minimizing complications and swift return to normal activities. Therefore, an individualized balance should be made between undertreatment, with potentially higher complication risks versus overtreatment, resulting in possible larger interventions and accompanying complications. Level of evidence Level IV, retrospective multicentre study.
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Affiliation(s)
- Thomas PG van Geloven
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Lizz van der Heijden
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Minna K Laitinen
- Bone Tumor Unit, Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Domenico A Campanacci
- Orthopedic Oncology and Reconstructive Surgery, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Kevin Döring
- Division of Orthopedics, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Dietmar Dammerer
- Department of Orthopaedics and Traumatology, University Hospital of Krems, Krems, Austria
| | - Ismail T Badr
- Orthopedic Surgery, Menoufia University, Shebin El-Kom, Egypt
| | - Mikko Haara
- Pediatric Surgery and Orthopedics, New Children’s Hospital Helsinki, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Giovanni Beltrami
- Pediatric Orthopedics, Azienda Ospedaliero Universitaria Meyer, Florence, Italy
| | - Gerhard M Hobusch
- Division of Orthopedics, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Tanja Kraus
- Pediatric Orthopedic Unit, Orthopedics and Traumatology, University of Graz, Graz, Austria
| | - Philipp Scheider
- Trauma Surgery, University Clinic of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Masood Umer
- Orthopedic Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Javeria Saeed
- Orthopedic Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Phillipp T Funovics
- Division of Orthopedics, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Marta Fiocco
- Medical Statistics Section, Department of Biomedical Data Science, Leiden University Medical Center, Leiden, The Netherlands
- Mathematical Institute, Leiden University, Leiden, The Netherlands
| | | | - Pieter Bas de Witte
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Wuennemann F, Kintzelé L, Weber MA, Kauczor HU, Rehnitz C. [Radiologic diagnosis of pathologic fractures]. Radiologe 2020; 60:498-505. [PMID: 32410104 DOI: 10.1007/s00117-020-00693-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pathologic fractures are fractures that occur without an adequate traumatic event due to focal benign or malignant skeletal lesions. The most common causes of pathologic fractures are cystic bone lesions, plasmocytoma or multiple myeloma, and the development of osseous metastases, which is increasing due to an aging general population and advances in cancer treatment. The differentiation of pathologic fractures from stress fractures, especially osteoporotic insufficiency fractures is crucial for correct treatment planning. OBJECTIVES This review intends to explain the imaging characteristics of pathologic fractures. Moreover, it explains the role of imaging when pathologic fractures are suspected. In addition, the Mirels' score and the SINS (Spinal Instability Neoplastic Score), which are powerful yet easy-to-use tools for the assessment of the fracture risk of benign or malignant bony lesions of the extremities and the vertebral column, shall be introduced. MATERIALS AND METHODS A PubMed literature search with the following terms was conducted: "pathologic fracture", "fatigue fracture", "insufficiency fracture", "treatment of pathologic fractures", "imaging of pathologic fractures", "fracture risk", "bone metastases", "MRI of pathologic fractures", "CT of pathologic fractures", "differentiation of pathologic and insufficiency fractures", "Mirels' score", "SINS" and "spinal instability neoplastic score". RESULTS The definitions of pathologic, fatigue, and insufficiency fractures are explained. Moreover, the role of imaging in the clinical workup of suspected pathologic fractures and the differentiation of pathologic fractures from fatigue or insufficiency fractures as well as common scoring systems to assess the fracture risk of pathologic fractures are described.
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Affiliation(s)
- Felix Wuennemann
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
| | - Laurent Kintzelé
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - Marc-André Weber
- Institut für diagnostische und interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Straße 6, 18057, Rostock, Deutschland
| | - Hans-Ulrich Kauczor
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - Christoph Rehnitz
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
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Thierfelder KM, Niendorf S, Gerhardt JS, Weber MAD. [Bone tumors and metastases: tips for initial diagnosis and follow-up : Update 2019]. Radiologe 2020; 60:169-178. [PMID: 31974747 DOI: 10.1007/s00117-019-00635-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Benign bone tumors are frequently discovered as incidental findings, whereas malignant tumors and metastases often become clinically noticeable due to pain or swelling. The initial radiological diagnostics by conventional X‑ray imaging, magnetic resonance imaging (MRI) and computed tomography (CT) play an important role in the assessment of dignity and further treatment planning. The aftercare of bone tumors is necessary for the recognition of recurrences and distant metastases as well as the detection of complications, e.g. after implantation of a prosthesis. Implanted metal and posttherapeutic alterations can impede the aftercare due to artifacts and treatment-associated tissue alterations. In addition to the recommendations of the Association of the Scientific Medical Societies in Germany (AWMF), the European Organisation for Research and Treatment of Cancer (EORTC) and the European Society of Musculoskeletal Radiology (ESSR), study protocols can be used as orientation for the aftercare of individual primary malignant bone tumors.
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Affiliation(s)
- Kolja M Thierfelder
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland.
| | - Sophie Niendorf
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland
| | - Judith S Gerhardt
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland
| | - Marc-An Dré Weber
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland
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Holl N, Weber MA. [Incidental findings in recurrent patella dislocation]. Radiologe 2018; 59:43-45. [PMID: 30523355 DOI: 10.1007/s00117-018-0477-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- N Holl
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland.
| | - M-A Weber
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland
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