Treatment of benign bone tumours of the hand using osteoscopy

Curettage and bone grafting are used traditionally to treat benign bone tumours of the hand. Some authors are proposing minimally invasive treatment using endoscopy. Our purpose is to standardise this technique based on a study of the number and locations of entry points. This is a report on three benign metacarpal bone tumours treated with three different endoscopic approaches: multiportal, extended uniportal and oblique uniportal. In theory, the multiportal approach has several drawbacks: weakening of the bone cortex, a limited visual field and seepage of injectable phosphocalcic cement. The extended uniportal approach causes cortical defects, unacceptable in a minimally invasive technique. The oblique uniportal approach seems less troublesome; vision of the bone cavity is good, curettage of the tumour is complete, the bone cortex is undamaged and there is no leakage of injectable phosphocalcic cement. All things considered, the oblique osteoscopic uniportal approach seems to be the best option for the management of benign bone tumours of the hand.     

Biphasic bone substitute and fibrin sealant for treatment of benign bone tumours and tumour-like lesions

Purpose  

Bone defects resulting from tumour resection or curettage are most commonly reconstructed with autologous bone graft which is associated with limited availability and donor site morbidity. Recent research has focussed on synthetic biomaterials as bone graft substitutes. The aim of this study was to assess the safety and efficiency of a bone substitute as an alternative for autologous bone in the treatment of benign bone tumours and tumour-like lesions.     

Surgical treatment of benign endobronchial tumours

Four cases of benign endobronchial tumour are reported which were successfully treated by bronchial resection. In two cases (of fibroma and leiomyoma respectively) a cylinder of bronchus alone was resected; in one case (lipoma) a healthy right upper lobe was preserved by a bronchoplastic procedure and in the other (chondroma) the tumour was removed with the right lower lobe, which was irreversibly damaged. It is important to recognise that such tumours are unsuitable for treatment by endoscopic means alone.     

Treatment of benign bone tumours using external fixation

We present a retrospective study of patients suffering from a variety of benign tumours in whom external fixators were used to treat deformity and limb-length discrepancy, and for the reconstruction of bone defects. A total of 43 limbs in 31 patients (12 male and 19 female) with a mean age of 14 years (2 to 54) were treated. The diagnosis was Ollier's disease in 12 limbs, fibrous dysplasia in 11, osteochondroma in eight, giant cell tumour in five, osteofibrous dysplasia in five and non-ossifying fibroma in two. The lesions were treated in the tibia in 19 limbs, in the femur in 16, and in the forearm in eight. The Ilizarov frame was used in 25 limbs, the Taylor Spatial Frame in seven, the Orthofix fixator in six, the Monotube in four and the Heidelberg fixator in one. The mean follow-up was 72 months (22 to 221). The mean external fixation period was 168 days (71 to 352). The mean external fixation index was 42 days/cm (22.2 to 102.0) in the 22 patients who required limb lengthening. The mean correction angle for those with angular deformity was 23 degrees (7 degrees to 45 degrees ). At final follow-up all patients had returned to normal activities. Four patients required a second operation for recurrent deformity of further limb lengthening. Local recurrence occurred in one patient, requiring further surgery.     

External fixation reconstruction of the residual problems of benign bone tumours

The mechanical features of and biologic response to using distraction osteogenesis with the circular external fixator are the unique aspects of Ilizarov’s contribution that allows deformity correction and reconstruction of bone defects. We present a retrospective study of 20 patients who suffered from a variety of benign tumours for which external fixators (EF) were used to treat deformity, bone loss, and limb-length discrepancy. A total of 26 bony segments in twenty patients (10 males, 10 females; mean age 17 years; range 7–58 years) were treated with EF for residual problems from the tumour itself (primary treatment) in 8 patients and for complications related to the primary surgery (secondary treatment) in 12 patients. Histological diagnoses were Ollier’s disease (n = 4), Fibrous Dysplasia (n = 5), Congenital multiple exostosis (n = 5), giant cell tumour (n = 2) and one case for chondromyxoid fibroma, desmoid fibroma, chondroma and unicameral bone cyst. Various types of external fixators used to treat these problems. These were Ilizarov, unilateral fixator, multiaxial correction frame (Biomet, Parsippany, NJ), Taylor spatial frame (Memphis, TN) and smart correction multiaxial frame. The mean follow-up time was 69.5 months (range 35–108 months). The mean external fixation time was 159.5 days (range 27–300 days). The mean external fixation index was 67.4 days/cm (12–610) in 26 limbs who underwent distraction osteogenesis. The mean length of distraction was 4.9 cm (range 0.2–14 cm). At final follow-up, all patients had returned to normal activities. Complications were in the form of knee arthrodesis in one patient, pin tract infection in six and residual shortening in eight patients. The use of EF and the principles of distraction osteogenesis, in the management of problems associated with benign bone tumours and related surgery yields successful results especially in young patients. With this approach, the risk for recurrence of shortening and deformity may be minimized with overcorrection or over-lengthening as dictated by preoperative planning.     

Limb preservation in the treatment of bone tumours

The treatment of primary malignant tumours of bones by resection and prosthetic replacement is discussed in relation to more conventional treatment by amputation. Removal of the hemipelvis with preservation of the limb is suggested as an alternative for some patients who hitherto might have been regarded as only suitable for hindquarter amputation.     

Scintigraphy in benign bone tumours. A report of 4 cases

Four cases are presented to show the value of bone scintigraphy as an aid in the diagnosis of benign bone tumours. Scintigraphy is not only capable of localising these tumours but is also a useful monitor of local recurrence after surgery. In addition, a whole-body bone scan done at the same time will exclude active multifocal disease.     

冷冻异体骨在手部内生软骨瘤治疗中的应用

目的：评价冷冻异体骨治疗手部内生软骨瘤的效果。方法：将手部内生软骨瘤刮除尽后,植入冷冻异体松质骨。结果：临床应用２２例,随访１４例,全部取得骨性愈合,疗效满意。结论：冷冻异体骨治疗手部内生软骨瘤,无排异反应,能促进骨愈合,具有取材方便等优点。     

Proximal fibula resection in the treatment of bone tumours

Background and objectives

We present a large study of patients with proximal fibula resection. Moreover we describe a new classification system for tumour resection of the proximal fibula independent of the tumour differentiation.

Methods

In 57 patients the functional and clinical outcomes were evaluated. The follow-up ranged between six months and 22.2 years (median 7.2 years). The indication for surgery was benign tumours in ten cases and malignant tumours in 47 cases. In 13 of 45 patients, where a resection of the lateral ligament complex was done, knee instability occurred. In 32 patients a resection of the peroneal nerve with resulting peroneal palsy was necessary.

Results

Patients with peroneal resection had significantly worse functional outcome than patients without peroneal resection. An ankle foot orthosis was tolerated well by these patients. Three of four patients with pathological tibia fracture had local radiation therapy. There was no higher risk of tibia fracture in patients with partial tibial resection.

Conclusions

Resection of tumours in the proximal fibula can cause knee instability, peroneal palsy and in cases of local radiation therapy, a higher risk of delayed wound healing and fracture. Despite the risks of proximal fibula resection, good functional results can be achieved.     

Desmoid tumours of the hand

We report a case of a 3-year-old child with a desmoid tumour of the hand, which is an exceedingly rare location. Desmoid tumours of the hand are difficult to treat because of the many important structures concentrated in the area as well as the infiltrative and recurrent character of these tumours.     

Reconstruction of hand in aggressive benign bone tumors by mini JESS fixator

We present two cases of young females with aggressive benign bone tumors of the bone (Enchondroma and Giant Cell Tumor). Giant cell tumors and Enchondromas in hand are commonly found benign tumors, which may be locally aggressive. The primary treatment of these lesions is surgical. The two reported cases were treated successfully by extended curettage, bone grafting, and spanning JESS fixator. There was no recurrence in either case at one year follow-up and good hand function and complete healing of the lesion.     

Use of purified beta-tricalcium phosphate for filling defects after curettage of benign bone tumours

Fifty-three patients with benign bone tumours were treated with curettage and filling with a purified beta-tricalcium phosphate (β-TCP). Recurrences occurred in two cases. There was neither a postoperative infection nor adverse reaction due to the material. Postoperative fractures did not occur in any patients. Radiographically, complete resorption of the material and bone remodelling were achieved in 23 cases (43%). Of these 23 cases, there was a statistical correlation between the filling volume and the time taken for complete resorption (p<0.05). We concluded that purified β-TCP was an ideal bone graft substitute for the treatment of benign bone tumours because of its good biocompatibility and resorption characteristics.

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Résumé 53 patients présentant une tumeur bénigne des os ont été traités par curetage et greffe par du beta-tricalcium phosphate (β-TCP) pur. La récidive de la tumeur n’a été observée que dans deux cas. Il n’y a eu aucune infection et aucune réaction négative dues au matériel. Nous n’avons pas constaté de fractures post-opératoires. Sur le plan radiographique, nous avons assisté à une résorption complète de la tumeur et remodelage osseux chez 23 patients (43%). Pour ces 23 patients, il existe une corrélation statistique non significative entre le volume du substitut et le temps pour sa complète résorption (p<0.05). Nous pouvons en conclure que le β-TCP est un substitut osseux idéal pour le traitement des tumeurs osseuses bénignes qu’il présente une bonne bio compatibilité et des caractéristiques satisfaisantes en terme de résorption.

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No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.     

Diagnostics and therapy of benign bone tumours (author's transl)

The diagnosis of benign bone tumours must be confirmed histologically; only in rare cases this can be omitted. After having identified the kind of tumour, a specific therapy must be established, covering a wide range, like excochleation as well as amputation. Malignant degeneration and high rates of relapse are possible.     

Vascularized free fibula transfer in the treatment of bone tumours

Summary The surgical treatment of two cases of bone tumours and one case of a tumour-like lesion are reported in this article. The tumours were resected radically and the massive bone defect or bone cavity were substituted by vascularized free fibula transfer. All of them were cured by early union. Neither atrophy nor non-union between the graft and the recipient bone occurred. Early restoration of function was observed. Our experiences of isolating the graft and the operative procedure are discussed. We believe that this method has prospects not only in the field of treatment of bone tumours but also in the management of bone defects or non-union due to various other causes.

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Zusammenfassung Die chirurgische Behandlung von 2 Fällen mit Knochentumoren und von einem Fall tumorähnlicher Veränderungen wird berichtet. Die Tumoren wurden vollständig entfernt, und der massive Knochendefekt bzw. die Knochenhöhle wurden durch freie Fibulaverpflanzung mit Mikro-Gefäßanschluß ersetzt. Bei alien kam es zur knöchernen Heilung. Es kam weder zur Atrophic noch zur Pseudarthrose zwischen Transplantat und Empfängerknochen. Es kam auch zur raschen funktionellen Wiederherstellung. Unsere Erfahrungen mit der Preparation des Transplantats und der Operationsverlauf wurden diskutiert. Wir glauben, daß these Methode — nicht nur in der Behandlung von Knochentumoren, sondern auch in der Behandlung von Knochendefekten oder Knochenbrüchen, die in verschiedenen anderen Fällen auftreten — glänzende Aussichten hat.