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Article Dans Une Revue The Bone & Joint Journal (BJJ) Année : 2024

Surgical management of proximal femoral unicameral bone cyst in children

Julien Maximen
Rose-Elisabeth Jeantet
Philippe Violas
Chloé Labarre
  • Fonction : Auteur
Jérôme Sales De Gauzy
  • Fonction : Auteur
Franck Accabled
  • Fonction : Auteur
Pierre Lascombes
  • Fonction : Auteur
Yan Lefèvre
Richard Gouron
Benoit de Billy
  • Fonction : Auteur
Pierre-Louis Docquier
  • Fonction : Auteur
Antoine Laquièvre
  • Fonction : Auteur
Aurélien Courvoisier
  • Fonction : Auteur
  • PersonId : 1043976
Raphaël Corsier
  • Fonction : Auteur
Damien Fron
  • Fonction : Auteur
Franck Launay
Jérôme Cottalorda
  • Fonction : Auteur
Antoine Hamel
  • Fonction : Auteur
  • PersonId : 1377889
Pierre Journeau
  • Fonction : Auteur
Eric Mascard
  • Fonction : Auteur
Brice Ilharreborde
  • Fonction : Auteur
Madeleine Aslan
  • Fonction : Auteur
Thierry Odent
  • Fonction : Auteur
Elodie Gaumetou
  • Fonction : Auteur

Résumé

Aims The aim of this study is to evaluate the surgical treatment with the best healing rate for patients with proximal femoral unicameral bone cysts (UBCs) after initial surgery, and to determine which procedure has the lowest adverse event burden during follow-up. Methods This multicentre retrospective study was conducted in 20 tertiary paediatric hospitals in France, Belgium, and Switzerland, and included patients aged < 16 years admitted for UBC treatment in the proximal femur from January 1995 to December 2017. UBCs were divided into seven groups based on the index treatment, which included elastic stable intramedullary nail (ESIN) insertion with or without percutaneous injection or grafting, percutaneous injection alone, curettage and grafting alone, and insertion of other orthopaedic hardware with or without curettage. Results A total of 201 patients were included in the study. The mean age at diagnosis was 8.7 years (SD 3.9); 77% (n = 156) were male. The mean follow-up was 9.4 years (SD 3.9). ESIN insertion without complementary procedure had a 67% UBC healing rate after the first operation (vs 30% with percutaneous injection alone (p = 0.027), 43% with curettage and grafting (p = 0.064), and 21% with insertion of other hardware combined with curettage (p < 0.001) or 36% alone (p = 0.014)). ESIN insertion with percutaneous injection presented a 79% healing rate, higher than percutaneous injection alone (p = 0.017), curettage and grafting (p = 0.028), and insertion of other hardware combined with curettage (p < 0.001) or alone (p = 0.014). Patients who underwent ESIN insertion with curettage had a 53% healing rate, higher than insertion of other hardware combined with curettage (p = 0.009). The overall rate of postoperative complications was 25% and did not differ between groups (p = 0.228). A total of 32 limb length discrepancies were identified. Conclusion ESIN insertion, either alone or combined with percutaneous injection or curettage and grafting, may offer higher healing rates than other operative procedures. Limb length discrepancy remains a major concern, and might be partly explained by the cyst’s location and the consequence of surgery. Therefore, providing information about this risk is crucial. Cite this article: Bone Joint J 2024;106-B(5):508–514.
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Dates et versions

hal-04607974 , version 1 (11-06-2024)

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Citer

Julien Maximen, Rose-Elisabeth Jeantet, Philippe Violas, Chloé Labarre, Jérôme Sales De Gauzy, et al.. Surgical management of proximal femoral unicameral bone cyst in children. The Bone & Joint Journal (BJJ), 2024, 106-B (5), pp.508-514. ⟨10.1302/0301-620X.106B5.BJJ-2023-0577.R4⟩. ⟨hal-04607974⟩
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