Author: Dominic K Puthur [1], Dijoe Davis [1], N Sanjay [1]

1. Department of Orthopaedics, Amala Institute of Medical Sciences, Thrissur, Kerala, India.

Address of Correspondence
Dr. Dijoe Davis,
Department of Orthopaedics, Amala Institute of Medical Sciences,
Cloud Nine, Kollannur Villas, Jasmin Road, Near Water Tank Street
Nehrunagar, Kuriachira P.O, Thrissur – 680 006, Kerala, India.
E-mail: dr.dijoe@gmail.com

Abstract

Introduction: Giant cell tumor of bone (GCTB) is a locally aggressive tumor well known for recurrence after surgical treatment. Local recurrence rate ranged from 10 to 25%. The objectives of this study are to find out the incidence of recurrence in GCT after extended surgical curettage, factors affecting recurrence, and also to find the best modality of treatment available for the recurred GCT.
Materials and Methods: It was a retrospective cohort study of 225 patients diagnosed and treated by extended surgical curettage in the Orthopaedic Department of a Tertiary Care Hospital in South India, between January 2003 and December 2017. Patients were followed up clinically and radiologically for diagnosis of recurrence. Factors affecting the recurrence were analyzed. These recurrent cases were further followed up. IBM SPSS v23 was used for data analysis such as age, gender, site of lesion and side, and material used to fill the defect after curettage. Descriptive statistics was elaborated in the form of means and standard deviations for continuous variables and frequencies and percentages for categorical variables. Fisher’s exact test is used for comparison.
Results: Recurrence was found in 27 patients of 225 cases of GCTB treated by extended surgical curettage. These include 9 of 135 cases initially treated by extended curettage and bone cement and 18 of 88 cases initially treated by curettage and bone graft. Recurrence was found to be more common in males than females.
Conclusions: Local recurrence is significantly lower in patients treated by cementation following extended surgical curettage than bone graft which makes bone cement as a better filling material with regard to recurrence.
Keywords: Giant cell tumor, Curettage, Bone cement, Bone graft, South India.

References

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Authors: Ismail Tawfeek Badr [1], Sanjiv Rampal [2], Ahmed Shahin [1]

[1] Department of Orthopaedic, Faculty of Medicine, Menoufia University, Faculty of Medicine, Egypt.
[2] Department of Orthopeaedic Department, Faculty of Medicine, Putra University, Faculty of Medicine, Malaysia.

Address of Correspondence

Dr. Ismail Tawfeek Badr,
Department of Orthopaedic, Faculty of Medicine, Menoufia University, Egypt.
E-mail: ismail.tawfeek@yahoo.com

Abstract

Introduction: Fibrous dysplasia (FD)is a benign pathological condition usually observed in the first three decades of life. A single bone may be involved either wholly or partially, or multiple bones may be affected, we aimed to use curettage and cementation as a control method of FDfibrous dysplasia of the proximal radius.
Methods: We describe our finding with the treatment of FDfibrous dysplasia of the proximal radius in five patients(four females and, one male), the mean age of 28.6 years (22 to –39 years). The lesions were in the metaphysis extending to the diaphysis. Persistent pain and pain after pathological fracture were the indications for surgical intervention. We used an extensile approach to expose the lesion then extended curettage using a high-speed burr and filling the cavity with bone cement. Functional outcome and radiological findings were monitored on follow-up visits.
Results: The mean follow-up period was 3.2 years (ranged from 2 years to 5 years).There waswereno recurrences and no patient sustained a fracture at the end of the filling cement. At the time of the last follow-up, all patients have excellent score(mean 27 points) according to the musculoskeletal tumor society scoring system.
Conclusion: Extended curettage and cementation provide a safe and reliable alternative for control of FDfibrous dysplasia of the proximal radius with little morbidity with little risk of recurrence and low incidence of complications.
Keywords: Fibrous dysplasia, Curettage, Cement.

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Authors: Manish Agarwal [1]

[1]Department of Surgical Oncology, P.D Hinduja Hospital & Medical Research Centre, Veer SavarkarMarg, Mahim, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Manish Agarwal,
P.D Hinduja Hospital & Medical Research Centre,
Veer SavarkarMarg, Mahim, Mumbai – 400 016, Maharashtra, India.
E-mail: mgagarwal@gmail.com

Abstract

Intralesionalsurgery is the most favored kind of surgery for giant-cell tumors of the bone. A good surgical technique helps minimize the risk of local recurrence. A good exposure followed by meticulous curetting aided by a high-speed burr is the backbone of this surgery. The role of chemical and thermal adjuvants is discussed with the evidence. The best way to reconstruct the cavity after curettage has been hotly debated. This article discusses the role of bone, cement, as well as a combination “sandwich” technique.
Keywords: Intralesional surgery, curettage, giant-cell tumor, adjuvant, “sandwich” reconstruction.

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