Risk factors of fracture following curettage for bone giant cell tumors of the extremities

BMC Musculoskeletal Disorders

Manabu Akahane¹  Davide Maria Donati²  Costantino Errani²  Shinji Tsukamoto³  Kanya Honoki³  Yasuhito Tanaka³  Akira Kido⁴  Andreas F. Mavrogenis⁵ 

[1] Department of Health and Welfare Services, National Institute of Public Health;Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli;Department of Orthopaedic Surgery, Nara Medical University;Department of Rehabilitation Medicine, Nara Medical University;First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine;

关键词: Giant cell tumor of bone;    Curettage;    Fracture;    Denosumab;    Cement;    Bone grafting;   

DOI  :  10.1186/s12891-022-05447-x

来源: DOAJ

【 摘 要 】

Abstract Background Following curettage of giant cell tumor of bone (GCTB), it is common to fill the cavity with polymethylmethacrylate (PMMA) bone cement, bone allograft, or artificial bone to maintain bone strength; however, there is a 2–14% risk of postoperative fractures. We conducted this retrospective study to clarify the risk factors for fractures after curettage for GCTB of the extremities. Methods This study included 284 patients with GCTBs of the extremities who underwent curettage at our institutions between 1980 and 2018 after excluding patients whose cavities were not filled with anything or who had additional plate fixation. The tumor cavity was filled with PMMA bone cement alone (n = 124), PMMA bone cement and bone allograft (n = 81), bone allograft alone (n = 63), or hydroxyapatite graft alone (n = 16). Results Fractures after curettage occurred in 10 (3.5%) patients, and the median time from the curettage to fracture was 3.5 months (interquartile range [IQR], 1.8–8.3 months). The median postoperative follow-up period was 86.5 months (IQR, 50.3–118.8 months). On univariate analysis, patients who had GCTB of the proximal or distal femur (1-year fracture-free survival, 92.5%; 95% confidence interval [CI]: 85.8–96.2) presented a higher risk for postoperative fracture than those who had GCTB at another site (100%; p = 0.0005). Patients with a pathological fracture at presentation (1-year fracture-free survival, 88.2%; 95% CI: 63.2–97.0) presented a higher risk for postoperative fracture than those without a pathological fracture at presentation (97.8%; 95% CI: 95.1–99.0; p = 0.048). Patients who received bone grafting (1-year fracture-free survival, 99.4%; 95% CI: 95.7–99.9) had a lower risk of postoperative fracture than those who did not receive bone grafting (94.4%; 95% CI: 88.7–97.3; p = 0.003). Conclusions For GCTBs of the femur, especially those with pathological fracture at presentation, bone grafting after curettage is recommended to reduce the risk of postoperative fracture. Additional plate fixation should be considered when curettage and cement filling without bone grafting are performed in patients with GCTB of the femur. This should be specially performed for those patients with a pathological fracture at presentation.

【 授权许可】

Unknown