Indications for prophylactic osteosynthesis associated with curettage in benign and low-grade malignant primitive bone tumors of the distal femur in adult patients: a case series.

Carlo Perisano,Carlo Perisano,Alfredo Schiavone Panni,Daniele Stomeo,Michele Vasso,Carlo Barone,Giulio Di Giacomo,Giulio Maccauro,Giulio Maccauro,Carlo Barone

doi:10.1007/s10195-016-0418-7

Abstract

BackgroundThe aim of the study was to evaluate whether the use of preventive osteosynthesis after curettage in benign and primitive low-grade malignant bone tumor localized in the distal femur in adult patients provides sufficient mechanical stability to the system as to allow weight-bearing and reduce the risk of postoperative fracture. Additionally, lower limb function after curettage and preventive osteosynthesis was evaluated.Materials and methodsWe analyzed twelve cases of benign and low-grade malignant bone lesions of the distal femur in adult patients treated in our orthopedic department between 2008 and 2011 with curettage, bone filling and preventive osteosynthesis. All patients were treated with curettage with the use of high-speed cutters, plus liquid nitrogen as local adjuvant in low-grade malignant lesions, and filling of the lesion with bone graft or allograft or acrylic cement, followed by osteosynthesis.ResultsNo fractures or major complications were observed; good function of the knee was observed.ConclusionWe recommend preventive osteosynthesis after curettage in patients with very large lesions (>5 cm, >60 cm3) or high functional requirements, in obese patients, and when local adjuvants are used.Level of evidenceLevel IV retrospective case-series study.

Highlights

Curettage is widely used in musculoskeletal oncology to treat benign, or even aggressive lesions, some cartilaginous malignant lesions, and bone metastases [1].The bone cavity resulting after curettage of the neoplastic lesion often requires the use of filling systems to ensure mechanical stability of the system, such as acrylic cement or bone grafts [2,3,4].For most of the benign tumors, intralesional curettage and subsequent bone filling represents the treatment of choice, maintaining structural integrity and functional stability of the bone and adjacent joint
Background The aim of the study was to evaluate whether the use of preventive osteosynthesis after curettage in benign and primitive low-grade malignant bone tumor localized in the distal femur in adult patients provides sufficient mechanical stability to the system as to allow weight-bearing and reduce the risk of postoperative fracture
All patients were treated with curettage with the use of high-speed cutters, plus liquid nitrogen as local adjuvant in low-grade malignant lesions, and filling of the lesion with bone graft or allograft or acrylic cement, followed by osteosynthesis

Summary

Introduction

Curettage is widely used in musculoskeletal oncology to treat benign, or even aggressive lesions, some cartilaginous malignant lesions, and bone metastases [1].The bone cavity resulting after curettage of the neoplastic lesion often requires the use of filling systems to ensure mechanical stability of the system, such as acrylic cement or bone grafts [2,3,4].For most of the benign tumors, intralesional curettage and subsequent bone filling represents the treatment of choice, maintaining structural integrity and functional stability of the bone and adjacent joint. Depending on the tumor-specific risk of recurrence, adjuvant measures such as phenol instillation or cryotherapy with liquid nitrogen may be applied due to their chemical and physical effects improving the local effect of curettage [1, 5,6,7] These surgical techniques do not appear to be sufficient to ensure adequate mechanical stability in all cases, with consequent risk of fracture in some patients (Fig. 1). The aim of the study was to evaluate whether the use of preventive osteosynthesis after curettage in benign and primitive low-grade malignant bone tumor localized in the distal femur in adult patients provides sufficient mechanical stability to the system as to allow weight-bearing and reduce the risk of postoperative fracture. All patients were treated with curettage with the use of high-speed cutters, plus liquid nitrogen as local adjuvant in low-grade malignant lesions, and filling of the lesion with bone graft or allograft or acrylic cement, followed by osteosynthesis

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