Purpose: Surgery is generally proposed for the treatment of giant-cell bone tumours but other options are discussed. The problem is to decide between curettagefilling and enucleation, using or not local adjuvant treatment with curettage, and filling with an autograft, an allograft, or cement. The purpose of this work was to provide a new perspective to the treatment of giant-cell tumours based on the tumour pathophysiology and calcitonin infiltration.

Material and methods: We report 25 cases of benign giant-cell tumours treated by calcitonin. Mean patient age was 31 years. Female gender clearly predominated (75%). All of the tumours were located at the extremity of long bones. We grouped the tumours as quiescent benign tumours, and active or aggressive tumours according to the Enneking classification. Our treatment protocol included four stages after histological confirmation of the diagnosis on the biopsy specimen. The first stage was aggressive curettage, followed by intramuscular injection of calcitonin until cutaneous healing. The third stage involved daily washing of the tumour cavity with saline solution for one month. The final stage lasted two months with intramuscular injections of calcitonin.

Results: We analysed outcome at mean three years (range 2 – 20 years). Progressive filling of the tumour cavity was observed in the majority of patients starting with the first month of treatment even for the aggressive forms where tumour resection was tempting. Using the Enneking scale, our rates were near 90%, largely above the rates obtained with other conventional techniques. There were no complications. We did however have eight cases of recurrence including three which were treated again with the same protocol with good outcome.

Discussion and conclusion: Giant-cell bone tumours are clearly hormone sensitive. Calcitonin would appear to arrest the osteolytic process by attacking the osteoclast-like cell which bears calcitonin-receptors. Daily washing of the tumour cavity is designed to modify the microenvironment and eliminate tumour growth factors and cytokines expressed by giant-cells. More detailed studies of the cell membrane might reveal an explanation of certain calcitonin escape phenomena which are the cause of more or less long-term recurrence.

Purpose: Cephalo-tuberosity (CT) fractures are complex fractures with a serious prognosis. Appropriate treatment is highly debated. We report long-term clinical and radiological results in a series of 34 patients treated by osteosynthesis.

Material and methods: The series included 34 patients (21 women and 13 men) who underwent surgery between 1987 and 1997. Mean age was 61 years. The dominant side was involved in 18 cases. There were 14 traffic accident victims and 20 fall victims. Fracture types (Duparc classification) were: CT2 (n10), CT3 (n=18), CT4 (n=6). Nervous complications were associated in five cases. Treatment consisted in closed osteosynthesis for 16 cases and open plate fixation or pinning for 18 cases. Constant score was used to assess functional outcome using the pain, activity, motion, and force scales. Radiological results were assessed on the AP and lateral axillary views. Statview was used for statistical analysis. Immobilisation was maintained for 28 days.

Results: All patients were seen for physical examination and radiographs at a mean follow-up of 40 months. Only four patients were fully satisfied with the outcome. The Constant pain score was rated 9 points. Thirteen patients contralateralised since their trauma. Active antepulsion was 97 and external rotation 30 without a statistical correlation between mobility and type of fracture. The overall mean Constant score was 60 points. Reduction was considered anatomic in 12 cases with a deformed callus in 14 cases. There were eight cases of secondary cephalic necrosis (four among the CT4). The most common complication was pin migration (n=15) and disassembly (n=7) with a significant correlation between complications and age.

Conclusion: The objective and subjective results of this series demonstrated that complications increase with age. There is a significant correlation between external rotation and reduction of the greater tubercle. We did not find any radio-clinical correlation. Although the overall results were not satisfactory, they must be compared with those of arthroplasty.