Abstract
BackgroundBoth unicameral bone cysts and intra-osseous lipoma of the calcaneus are rare entities which are mostly diagnosed due to unspecific heel pain, pathologic fracture or as an incidental finding. Minimally-invasive ossoscopy with endoscopic resection of the tumor followed by grafting can potentially minimize risks of open surgery and speed up convalescence. The objective of this study is to present a simple, safe and cost-effective surgical technique for endoscopic surgical treatment of benign osteolytic lesions of the calcaneus.Description of techniqueWe present our modifications to previously described techniques of endoscopic curettage with a particular focus on intraosseous lipoma. The key point for grafting is the use of a funnel-shaped ear speculum facilitating the plombage with allogenic cancellous bone chips.Patients and methodsBetween June 2013 and January 2015 ten consecutive patients underwent ossoscopy of the calcaneus. There were 4 cases of intraosseous lipoma and 6 cases of unicameral bone cyst. In a retrospective study, radiological results were analyzed using the Glutting-Classification, functional outcome was recorded with the AOFAS Hindfoot score.ResultsRadiographic follow-up and functional outcome showed good to excellent results. All lesions radiologically classified as “healed”. AOFAS score (max. 100 pts) ranged from 74 to 100 (ø94.4 ± 9.3).ConclusionsThis technique is a simple and safe procedure for benign osteolytic bone lesions of the calcaneus. Compared to its alternatives, grafting with allogenic cancellous bone might prove favourable in this localization for several reasons: Osteointegration, handling, availability and costs. Our preliminary investigations show promising results although further clinical and radiographic results are needed.
Highlights
Both unicameral bone cysts and intra-osseous lipoma of the calcaneus are rare entities which are mostly diagnosed due to unspecific heel pain, pathologic fracture or as an incidental finding
Compared to its alternatives, grafting with allogenic cancellous bone might prove favourable in this localization for several reasons: Osteointegration, handling, availability and costs
Lipoma of bone is a benign neoplasm of adipocytes that typically arises within the medullary cavity of bone
Summary
Both unicameral bone cysts and intra-osseous lipoma of the calcaneus are rare entities which are mostly diagnosed due to unspecific heel pain, pathologic fracture or as an incidental finding. The objective of this study is to present a simple, safe and cost-effective surgical technique for endoscopic surgical treatment of benign osteolytic lesions of the calcaneus. Description of technique: We present our modifications to previously described techniques of endoscopic curettage with a particular focus on intraosseous lipoma. Intraosseous lipoma and simple bone cyst are the two entities most often responsible for benign osteolytic lesions of the calcaneus. Intra-osseous lipoma is rare and accounts for less than 0.1 % of primary bone tumors, their actual incidence is not known. A pathologic fracture of calcaneal lipoma is very rare (Weinfeld et al 2002)
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