Search

Objectives: We evaluated the results of a new technique developed for aneurysmal bone cysts centrally located in the proximal humeral metaphysis leading to widespread destruction.Methods: The study included seven patients (5 boys, 2 girls; mean age 12.8 years; range 9 to 15 years) who were treated with cortical collapsing and massive fibular autograft for centrally located aneurysmal bone cysts in the proximal humeral metaphysis leading to widespread destruction. All the patients had type II and active tumors according to the criteria of Capanna et al. and Campanacci et al., respectively. Final evaluations included six patients because one patient was lost to follow-up. The mean follow-up period was 49 months (range 12 to 105 months).Results: No complications were seen in the early postoperative period. Radiographic examination showed partial recurrence in two patients; of whom, one patient underwent curettage and bone grafting in the postoperative second year because of pain and discomfort. No deformity was observed. One patient developed shortening of 0.5 cm. Radiographically, all the patients exhibited metaphyseal remodelling one year after surgery. Function of the shoulder joint was near-normal in all the patients.Conclusion: In this technique, cortical collapsing reduces the amount of bone graft used, and massive fibular strut grafting provides structural support to prevent deformities., Amaç: Bu çalışmada, humerus proksimal metafizine santral olarak yerleşmiş, geniş destrüksiyon yapmış anevrizmal kemik kistleri için geliştirdiğimiz yeni bir tekniğin sonuçları değerlendirildi.Çalışma planı: Humerus proksimal metafizinde santral olarak gelişen ve geniş destrüksiyona neden olan, klinik ve radyografik olarak anevrizmal kemik kisti tanısı konan yedi hasta (5 erkek, 2 kız; ort. yaş 12.8; dağılım 9-15) kortikal çöktürme ve fibuladan alınan masif otogreft ile tedavi edildi. Tüm olgularda Capanna ve ark.nın sınıflandırmasına göre tip II, Campanacci ve ark.nın sınıflandırmasına göre aktif tümör vardı. Bir olgu takipten çıktığı için çalışma dışı bırakıldı. Hastaların ortalama takip süresi 49 ay (dağılım 12-105 ay) idi.Sonuçlar: Ameliyat sonrası erken dönemde hiçbir olguda komplikasyon görülmedi. Radyografik değerlendirmede iki olguda kısmi nüks saptandı; bu olgulardan birine, ağrı yakınması nedeniyle ameliyat sonrası ikinci yılda küretaj ve greftleme uygulandı. Olgularda deformite izlenmedi. Sadece bir olguda 0.5 cm’lik kısalık saptandı. Ameliyattan yaklaşık bir yıl sonra metafizer bölgenin anatomik görünümde yeniden şekillendiği gözlendi. Tüm olgularda omuz eklem fonksiyonu normale yakın bulundu.Çıkarımlar: Uyguladığımız teknikte, kortikal çöktürme ile greft ihtiyacı azalmakta, fibular greft de yapısal destek oluşturarak deformite oluşumunu engellemektedir.

The objective was to study the different types of lengthened bone regeneration and their development during the various phases of the process to correlate them with patient factors and the surgical technique used, and to establish a possible relation between the development of the bone lengthening formation and the problems or complications. The authors studied the radiographs of a random group of 55 patients taken at three points during the course of treatment. The callus was classified with regard to its transverse diameter and the presence or absence of hypodense areas. The overall callus type was significantly influenced by the etiology, the osteotomy site, and the percentage lengthened. The percentage by which the limb was lengthened at the beginning of the process influences the overall morphology of the callus. Poor callus had been lengthened the most, atrophic callus the least. There was a correlation between the morphology of the overall callus at the end of treatment and the percentage lengthened, and between the percentage lengthened and the presence of bands at the end of treatment. The authors also found a significant correlation between age and the appearance of bands at the end of distraction. A central band was found among younger patients. The type of osteotomy affected the overall callus at the end of distraction and at the end of treatment and also influenced the transverse diameter. All the elongations with poor bone formation at the end of treatment were found to have undergone a diaphyseal osteotomy. The most common complication at the first follow-up and at the end of distraction was angulation. The diameter of the callus and the presence of bands at the end of treatment were significantly related to the complications. Fracture occurred in the first 2 weeks after removal of the external fixator in 88% of cases and in the third and fourth week in the rest. However, the segment had no significant influence on the appearance of complications. Lengthened callus with incomplete trabecular formations and hypodense areas at the end of the treatment has a high risk of fracture at the end of treatment. Callus with axial deviation, hypodense areas, or an insufficient transverse diameter during the lengthening procedure must be manipulated so that it reaches the maturing phase in better condition