RSS-Feed abonnieren
DOI: 10.1055/s-0029-1241866
© Georg Thieme Verlag KG Stuttgart · New York
ChronOS Inject in Children with Benign Bone Lesions – Does It Increase the Healing Rate?
Publikationsverlauf
received July 19, 2009
accepted after revision August 22, 2009
Publikationsdatum:
06. November 2009 (online)
Abstract
Objective: Benign bone lesions in children although rare, can result in a pathological fracture. Although their etiology and pathogenesis are not yet entirely clear, the phenomenon of spontaneous healing is well known. Nevertheless, some benign bone lesions are unlikely to heal spontaneously due to the patient's age or high risk of fracture and deformity due to the lesion's location or size. The following study presents our results after treatment of these bone cysts with chronOS Inject.
Methods: From June 2004 to May 2007 23 patients with 24 benign bone cysts were treated with chronOS Inject, an injectable tricalcium phosphate, using a minimally invasive technique at two pediatric surgery departments. Postoperative follow-up examined bone healing, remodeling, chronOS Inject resorption and adverse effects.
Results: 15 males and 9 females, mean age 11 years at time of diagnosis, were treated with chronOS Inject. The humerus was affected 13 times, the femur 7 times, the tibia twice and the radius, the fibula and talus once each. Except for one case, all pathological fractures healed within five weeks post-injection. Two children had cystic residues. No severe adverse effects were seen.
Conclusions: These preliminary results indicate that chronOS Inject could provide an alternative treatment for benign bone cysts that are unlikely to heal spontaneously due to the patient's age, high risk of instability or pathological fracture due to the lesion's size or location, or lesions that have already been treated several times using other methods without success.
Key words
benign bone lesion - tricalcium phosphate - injectable - children
References
- 1 Baschang A, von Laer L. Indication and procedure of the operative treatment of benign bone cysts in children and adolescents. Eur J Pediatr Surg. 1991; 1 ((4)) 207-209
- 2 Chigira M, Maehara S, Arita S. et al . The aetiology and treatment of simple bone cysts. J Bone Joint Surg Br. 1983; 65 ((5)) 633-637
- 3 Cohen J. Etiology of simple bone cyst. J Bone Joint Surg Am. 1970; 52 ((7)) 1493-1497
- 4 Cottalorda J, Kohler R, Sales de Gauzy J. et al . Epidemiology of aneurysmal bone cyst in children: A multicenter study and literature review. J Pediatr Orthop B. 2004; 13 ((6)) 389-394
- 5 Fahey JJ, O’Brien ET. Subtotal resection and grafting in selected cases of solitary unicameral bone cyst. J Bone Joint Surg Am. 1973; 55 ((1)) 59-68
- 6 Garceau GJ, Gregory CF. Solitary unicameral bone cyst. J Bone Joint Surg Am. 1954; 36 ((2)) 267-280
- 7 Glancy GL, Brugioni DJ, Eilert RE. et al . Autograft versus allograft for benign lesions in children. Clin Orthop Relat Res. 1991; 262 28-33
- 8 Hass HJ, Krause H, Kroker S. et al . Bone formation using human demineralised bone matrix (Grafton) for the treatment of bone cysts in children. Eur J Pediatr Surg. 2007; 17 ((1)) 45-49
- 9 Jaffe HL, Lichtenstein L. Solitary unicameral bone cyst: With emphasis on the roentgen picture, the pathologic appearance and the pathogenesis. Arch Surg. 1942; 44 1004-1025
- 10 Kaelin AJ, MacEwen GD. Unicameral bone cysts. Natural history and the risk of fracture. Int Orthop. 1989; 13 ((4)) 275-282
- 11 Killian JT, Wilkinson L, White S. et al . Treatment of unicameral bone cyst with demineralized bone matrix. J Pediatr Orthop. 1998; 18 ((5)) 621-624
- 12 Knorr P, Schmittenbecher PP, Dietz HG. Treatment of pathological fractures of long tubular bones in childhood using elastic stable intramedullary nailing. Unfallchirurg. 1996; 99 ((6)) 410-414
- 13 Komiya S, Minamitani K, Sasaguri Y. et al . Simple bone cyst. Treatment by trepanation and studies on bone resorptive factors in cyst fluid with a theory of its pathogenesis. Clin Orthop Relat Res. 1993; 287 204-211
- 14 Kuemmerle JM, Oberle A, Oechslin C. et al . Assessment of the suitability of a new brushite calcium phosphate cement for cranioplasty – an experimental study in sheep. J Craniomaxillofac Surg. 2005; 33 ((1)) 37-44
- 15 Linhart WE, Helou D. Die Behandlung von Knochenzysten durch “Elastisch Stabile Fixation”. Zentralbl Kinderchir. 1995; 4 134-139
- 16 McKay DW, Nason SS. Treatment of unicameral bone cysts by subtotal resection without grafts. J Bone Joint Surg Am. 1977; 59 ((4)) 515-519
- 17 Mylle J, Burssens A, Fabry G. Simple bone cysts A review of 59 cases with special reference to their treatment. Arch Orthop Trauma Surg. 1992; 111 ((6)) 297-300
- 18 Neer 2nd CS, Francis KC, Marcove RC. et al . Treatment of unicameral bone cyst. A follow-up study of one hundred seventy-five cases. J Bone Joint Surg Am. 1966; 48 ((4)) 731-745
- 19 Rougraff BT, Kling TJ. Treatment of active unicameral bone cysts with percutaneous injection of demineralized bone matrix and autogenous bone marrow. J Bone Joint Surg Am. 2002; 84 ((6)) 921-929
- 20 Scaglietti O, Marchetti PG, Bartolozzi P. Final results obtained in the treatment of bone cysts with methylprednisolone acetate (depo-medrol) and a discussion of results achieved in other bone lesions. Clin Orthop Relat Res. 1982; 165 33-42
- 21 Scaglietti O, Marchetti PG, Bartolozzi P. The effects of methylprednisolone acetate in the treatment of bone cysts. Results of three years follow-up. J Bone Joint Surg Br. 1979; 61 ((2)) 200-204
- 22 Spence Jr KF, Bright RW, Fitzgerald SP. et al . Solitary unicameral bone cyst: treatment with freeze-dried crushed cortical-bone allograft. A review of one hundred and forty-four cases. J Bone Joint Surg Am. 1976; 58 ((5)) 636-641
- 23 Spence KF, Sell KW, Brown RH. Solitary bone cyst: Treatment with freeze-dried cancellous bone allograft. A study of one hundred seventy-seven cases. J Bone Joint Surg Am. 1969; 51 ((1)) 87-96
-
24 Virchow R. On the formation of the bone cysts.
Über die Bildung von Knochenzysten . Berlin: S-B Akad Wiss 1876: 369-380
Correspondence
Alexander JoerisM.D.
Dept. Pediatric Surgery, Children's University Hospital
University of Berne Inselspital
3010 Berne
Switzerland
Telefon: +41 31 6322111
Fax: +41 31 6329292
eMail: alexander.joeris@insel.ch