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De Vitis R, Vitiello R, Perna A, Passiatore M, Cipolloni V, Pripp C, Taccardo G. Hand's aneurysmal bone cyst: A rare localization. Case report and systematic literature review. Orthop Rev (Pavia) 2020; 12:8658. [PMID: 32913594 PMCID: PMC7459386 DOI: 10.4081/or.2020.8658] [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: 06/10/2020] [Accepted: 06/17/2020] [Indexed: 11/30/2022] Open
Abstract
Aneurysmal bone cysts are benign, rare bony tumours frequently observed among children and young adults principally located in the long bones, pelvis, and spine and rarely in other anatomical district such as the hand. We report the case of a 12-year-old girl with an aneurysmal bone cyst, in active stage, involving the still-open epiphysis of the fourth metacarpal of the right hand, which was in a first time treated by curettage, and 3 months later, occurring a recurrence, by a radically excision of the bone and reconstruction with a graft from the iliac crest. At 10-year follow-up the patient had good cosmetic results and a functioning hand. We also performed a systematic Literature review in order to retrieve the key information regarding: the diagnosis, the clinical features and the treatment.
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Affiliation(s)
- Rocco De Vitis
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Raffaele Vitiello
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Perna
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Passiatore
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valerio Cipolloni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Giuseppe Taccardo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Università Cattolica del Sacro Cuore, Rome, Italy
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Zaidenberg EE, Farias Cisneros E, Miller R, Zaidenberg CR. Metacarpal Aneurysmal Bone Cyst En Bloc Resection Reconstructed With Osteoarticular Allograft. J Hand Surg Am 2019; 44:425.e1-425.e5. [PMID: 30017650 DOI: 10.1016/j.jhsa.2018.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/18/2018] [Accepted: 06/05/2018] [Indexed: 02/02/2023]
Abstract
Aneurysmal bone cysts are large lytic lesions that appear most often around metaphyseal bone. The lesions are locally aggressive with high recurrence rates. Therefore, wide resection is commonly necessary, leading to challenging reconstruction of the defect, especially when the articular surface is involved. We present a case of an aneurysmal bone cyst of the fourth metacarpal, treated with an en bloc resection and reconstruction with a metacarpal osteoarticular allograft. At 8 years after surgery, the patient has shown no signs of recurrence, but radiographic articular reabsorption was noted. However, the patient showed an excellent outcome with a satisfactory active range of motion and grip strength. Despite potential complications, osteoarticular allograft is a feasible alternative when autologous osteoarticular reconstruction is not an option.
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Affiliation(s)
- Ezequiel Ernesto Zaidenberg
- Department of Orthopaedics, Italian Hospital of Buenos Aires, University of Buenos Aires, Buenos Aires, Argentina; Kleinert-Kutz Institute for Hand and Microsurgery, Louisville, KY.
| | - Efrain Farias Cisneros
- Department of Orthopaedics, Italian Hospital of Buenos Aires, University of Buenos Aires, Buenos Aires, Argentina
| | - Ryan Miller
- Department of Orthopaedics, Italian Hospital of Buenos Aires, University of Buenos Aires, Buenos Aires, Argentina
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3
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The Radial Aspect of the Distal Radial Metaphysis/Diaphysis as a Source of Cortical Bone Graft. J Hand Surg Am 2017; 42:577.e1-577.e5. [PMID: 28533002 DOI: 10.1016/j.jhsa.2017.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 09/18/2016] [Accepted: 04/18/2017] [Indexed: 02/02/2023]
Abstract
Cortical bone grafting is commonly required in the finger, hand, and carpus when managing bony trauma. A donor site that can provide a small or large amount of cortical bone graft that is easily accessible and within the same surgical field would be the ideal donor site. In high-energy injuries, a long cortical graft may be needed to reconstruct massive bony defects. In low-energy injuries such as scaphoid nonunions in which a wedge graft is needed, a reliable and easily accessible source of bone grafting would be beneficial. Although the traditional iliac bone grafting can be used, this option requires a separate sterile field to be prepared and may lead to donor site pain and morbidity. We propose an option that places the donor source close to the hand and wrist. The radial aspect of the distal radius metaphysis/diaphysis is superficial, which makes access and closure simpler than other alternatives. Furthermore, the technique only partly violates 1 of the 3 surfaces of the radius so that there is minimal weakening of the integrity of the bone and the likelihood of fracture is low. In this article, we describe the indications, contraindications, surgical technique, and postoperative management of the radial aspect of the distal radius metaphysis/diaphysis as a source of bone grafting.
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Lesensky J, Nemec K, Kofranek I, Matejovsky Z. Autologous structural iliac bone grafts in reconstructions of short bone defects in the hand and foot after primary bone tumor resections: a single-institution retrospective study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:797-804. [DOI: 10.1007/s00590-017-1990-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 05/26/2017] [Indexed: 11/28/2022]
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Bipolar electric cauterization as adjuvant treatment after curettage of aneurysmal bone cysts of the hand. Ann Plast Surg 2013; 72:38-40. [PMID: 24317236 DOI: 10.1097/sap.0000000000000000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Almost all aneurysmal bone cysts of the hand were managed with either simple curettage plus or minus bone graft or en block excision and autograft reconstruction. The high recurrence rate is a major disadvantage of the former technique, whereas complexity/donor-site morbidities are known disadvantages of the latter technique. In the long bones of the lower limbs, adjuvant therapy after curettage is known to reduce the recurrence rate. This article introduces adjuvant bipolar electrical cauterization after curettage of aneurysmal bone cysts of the hands. This technique was used in 6 cases including 1 case with a recurrent lesion after curettage done elsewhere. Complications have been minimal and there was no recurrence at a mean follow-up of 3 years. Although the number of cases in this series is small, the favorable results warrant trying the technique in a multicenter comparative study.
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Jones NF, Dickinson BP, Hansen SL. Reconstruction of an entire metacarpal and metacarpophalangeal joint using a fibular osteocutaneous free flap and silicone arthroplasty. J Hand Surg Am 2012; 37:310-5. [PMID: 22154723 DOI: 10.1016/j.jhsa.2011.10.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 10/13/2011] [Accepted: 10/14/2011] [Indexed: 02/02/2023]
Abstract
Radical resection of the entire ring finger metacarpal for a giant cell tumor resulted in a bony defect extending from the distal surface of the hamate to the proximal surface of the proximal phalanx. We reconstructed the metacarpal with a custom-contoured free fibular osteocutaneous flap and maintained motion at the new fibulophalangeal joint using a silicone arthroplasty. At 4.5 years postoperatively, the patient has shown no signs of recurrence of the giant cell tumor. The silicone arthroplasty has maintained 15° to 85° of motion at the new joint. Because of its similar shape to a metacarpal and because it allows faster bony healing compared with a nonvascularized fibular bone graft, a free vascularized fibular bone graft is an ideal candidate for reconstruction of extensive defects of the metacarpals, and placement of a silicone spacer in its distal medullary cavity can preserve motion at the new metacarpophalangeal joint.
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Affiliation(s)
- Neil F Jones
- University of California Irvine Center for Hand and Upper Extremity Surgery, Department of Orthopaedic Surgery, University of California Medical Center, Orange, CA, USA
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Ozyurek S, Rodop O, Kose O, Cilli F, Mahirogullari M. Aneurysmal bone cyst of the fifth metacarpal. Orthopedics 2009; 32:orthopedics.41932. [PMID: 19708623 DOI: 10.3928/01477447-20090624-25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Aneurysmal bone cyst is a rare, rapidly growing, and destructive benign bone tumor that even more rarely involves the bones of the hand. Various treatment options for aneurysmal bone cyst have been reported in the literature, but controversy exists regarding optimal treatment. Due to its rarity in the hand, no evidence-based treatment regimen has been established. A 21-year-old man presented with a history of pain and local swelling over his fifth metacarpal of 5 months' duration. Physical and radiographic examination of the hand was consistent with aneurysmal bone cyst. After biopsy, pathologic examination confirmed the diagnosis of aneurysmal bone cyst. En-block resection of the tumor and autologous bicortical strut graft fixation with Kirschner wires was performed. The hand was immobilized in a short arm cast for 3 weeks after the patient received 3 weeks of physiotherapy. Kirschner wires were removed 6 weeks postoperatively. Excellent clinical and functional results were obtained with no recurrence after 3 years of follow-up with en-block resection and reconstruction with iliac crest graft. Radiographic examination demonstrated the osseous integration of the graft with no signs of recurrence. Although treatment should be planned individually according to lesion site and size and to patient age, we suggest en-block resection to prevent recurrence and secondary surgical interventions particularly in cases with no articular involvement.
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Affiliation(s)
- Selahattin Ozyurek
- Department of Orthopedics, Izmir Military Hospital, Inonu Caddesi, Hatay, Izmir, Turkey
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Kotwal PP, Nagaraj C, Gupta V. Vascularised joint transfer in the management of recurrent giant cell tumour of the second metacarpal. J Hand Surg Eur Vol 2008; 33:314-6. [PMID: 18562363 DOI: 10.1177/1753193408089048] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This paper presents the medium-term follow-up results (34 and 40 months, respectively) of two cases of recurrent giant cell tumour of the head of the second metacarpal, treated by marginal excision and reconstruction with a vascularised toe joint transfer. Both patients had painless, stable joints with excellent ranges of motion at the metacarpophalangeal joint of 80 degrees and 70 degrees , respectively, no degenerative changes and no recurrence of the tumours.
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Affiliation(s)
- P P Kotwal
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
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Ropars M, Kaila R, Briggs T, Cannon S. Kystes anévrismaux des phalanges et des métacarpiens. À propos de six cas et revue de la littérature. ACTA ACUST UNITED AC 2007; 26:214-7. [PMID: 17869566 DOI: 10.1016/j.main.2007.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Revised: 01/02/2007] [Accepted: 08/09/2007] [Indexed: 11/19/2022]
Abstract
Aneurysmal bone cysts arising from tubular bones of the hand occur very rarely and require particular diagnostic and therapeutic management techniques. The authors report the diagnostic and surgical management of a monocentric case series of six aneurysmal bone cysts involving the phalangeal and metacarpal bones. In addition to hightlighting the use of diagnostic MRI and biopsy prior to surgical intervention, the authors describe the favourable outcome of curetage with and without the use of bone graft. An aggressive treatment approach such as cryotherapy or resection with reconstruction should only be used in cases when the articular surface is involved, when full bone invasion of the phalanx or metacarpal has occurred, or in case of more than one recurrence.
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Affiliation(s)
- M Ropars
- Service de chirurgie orthopédique et de réparatrice (SCOR) du Professeur Langlais, Rennes Urgences Main, hôpital Sud, 129, boulevard de Bulgarie, 35056 Rennes cedex, France.
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Ertem K, Karadag N, Altinok T, Karakas HM. Aneurysmatic bone cyst of the second metacarpal: en-block resection and bicortical iliac crest graft replacement. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2006. [DOI: 10.1007/s00590-006-0113-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Verolino P, Casoli V, Kostopoulos E, Castede JC, Pelissier P, Martin D, Baudet J. Second to Third Phalanx Vascularized Bone Transfer. Plast Reconstr Surg 2006; 117:1e-5e. [PMID: 16404238 DOI: 10.1097/01.prs.0000194909.73613.9d] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Pasquale Verolino
- Plastic Surgery and Burns Unit, University Hospital of Bordeaux, Bordeaux, France
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Ramboaniaina S, Berger M, Oweida H. Kyste anévrismal du deuxième métacarpien : technique de conservation de l'articulation métacarpophalangienne et résultat à court terme. ACTA ACUST UNITED AC 2005; 24:258-61. [PMID: 16277152 DOI: 10.1016/j.main.2005.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The authors report an aneurismal bone cyst in the second metacarpal of a 16-year-old patient. It was an aneurismal bone cyst of the agressive diffuse variety involving the proximal metaphyseal, diaphyseal and distal epiphyseal zones. Conservation of the MCP joint of the index was the priority. The authors report the technique used as well as the clinical and radiological results.
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Affiliation(s)
- S Ramboaniaina
- Service de chirurgie orthopédique et traumatologique, centre hospitalier de Douai, route de Cambrai, 59507 Douai, France.
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Salon A, Rémi J, Brunelle F, Drapé JL, Glorion C. Reconstruction d'une phalange totale par greffe chondrale libre non vascularisée après échec de sclérothérapie d'un kyste anévrysmal. ACTA ACUST UNITED AC 2005; 24:187-92. [PMID: 16121628 DOI: 10.1016/j.main.2005.04.003] [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: 10/25/2022]
Abstract
We treated an eleven year-old boy for an aneurysmal bone cyst of the middle phalanx of the long finger. Diagnosis was established after total curettage. The tumor involved the whole phalanx and grew steadily after two attempts at sclerotherapy (with absolute alcohol and Ethibloc). After two years, en-bloc resection had to be performed, and raised the problem of reconstructing a complete finger phalanx with its proximal and distal epiphyses. A free cartilaginous graft from the non-ossified iliac crest was shaped to the exact dimensions of the phalanx and set in its place, with minimal damage to the surrounding tissues during dissection and fixation. By six months an almost normal range of motion was achieved in the PIP (10 to 90 degrees ) and DIP (5 to 30 degrees) joints and radiographs showed complete metaplasia of the chondral graft into an ossified phalanx at 20 months follow-up. The joint spaces also remodelled, and this was confirmed with MRI scanning. Reports on partial replacement of diaphysis or epiphyses in the digits are discussed, but the only valid comparison of total phalanx replacement is free toe phalanx grafting. We did not choose this solution in a normal hand because of the length discrepancy between finger and toe phalanges. This case shows that, in this particular paediatric situation, the free non-vascularised transfer of a chondral graft restored excellent function, with remodelling of the phalanx and joint spaces of the finger.
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Affiliation(s)
- A Salon
- Service d'orthopédie infantile, hôpital Necker-Enfants-Malades, 147, rue de Sèvres, 75015 Paris, France.
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Gudemez E, Eksioglu F. Aneurysmal bone cyst of the thumb metacarpal: en-block resection and free toe phalanx transplantation. Orthopedics 2003; 26:1229-30. [PMID: 14690296 DOI: 10.3928/0147-7447-20031201-15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Eftal Gudemez
- Department of Orthopedic Surgery and Traumatology, Kirikkale University Faculty of Medicine, Kirikkale, Turkey
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Sproule JA, Salmo E, Mortimer G, O'Sullivan M. Aneursymal bone cyst of the proximal phalanx of the thumb in a child. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2002; 7:147-50. [PMID: 12365056 DOI: 10.1142/s0218810402000959] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2001] [Accepted: 06/26/2001] [Indexed: 11/18/2022]
Abstract
Aneursymal Bone Cysts (ABCs) involving the hand are a rare occurrence. We report a case of an ABC of the proximal phalanx of the thumb in a boy which was treated successfully with curettage and autologous bone grafting. When the diagnosis of ABC of the small bones of the hand is entertained, prompt therapeutic intervention is indicated because of the potential for aggressive local behaviour. In the paediatric patient, simple surgery to preserve the growth plate is recommended.
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Affiliation(s)
- J A Sproule
- Departments of Orthopaedics, University College Hospital, Galway, Ireland.
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Affiliation(s)
- M A Katz
- University of Pennsylvania School of Medicine, Philadelphia, USA
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