3.P.07 HOW TO TREAT VANISHING BONE SEGMENTS?

Abstract

Aneurysmal bone cysts are benign lesions of bone that tend to recur if they display an aggressive behaviour. In this study, an aggressive lesion is described as one with almost completely lost cortices on standard x-rays, mimicking ‘vanishing bone disease’. Purpose of this study is to retrospectively analyse the treatment results in this special patient subgroup.

Sixteen patients with a mean age of 23.1 (6–44) were included in this study. Femur (%25) was the most commonly affected bone. Spinal lesions were excluded. All lesions were diagnosed by preoperative tru-cut biopsy, however open biopsy was also done if requested by the pathologist. All lesions were preoperatively examined by contrast enhanced MRI. They were evaluated as having almost no cortical bone rim but a periosteum like soft tissue envelope. Intraoperatively, following an extended curettage, this tissue was observed as an alive periosteal layer. Phenolisation was added and cavities were filled with allograft bone chips. The periosteum was sutured around the grafts. Additional stabilisation was performed by external fixator in 3 patients, dynamic compression hip screw in 1.

Patients were followed up for a mean period of 47.8 months (9–84). Lesions healed after a mean period of 28.2 weeks (6–126). There was recurrence in 5 patients. The number of additional procedures necessary for relapsed lesions was 3 for one patient, 2 for another patient and 1 for the remaining 2 patients. Time to healing was not included for 1 patient who refused surgery for relapse and another patient who recently underwent surgery for relapse. One patient healed with a deformity.

Aneurysmal bone cysts may present as highly aggressive local bone lesions. Even in such a subgroup, resection to prevent relapses seems an exaggerated procedure. Extended curretage and packing may yield satisfactory results, with acceptable recurrence rates.