Localised Langerhans-cell histiocytosis of bone (eosinophilic granuloma) is a benign tumour-like condition with a variable clinical course. Different forms of treatment have been reported to give satisfactory results. However, previous series all contain patients with a wide age range. Our aim was to investigate the effect of skeletal maturity on the rate of recurrence of isolated eosinophilic granuloma of bone excluding those arising in the spine. We followed up 32 patients with an isolated eosinophilic granuloma for a mean of five years; 17 were skeletally immature. No recurrences were noted in the skeletally immature group even after biopsy alone. By contrast, four of 13 skeletally mature patients had a recurrence and required further surgery. This suggests that eosinophilic granuloma has a low rate of recurrence in skeletally immature patients.
Only 10–15% of those thought clinically to have a fractured scaphoid are confirmed as having fractures on initial radiographs. A further 1–20% of those who had initially negative radiographs go on to have fractures confirmed on subsequent radiographs taken 10–14 days later. Fifty patients initially considered clinically to have scaphoid fractures were identified: 32 females and 18 males, with a mean age of 32 years, range 10–88 years, 68% were noted to have injured their dominant hand. Four patients, (8%), had scaphoid fractures identified on initial radiographs and only 1 patient, (2%), was found to have an occult scaphoid later. Three patients were found to have other bony injuries leaving 42 patients, (84%), having no fracture identified. Thirty-eight of this final group could be contacted and completed telephone questionnaires. The remaining 4 were lost to follow up. Patients were asked questions about employment, time off work, interference with other activities and general satisfaction with treatment. The mean time in plaster was 16 days, range 9–42 days. Eighteen of those in work, (47% of the total, 66.7% of the workers), had time off work. The mean length of time off work was 18.4 days, range 14–42 days. Sixteen of these received full “sick pay” for their time off. Personal hygiene was affected in 84%, housework in 37.5%, sports/hobbies for 55%, driving in 76% and social activities in 11.8%. Only 2 patients overall, suffered personal financial loss which amounted to less than one hundred pounds each. Only 3 people, (8%), expressed dissatisfaction with their management when directly questioned. All patients would have preferred an immediate diagnosis had this been possible. Alternative to this treatment including bone scanning and MRI are discussed.
