The Need of Filling of Bone Defects After Curettage of Benign Bone Tumors
Ismail Tawfeek Abdelaziz1, Ahmed El-Badawy Mahmoud Shahin1, Ahmed Mohammed Ahmed Fawzy El-Beheiry1 and Bola Adel Alfy Hakim2*
1MD of Orthopedic Surgery, Horus Specialized Hospital, Luxor, Egypt
2MSc of Orthopedic Surgery, Horus Specialized Hospital, Luxor, Egypt
*Corresponding Author: Bola Adel Alfy Hakim, MSc of Orthopedic Surgery,
Horus Specialized Hospital, Luxor, Egypt.
May 20, 2022; Published: July 15, 2022
Background: Benign bone tumors regularly weaken bones and predispose patients to pathological fractures. Benign lytic bone lesions such as Simple Bone Cyst, Non-Ossifying Fibroma, Fibrous Dysplasia, etc. most often affect younger individuals.
Treatment includes observation, injection of bone marrow or demineralized bone matrix, curettage blended with bone or synthetic grafting, decompression with intramedullary nailing or cannulated screw, or a mixture of these approaches.
This study aims to clinical and radiological evaluation of benign bone tumors after curettage with or without filling of bone defects.
Patients and Methods: This is a retrospective study diagnosed as benign bone tumors who underwent curettage (with or without grafting or filling) during the surgical treatment, operated between Jan 2017 and Feb 2021. Lesions’ size (length, width, and depth) was measured on plain radiographs using the image j program. When applicable, the degrees of filling of the resultant cavity were classified into four categories according to Modified Neer's classification. Functional evaluation using the musculoskeletal tumor society (MSTS) score was also reviewed
Results: 41 patients were included in this study, 19 male (46.3%) and 22 female (53.7%) ranged from 3 to 53 years old with a mean age of 22.83 ± 13 years.
Extended curettage was done in 32 cases (78%). Hydrogen peroxide was used in 34 cases (82.9%). High-speed burr was performed in 34 cases (82.9%). Filling materials were mainly bone cement in 13 cases (31.7%) and Autograft in 7 cases (17.1%), while 21 cases (51.2%) were without any filling material.
Cystic lesions were mainly centric, while NOFs and GCTs were mainly eccentric.
Most benign tumors expressed cortical involvement, while UBCs didn't. The lesion size varies according to its type.
51% of cases were not filled with any type of fillers, 32% were filled with cement, and 17% with autograft. This depends on many variables such as Skeletal maturity, Lesion centricity, Cortical breakdown, curettage, and age.
Conclusion: Filling defects resulting from curettage of benign bone tumors by autograft showed the best results. Better results are obtained while using plate osteosynthesis.
Level of evidence: Level III, retrospective.
Keywords:Enneking; Benign Bone Tumors; Filler; Surgical Interventions; Extended Curettage; Giant Cell Tumor; Simple Bone Cyst; Non-Ossifying Fibroma; Osteolytic; Bone Defects
- Moretti VM., et al. “Curettage and graft alleviates athletic-limiting pain in benign lytic bone lesions”. Clinical Orthopaedics and Related Research 1 (2011): 283-288.
- Ramirez JM., et al. “Benign Bone Tumors”. Essent Orthop Rev Quest Answers Sr Med Students (2018): 357-358.
- Hirn M., et al. “Bone defects following curettage do not necessarily need augmentation: A retrospective study of 146 patients”. Acta Orthopaedica 1 (2009): 4-8.
- Bola Adel Alfy Hakim. “Benign Bone Tumors, An Overview". Acta Scientific Orthopaedics10 (2021): 01-02.
- Jeys LM., et al. “Impending fractures in giant cell tumours of the distal femur: incidence and outcome”. International Orthopaedics 30 (2006): 135-138.
- Wu PK., et al. “Grafting for bone defects after curettage of benign bone tumor - Analysis of factors influencing the bone healing”. Journal of the Chinese Medical Association 7 (2018): 643-648.
- Zheng K., et al. “How to fill the cavity after curettage of giant cell tumors around the knee? A multicenter analysis”. Chinese Medical Journal (England)21 (2017): 2541-2546.
- Franchi A. “Epidemiology and classification of bone tumors”. Clinical Cases in Mineral and Bone Metabolism 2 (2012): 92-95.
- Horstmann PF., et al. “Treatment of benign and borderline bone tumors with combined curettage and bone defect reconstruction”. Journal of Orthopaedic Surgery3 (2018): 1-7.
- Kim JH., et al. “Grafting using injectable calcium sulfate in bone tumor surgery: Comparison with demineralized bone matrix-based grafting”. Clinics in Orthopedic Surgery 3 (2011): 191-201.
- Eyesan SU., et al. “Surgical consideration for benign bone tumors”. Nigerian Journal of Clinical Practice 2 (2011): 146-150.
- Darwish AE., et al. “The Clinical and Radiological Outcome of Stages 1 and 2 Enneking Benign Bone Lesions with Pathological Fracture”. Injury (2021): 1-6.
- Aboulafia AJ., et al. “Begnign bone tumors of childhood”. Journal of the American Academy of Orthopaedic Surgeons 6 (1999): 377-388.
- Bashaireh KM., et al. “Primary Bone Tumors in North of Jordan”. Journal of Epidemiology and Global Health 1 (2020): 132.
- Kindblom LG. “Bone Tumors : Epidemiology , Classification , Pathology.
- Joyce BMJ., et al. “Benign Bone Tumors and Cysts (2020).
- Ladd LM and Roth TD. “Computed Tomography and Magnetic Resonance Imaging of Bone Tumors”. Seminars in Roentgenology 4 (2017): 209-226.
- Sobti A., et al. “Giant cell tumor of bone - An overview”. The Archives of Bone and Joint Surgery 1 (2016): 2-9.
- Herget GW., et al. “Non-ossifying fibroma: Natural history with an emphasis on a stage-related growth, fracture risk and the need for follow-up”. BMC Musculoskeletal Disorders 1 (2016): 1-7.
- Sasaki H., et al. “Diagnosing and discriminating between primary and secondary aneurysmal bone cysts”. Oncology Letters 4 (2017): 2290-2296.
- Li J., et al. “Pediatric physeal slide-traction plate fixation for pathological distal femoral fracture caused by unicameral bone cyst in adolescents”. BMC Musculoskeletal Disorders 1 (2020): 1-6.
- Wang D. “Outcome of Chondroblastoma Treated With Intralesional Curettage and Autogenous Iliac Bone Graft : A Retrospective Study (2020): 1-12.
- Pan J., et al. “Radiomics Nomograms Based on Non-enhanced MRI and Clinical Risk Factors for the Differentiation of Chondrosarcoma from Enchondroma”. Journal of Magnetic Resonance Imaging (2021).
- Lin F., et al. “The epidemiological and clinical features of primary giant cell tumor around the knee: A report from the multicenter retrospective study in China”. Journal of Bone Oncology 1 (2016): 38-42.
- Hakim DN., et al. “Benign tumours of the bone: A review”. Journal of Bone Oncology 2 (2015): 37-41.
- Baena-Ocampo L del C., et al. “Epidemiology of bone tumors in Mexico City: retrospective clinicopathologic study of 566 patients at a referral institution”. Annals of Diagnostic Pathology 1 (2009): 16-21.
- Limaiem F., et al. “Chondroblastoma Pathophysiology Histopathology (2021).
- Hashemi J., et al. “Radiological features of osteoid osteoma: Pictorial review”. Iranian Journal of Radiology 3 (2011): 182-189.
- Eppley BL., et al. “Allograft and alloplastic bone substitutes: A review of science and technology for the craniomaxillofacial surgeon”. Journal of Craniofacial Surgery6 (2005): 981-989.
- Farouk HA., et al. “All-endoscopic management of benign bone lesions; a case series of 26 cases with minimum of 2 years follow-up”. Sicot-J 4 (2018): 50.
- Ebeid WA., et al. “Management of Fibrous Dysplasia of Proximal Femur by Internal Fixation Without Grafting: A Retrospective Study of 19 Patients”. JAAOS Global Research and Reviews 10 (2018): e057.
- Gortzak Y., et al. “The efficacy of chemical adjuvants on giantcell tumour of bone: An in vitro study”. Journal of Bone and Joint Surgery - Series B10 (2010): 1475-1479.
- Gupta SP and Garg G. “Curettage with cement augmentation of large bone defects in giant cell tumors with pathological fractures in lower-extremity long bones”. Journal of Orthopaedics and Traumatology 3 (2016): 239-247.
- Veth R., et al. “Cryosurgery in aggressive, benign, and low-grade malignant bone tumours”. The Lancet Oncology 1 (2005): 25-34.
- Teoh KH., et al. “Predictive factors for recurrence of simple bone cyst of the proximal humerus”. Journal of Orthopaedic Surgery (Hong Kong)2 (2010): 215-219.
- Omlor GW., et al. “Retrospective analysis of 51 intralesionally treated cases with progressed giant cell tumor of the bone: Local adjuvant use of hydrogen peroxide reduces the risk for tumor recurrence”. World Journal of Surgical Oncology 1 (2019): 1-10.