A modern method of treatment of long bones solitary bone cyst. The usage of minimal invasive ostheosyntesis and bone grafting (Allograft and synthetic materials)

Abstract

Benign bone tumours represents an old but challenging issue (by frequency, morbidity and continuous studies of multiple methods of treatment). Simultaneosly with the evolution of technology and the studies regarding bone physiopathology,new surgical techniques are developed and applied everyday. The aim of this study is to find a simple but effective technique to cure this condition in childhood and adolescence. This study was performed between 2009-2014 in the Pediatric orthopedic dept.of the Clinical Hospital for Children M.S.Curie-Bucharest and contains 101 patients. We divided the patients in several groups, according to localization, complication of the disease and symptoms at admition. We considered the follow-up of radiographs, dissapearing of the clinical symptoms, relapses and the time for full recovery. The mean follow-up time was between 3-36 months. Complete healing has been achieved in 90% of the cases. We found 2 relapses in which we performed secondary surgery. The method we’ve used was effective and it can also be applied in cases of delayed healing or pseudarthrosis, therefore it is our goal to standardise this method. Material and method: • we studied 101 patients diagnosed with SBC of the long bones in a period of 4 years; • we divided these pacients in 2 groups, first group with SBC without fracture; the other SBC complicated by pathologycal fracture; • another classification was made by localization: 28 were situated in the proximal metaphysis of the humeral bone,44 were situated in the proximal femur,14 were located in the proximal tibia, 6 in the distal tibia, 9 on fibula; • the average age was 9,3 yrs old; • the male to female ratio was 2,3:1. The method we’ve performed was surgical: under general anesthesia we localized the lesion with C-Arm image intensifier, with a minimal incision we treated the cyst by curettage, cauterisation, filling with graft material followed by elastic reinforcement. We also performed a biopsy. The hystological appearance confirmed the previous diagnosis. Results: • we achieved complete healing in 90% of cases; in 9% we found incomplete filling of the cavity and 2 cases relapsed; • the average follow-up time was 12 months, first postoperative radiography was taken at six weeks. Conclusion: This method of treatment is effective and rather simple, with low morbidity rate and low postoperative complications. It is considered expensive because of the need of fluoroscopy and the titan elastic nails, but the total cost is lower than other methods of treatment. The physical recovery after surgery is rapid, so the child is able to perform sport activities soon after the operation. Because of the benefits of the grafting material, the relapses are rare and the mechanical properties of the titanium nails give strength and elasticity to the bone. This method of treatment can be used in the situation of delayed consolidation because it enhances the healing of the affected bone and it stabilizes the site.