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Surgical treatment of benign lesions and pathologic fractures of the proximal femur in children

  • Orthopaedic Surgery
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Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

Benign lesions of the proximal femur region, such as simple bone cysts, aneurysmal bone cysts, and fibrous dysplasia, are common in children. Benign lesions may cause pathologic fractures, limb length inequities, and growth disturbances. Differential diagnoses, e.g., malignant bone tumors and osteomyelitis, are sometimes difficult to rule out.

Objective

We aimed to evaluate outcomes in children with benign lesions of the proximal femur treated with curettage, bone grafting, and plate fixation.

Methods

In this retrospective study, we included 30 children (median age 10.5 years; range 1.1–17.8 years) suffering from bone cysts and tumor-like lesions of the proximal femur region treated between 2002 and 2018. We analyzed plain X-ray images and CT scans in all children and obtained MRI scans in a selected group of children (63.3%). We examined histopathologic biopsy results for all bone lesions before initiating treatment. Surgical management comprised tumor curettage with adjuvant high-speed drilling and allogenic bone grafting supplemented by bone graft substitutes before plate fixation. Median follow-up interval was 87 months (range 24–156 months). We evaluated the healing of lesions according to Capanna’s classification and rated functional outcomes according to Merle d’Aubigné and Postel score.

Results

Overall, 25 of 30 (83.3%) patients were admitted to hospital because of a pathologic fracture. We diagnosed simple bone cysts in 15 (50.0%) patients, aneurysmal bone cysts in 7 (23.5%) patients, and fibrous dysplasia in 8 (26.5%) patients. Bone consolidation was achieved in 22 of 30 (73.3%) patients after a mean of 5 months (range 3–7 months). The main complication was recurrence of the lesion in 4 of 30 (13.3%) patients. With respect to the Merle d’Aubigné and Postel scores, 17 of 30 (56.7%) patients obtained an excellent result (18 points), while 12 (40.0%) patients had a good result (15–17 points) and only 1 (3.3%) patient had a fair result (14 points).

Conclusion

Surgical treatment of bone cysts and tumor-like lesions of the proximal femur by local resection or destruction of the lesion, followed by filling the defect with bone graft material and internal stabilization represents a safe and effective treatment option in children.

Level of evidence

Therapeutic, retrospective comparative study—Level III

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Abbreviations

ABC:

Aneurysmal bone cyst

BCI:

Bone cyst index

CT:

Computer tomography

FD:

Fibrous dysplasia

MRI:

Magnetic resonance imaging

SBC:

Simple bone cyst

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Acknowledgement

All authors have read and agreed to the published version of the manuscript.

Author information

Author notes

  1. Ryszard Tomaszewski and Erich Rutz served as co-first authors.

Authors and Affiliations

  1. Department of Pediatric Traumatology and Orthopedics, Silesian Medical University, Katowice, Poland

    Ryszard Tomaszewski

  2. Department of Orthopaedics, The Royal Children’s Hospital Melbourne, 50 Flemington Road Parkville Victoria, Melbourne, 3052, Australia

    Erich Rutz

  3. Department of Pediatric Surgery, University Children’s Hospital Basel, Basel, Switzerland

    Johannes Mayr

  4. Institute of Computing, University of Silesia, Chorzów, Katowice, Poland

    Jerzy Dajka

  5. Institute of Biomedical Engineering, Faculty of Science and Technology, University of Silesia, Katowice, Poland

    Ryszard Tomaszewski

  6. The University of Basel, Basel, Switzerland

    Erich Rutz & Johannes Mayr

  7. Murdoch Children’s Research Insitute, MCRI, Melbourne, 3052, Australia

    Erich Rutz

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  1. Ryszard Tomaszewski
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Contributions

Conceptualization WL, JM, RT, ER; formal analysis WL, RT, JD; investigation WL, RT; resources WL, JM, RT; statistical analysis, J.D.; writing—original draft preparation, WL, RT, ER; writing—review and editing JM; visualization WL, RT; supervision, JM, RT, ER.

Corresponding author

Correspondence to Erich Rutz.

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The authors declare that they have no conflict of interest.

Ethical statement

This retrospective study was approved by the Ethics Committee of the Silesian Medical University, Katowice, Poland (PCN/0022/KB/99/20 dated June 5th, 2020).

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Tomaszewski, R., Rutz, E., Mayr, J. et al. Surgical treatment of benign lesions and pathologic fractures of the proximal femur in children. Arch Orthop Trauma Surg 142, 615–624 (2022). https://doi.org/10.1007/s00402-020-03687-x

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