Curettage of aneurysmal bone cysts of the feet

Primary aneurysmal bone cyst of hands and feet: A series of 14 cases

Aneurysmal bone cyst (ABC) is a relatively rare, benign bone tumor that occurs exceptionally in the hands and feet. The objective of this article is to present clinical, radiological, histopathological features and management of a series of 14 primary ABC cases in these unusual locations. Eight cases occurred in hands and six in feet. We present the first reported subungual case to occur in the hand. The average age of the patients was 26 years (range 7 to 49), with half being over the age of twenty at diagnosis. The male to female ration was 9:5. In radiological terms, ABC appeared as an expansive lesion with internal septa and without cortical disruption. Twelve cases displayed the classic multicystic morphology and two cases were of the solid variant. "Blue bone" was detected in 50 % of the specimens. Treatment consisted of curettage, excision, or amputation in all cases. Recurrence rate was observed in 35 % of the cases, with the similar ABC morphology as the original samples. New therapeutic options have been proposed on their own or in combination with surgery to reduce local recurrence rates.

Aneurysmal bone cyst of the foot: A series of 10 cases

BACKGROUND

Aneurysmal bone cyst (ABC) is a benign, locally aggressive tumor that occurs in childhood and early adulthood. It usually affects the metaphysis of long bones but can also occur in the foot.

METHODS

This single-center study is a retrospective review of ten patients with primary ABCs of the foot which underwent an intralesional curettage or a polidocanol instillation.

RESULTS

After intralesional curettage a local recurrence was observed in 3/5 cases. The instillation of polidocanol showed a significant reduction of the initial cyst volume (p=0.0267). In the instillation subgroup a primary complete healing was achieved in three cases. Due to a persisting disease two cases were converted to intralesional curettage without local recurrence in the follow-up.

CONCLUSIONS

Percutaneous instillation of polidocanol is a minimally invasive treatment option for ABCs of the foot and especially for small bones. Nevertheless, several sequential instillations and a conversion to intralesional curettage can be necessary.

Benign and Malignant Tumors in Child Foot

Bone tumors affecting pediatric foot are a rare occurrence. Most lesions are benign, but a thorough diagnostic evaluation must always be performed to rule out malignant tumors. Approach to benign lesions is conservative, from observation follow-up to curettage or mininvasive techniques. In malignant lesions, a wide resection must be performed and same protocols applied as in tumors affecting other skeletal sites. Reconstructive procedures should aim to mechanical stability and long-lasting results; joint motion restoring can be attempted when not negatively affecting stability. Amputation procedures should be considered as a still viable choice because of their good functional result in the foot.

Atypical Presentation of Navicular Aneurysmal Bone Cyst in a Symptomatic Pediatric Flatfoot Deformity: A Case Report

Aneurysmal bone cysts (ABCs) are rare in the foot, accounting for 4% to 6.3% of all ABCs found in the body. Approximately 80% of patients diagnosed with an ABC are in the second decade of life. While benign, pain and deformity are often the presenting symptoms. This report's objective is to describe, to our knowledge, the first reported case of a pediatric navicular ABC in association with pediatric flatfoot deformity that was successfully treated with curettage and bone grafting. An additional goal of the report is to highlight how the diagnosis of these osseous tumors can easily be missed given the overlap in symptoms with pediatric flatfoot deformity. An 11-year-old female presented to clinic with a chief complaint of painful, flatfoot deformity and discomfort to the medial midfoot after walking for more than 2 city blocks. The patient was conservatively treated for pediatric flatfoot deformity at an outside institution and advised that a surgical flatfoot reconstruction would be necessary to relieve her symptomology. On examination, the patient exhibited focal pain to the medial aspect of the navicular. Radiographs revealed an ill-defined, expansile, sclerotic lesion of the navicular, and MRI demonstrated a multicystic lesion filling the navicular, consistent with an ABC. Treatment included curettage and packing with allograft. At 1-year follow-up, the patient is well, with minimal pain and return to full activity without functional limitations. Local recurrence of an aneurysmal bone cyst following curettage and bone grafting is as high as 22% with patient age and lesion size comprising the main risk factors. This report demonstrates successful curettage of an ABC within the navicular and preservation of osseous articulations in a pediatric patient. At 1-year follow-up, the patient had minimal pain with no evidence of recurrence.

Aneurysmal Bone Cyst of the Medial Cuneiform: A Case Report

The aneurysmal bone cysts, usually found in the tibia, femur, pelvis, or humerus, are expansile pseudotumor lesions of unknown etiology. An aneurysmal bone cyst is rarely seen in the medial cuneiform. In this case report, a 43-year-old man with an aneurysmal bone cyst in the left medial cuneiform is presented. The cyst was curetted, and the defect was filled with an en bloc iliac crest graft. A screw was placed to fix the graft in the proper position. In the 2-year follow-up of the patient, recurrence was not detected radiologically.

Aneurysmal Bone Cysts of Spine: An Enigmatic Entity

Aims

The study was done to review the literature about the intriguing aspects of the aneurysmal bone cyst and to describe our experience with these cases.

Design

Retrospective.

Material and Method

We reviewed the records of all patients with primary spinal tumours whom we managed over last 8 years. We selected the patients with biopsy proven aneurysmal bone cyst (ABC) for our study.

Results

Four patients (two males and two females) were included. The age ranged from 15-18 years. Three of them had neurological deficits and one had only pain. All of them were operated and three required instrumentation for stabilization. Neurological deficits improved in all the cases. However we had to re- operate one of the cases for recurrence and that patient was administered adjuvant radiotherapy.

Conclusions

ABC is not a tumour in real sense but due to destructive nature that are classified as tumours. The patients have an excellent outcome as the disease is benign and has very low recurrence rates if surgical excision is complete. Best treatment modality is complete excision. Aneurysmal bone cyst is one of the uncommon tumors of the spine, and many of its features continue to be unclear even today. There is ambiguity about the definition, etiopathogenesis, radiological characteristics, histopathology and treatment modalities. They are common in young age and etiology is not clear. The presentation is varied with pain being the common symptom and neurological deficit depends on extent of cord involvement. The best treatment is controversial although surgery is believed to be curative in the majority of cases. We here describe our experience with four such cases who had varied clinical presentation and outcome.

Cystic bone tumors of the foot and ankle

Bone tumors are relatively rare in the foot and ankle region. Many of them present as cystic lesions on plain films. Due to the relative rarity of these lesions and the complex anatomy of the foot and ankle region, identification of such lesions is often delayed or they get misdiagnosed and mismanaged. This review discusses the most common cystic tumors of the foot and ankle including their radiographic features and principles of management.

Pathological Fracture of Calcaneum: A Case Report

INTRODUCTION

Aneurysmal bone cysts (ABCs) are blood filled fibrous tumor-like cysts that expand the bone giving it a blown out appearance. It is usually seen in the second decade. ABCs were first described by Jaffe and Litchensen in 1942. The exact etiology is unknown. One of the most widely accepted ideas was that aneurysmal bone cyst was a consequence of increased venous pressure and subsequent dilatation and rupture of the local vascular network. However, studies by Panoutsakopoulus et al. and Olivia et al. uncovered the clonal neoplastic nature of ABCs. Here, we report a case of aneurysmal bone cyst of calcaneum, which is one of the rarest sites.

CASE REPORT

A 25-year-old male presented with a history of trivial fall from a ladder and landing on the right heel. He complained of pain and swelling. On examination, he had swelling over the medial aspect of the right heel. The skin over the swelling was stretched, and it was soft in consistency and tender. Curettage and bone grafting was done. The patient was pain-free and was bearing weight fully on the operated limb, 12 weeks postoperatively.

CONCLUSION

Aneurysmal bone cyst of calcaneum although seen rarely should be considered as one of the differential diagnoses in the cystic lesions in calcaneum. Curettage and bone grafting has stood the test of time as standard treatment.

Mother's fibula in son's forearm: use of maternal bone grafting for aneurysmal bone cyst not amenable to curettage - a case report with review of literature

It has always been a challenge to reconstruct large bone gaps. The aim of this case report is to highlight the success of homologous maternal bone grafting in a large cystic lesion. A six and half years old boy presented to us with an aneurysmal bone cyst (ABC) of the right radius, not amenable to curettage. We excised the lesion in toto, which created an 11 cm bone loss. Considering the age of the patient, we reconstructed the bone gap with maternal fibular graft. Accordingly, 12 cm of fibular graft was harvested and fashioned to fit into the bone gap. It was fixed with an intramedullary K-wire. No cancellous graft was used in the procedure. The limb was kept in the above elbow cast till incorporation of the fibula was noted on the radiographs. Six months following surgery the skiagram showed that the fibula was incorporated. Mobilization of the elbow and wrist was started along with strengthening of the forearm muscles. K-wire was removed at nine months. At the latest follow up of 24 months, the fibula is fully incorporated, the child regained full range of motion and strength of elbow. We discuss the techniques adopted in this particular case along with the review of literature.

Surgical treatment of active or aggressive aneurysmal bone cysts in children

The aim of this study was to evaluate functional and radiological results, tumor control, and complications of the surgical treatment of aneurysmal bone cysts (ABCs) in children by extended curettage using a mechanical burr and cauterization, grafting, and internal fixation in specific locations. Sixty-four children [38 males, 26 females, median age=10 years (range, 5-18 years)] with active or aggressive ABCs of long and flat bones were subjected to a median follow-up of 66 months (range, 28-130 months) following surgical treatment. The pathological fracture rate was 72%. Surgical procedures included intralesional extended curettage (92%) or en-bloc resection (8%). Internal fixation was required in 53%. The pathological fractures healed successfully in 8-12 weeks. The median Musculoskeletal Tumor Society (MSTS) score at the last follow-up was 95% (range, 55-100%). Treatment failure (partial healing/recurrence) and complication rates following extended curettage were 7 and 5.2%, respectively. Statistically, the only parameter affecting partial healing and local recurrence was proximity of the lesion to the growth plate (P=0.011). Extended curettage using a mechanical burr and cauterization, grafting, and internal fixation in specific locations can promote healing in most cases of ABC, with low recurrence and complication rates.

Aneurysmal bone cyst of medial cuneiform and a novel surgical technique for mid-foot reconstruction

Aneurysmal bone cyst of the foot is extremely rare and the involvement of medial cuneiform has never been reported in the literature. In this report, we describe a 15-year-old boy who presented with a 6-month history of pain and swelling in his left foot. Radiograph demonstrated a lytic lesion in the medial cuneiform extending on to the middle cuneiform, the navicular bone and the base of the first metatarsal. En bloc resection of the lesion was performed using a dorsal longitudinal incision along the first ray. Tricortical iliac crest graft was harvested and shaped to fill the defect. Two drill holes were made and the tibialis anterior tendon was attached to the graft. Prepared, morcellised allograft was placed along the junction of autograft and host bone. At 1-year follow-up, the patient was pain free, the medial arch of the foot was maintained and the graft had united with the host bone.