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We describe an unusual case of a postoperative bone cyst resulting from a retained fragment of surgical glove. We highlight some of the problems associated with gloves and suggest ways of safeguarding against similar complications.
We carried out a retrospective review of 75 children with unicameral bone cysts, who had sustained 52 pathological fractures, to determine which cysts were likely to be at risk and whether healing was accelerated after a fracture. Most lesions were in the metaphysis of a tubular bone, the commonest sites being the the upper part of the humerus and femur. The percentage of bone occupied by the cyst in the transverse plane was more than 85% in both anteroposterior and lateral radiographs in every case of pathological fracture. In most cases, the cyst recurred and sometimes became large without any acceleration of healing.
Atypical radiologic and scintigraphic findings of a benign bone cyst in a 49-year old male are presented. The cyst is surrounded by a polygonal thick uneven sclerotic rim and shows radionuclide uptake.
Giant cell-rich bone lesions consist of tumor-like lesions and true neoplastic giant cell tumors. In this study it was investigated whether DNA cytometry may contribute to the differential diagnosis between aneurysmal bone cysts and giant cell tumors. Statistically significant differences in the frequency of tetraploid stemlines were detected. Nevertheless, the knowledge of age, localization and radiological signs in addition to morphological findings are essential to distinguish between these lesions.
PURPOSE OF THE STUDY: Proximal femoral fractures in children are rare, pathologic fractures being extremely rare. Despite many meanings these fractures are still "unsolved" there are some definite rules for treatment of true accidental injuries. Pathologic fractures are outstanding with their extremely rare incidence. The aim of the study is to overview a large clinical material, find out the incidence of this pathologic fracture, the extent and shape of the unicameral bone cyst (UBC), specific therapeutic approach, technical problems of eventual osteosynthesis, number of reoperations and sequels. MATERIAL: Altogether 49 children with 50 accidental and pathologic fractures of proximal part of the femur treated in the Regional Pediatric Trauma Centre of the Department of Pediatric and Trauma Surgery, 3rd Faculty of Medicine, Charles University, Prague. METHODS: Retrospective and prospective study of children (0 to 15 years of age) treated with proximal femoral accidental and pathologic fractures during the 20 year period (from August 1984 to November 2004). Classification of fractures according to Delbet and Colonna. Diagnosis of bone cyst with plain X-rays, eventually CT scans. RESULTS: During the 20 years period (August 1984 to November 2004) 49 children with 50 proximal femoral fractures were treated in the Department. Four patients sustained a pathologic fracture through an unicameral bone cyst. Two of these latter children were treated by an open reduction and osteosynthesis with the use of the proximal femoral AO-ASIF angled-plate and two children nonoperatively using skeletal traction because of impossibility of insertion of the osteosynthetic material without a damage of the growth plate. Subsequent operations of the UBC were necessary in these two children. All four patients recovered well without sequels. DISCUSSION: Pathologic fractures in UBC are usually treated nonoperatively and the cyst itself is treated after fracture healing. Proximal femoral impairment is the exception from this rule because of weigh bearing necessity. However, there may be problems with insertion of the implant when the cyst is very near to capital physis and traction treatment is then the method of choice with a delay of operative treatment of the cyst. CONCLUSIONS: Pathologic proximal femoral fractures in UBC are extremely rare and need individual approach. Some of them should be operated on the others primarily treated by traction with secondary operation of the cyst. Complications can be frequent.
A case of aneurysmal bone cyst (ABC) of the mandible, recurring for the third time and arising in conjunction with fibrous dysplasia, is reported. A comprehensive review of the literature and analysis of over 50 cases of ABC of the jaws yielded the following results: ABCs of the jaws constitute 1.5 % of all non-odontogenic and non-epithelial cysts of the jaws, and 1.9 % of all ABCs of the skeleton. The mandible was affected in 55 % of the cases, the maxilla in 45 % of the patients. Females represented 53 % of the patients and males the remaining 47 %. Seventy-four percent of the ABCs occurred in patients 20 years old and younger. This lesion is regarded as non-neoplastic and as most likely secondary to a pre-existing bone lesion. Our review established that 21 % of the reported cases in the jaws had developed in association with various primary lesions of bone, including fibro-osseous lesions. The primary bone lesion initiates an osseous, arteriovenous fistula which, through its hemodynamic forces, creates a secondary reactive lesion, that is an aneurysmal bone cyst. We also established a recurrence rate of 26 %, based upon previously reported cases as well as our own. The treatment of choice is surgical curettage with cryosurgery and immediate packing with bone chips.
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PURPOSE: This study evaluated the significant differences in clinicopathologic features of aneurysmal bone cyst in the maxilla and mandible. MATERIALS AND METHODS: A search of the literature showed 30 recorded maxillary cases, and these together with one previously unrecorded case formed the basis of the study. RESULTS: There were no differences in the age and sex incidence. Only two patients complained of pain, and no patient complained of tenderness. No patient gave a history of trauma. Swelling was present in virtually every patient. In seven cases, there was tooth mobility or migration of teeth. Two patients complained of paresthesia. Four patients presented with proptosis, two of whom complained of diplopia. The radiographic appearance of the aneurysmal bone cyst is suggestive but not diagnostic. CONCLUSION: Although these differences do not enable the clinician to make a definitive diagnosis before biopsy, they have important implications for management.
In a retrospective study, 21 simple bone cysts (SBC) treated by curettage (with or without bone grafting) are compared to 20 SBC treated by intralesional injections of methylprednisolone. Curettage led to 43% favourable results and 29% recurrences. Cortisone injections led to 90% favourable results and 5% recurrences. Combined therapy (curettage and injections) led to results comparable to injections only. In our experience, curettage and hydroxyapatite grafting led to 100% complete healing (only 2 cases). We recommend intralesional methylprednisolone injections because the method is easy, effective and safe.
Unicameral bone cysts in 57 patients, seen at the Alfred I. duPont Institute between 1949 and 1982, were studied retrospectively. We present the natural history in several patients and report a "cyst index" which allows the progress of the cyst to be followed and makes it possible to determine whether there is a significant risk of fracture which would warrant treatment. We have found that measuring the cyst index in patients treated by injections of methylprednisolone acetate helps to assess the response to treatment.
Four cases are described of simple bone cysts of the mandible arising concurrently with benign fibro-osseous (cemental) lesions. Previous reports of such findings, and a possible relationship to the so-called 'cementoma' of the long bones, are considered. The relevance of this to the aetiology is addressed, and it is suggested that at least some cases diagnosed as simple bone cysts are closely related to the fibro-osseous lesions.
A 6-month-old female Yorkshire Terrier was examined because of acute left forelimb lameness secondary to a Salter-Harris type IV fracture of the lateral condyle of the humerus. Radiography revealed an eccentric, osteolytic lesion in the distal humeral metaphysis associated with a pathologic fracture. The limb was amputated, and the dog recovered. Microscopic examination revealed an extensive zone of hemorrhage and dilated coalescent spaces, which were filled with blood. Hemosiderin-laden macrophages and multinucleated giant cells were observed throughout the stroma. On the basis of clinical, radiographic, and histologic examinations, a diagnosis of aneurysmal bone cyst was made. Aneurysmal bone cysts generally have been detected in 11- to 13-year-old, medium- to large-sized dogs. They can develop secondary to malignant processes.
Two cases of solitary bone cyst are described. Case 1 is interesting in that the age of presentation was near the extreme lower end of the range of recorded cases, and also the site was in the mandibular ramus, extending to the sigmoid notch, which is one of the least common sites in this bone. Furthermore, the lesion was not clinically silent; 26 per cent of Howe's series had swelling with or without pain, and 24 per cent of Huebner's and Turlington's series. Cases 2 illustrates the value of radiographs which give a general view of the mandible and maxilla, since this particular lesion was quite unexpected. Although the etiology is still dispute, the treatment by surgical intervention is almost universally agreed upon.
An eighteen month old female Doberman pinscher dog was referred to teaching hospital of Adnan Menderes University, Faculty of Veterinary Medicine with the complaint of right forelimb lameness for a month. On the basis of clinical, radiographical, scintigraphical, computed tomographical and histopathological findings, aneurysmal bone cyst was diagnosed. Surgical curettage and bone cement treatment were applied. The patient recovered after 12 months. This case proves that aneurysmal bone cyst, without osteolysis and/or damages to the surrounding tissues, may result in a good prognosis if curettage and treatment with bone cement are done.
A case of a traumatic bone cyst is reported because of the unusual nature of the chief complaint. The initial symptom of the disease was mandibular nerve neuropathy with numbness of the left side of the lower lip and chin.
A large solitary bone cyst involving the epiphysis produced 5.0 cm shortening of the proximal humerus in a 15-year-old girl. Biopsy revealed the cyst was filled with thin yellow fluid under pressure and lined by a fibrous membrane. X-rays 9 months after biopsy demonstrated progressive cyst obliteration. A review of literature revealed no similar case. It is postulated that solitary cysts rarely may involve the physeal and epiphyseal structures and thereby retard longitudinal bone growth.
Twelve patients are reported in whom a unicameral bone cyst was found to involve the epiphysis or apophysis across an open growth plate. Nine patients showed pathologic fracture. In four patients a growth disturbance was found. A varying amount of varus angulation was present in most cases. No patient had functional impairment.
A case report of aneurysmal bone cyst of the mandible in a seven-year-old boy which caused the destruction and loss of the bony crypt around the tooth germ and displacement of the unerupted tooth is presented. This unusual dental findings have not been previously reported in the dental literature.