Use of an autologous nonvascularized fibular strut graft in the treatment of benign cystic lesions of the proximal femur

Abstract

IntroductionThe proximal end of the femur is a common site of benign aggressive lesions that might cause destruction and lead to pathological fracture. Treatment of these lesions usually entails curettage, and bone grafting with or without plate osteosynthesis.Patients and methodsThis study included 18 patients; 11 were males, mean age 12 years (range 4-34 years). The diagnosis was as follows: aneurysmal bone cyst (n=10), simple bone cyst (n=4), and one case of a giant cell tumor, eosinophilic granuloma, fibrous dysplasia, and enchondroma. Treatment involved curettage, hydrogen peroxide lavage, and an autologous nonvascularized fibular graft without internal fixation, except in one case presenting with a pathological fracture. The fibula was impacted as a strut, and a Kirschner wire was used to fix it in four cases. Patients were placed in hip spica for 6-8 weeks. Follow-up ranged from 20 to 40 months, with a mean of 26 weeks.ResultsAll patients had an excellent functional outcome at the last visit, except one patient, who showed good function according to the musculoskeletal tumor society score. Fibular incorporation took 8-12 months. Time to weight bearing ranged from 3 to 6 months. Fibula was reformed at the donor site in most cases with minimal complications.ConclusionWe believe that thorough curettage without refilling of the cavity is a satisfactory method of treatment of benign aggressive lesions of the proximal femur; the use of a nonvascularized autologous fibular graft is helpful as an early biological support and aids healing of the cyst. Internal fixation is not necessary, especially in younger patients.