ELASTIC STABLE INTRAMEDULLARY NAILING FOR TREATMENT OF BENIGN LESIONS OF HUMERUS COMPLICATING BY PATHOLOGICAL FRACTURE IN CHILDREN_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LUO Leiming , LU Xiaobo , GE Jianhua , YE Lizi , WANG Yuanhui.

Department of Bone and Joint Surgery, the Affiliated Hospital of Luzhou Medical College, Luzhou Sichuan, 646000, P.R.China. Corresponding author: LU Xiaobo, E-mail: lux90366@126.com;

Corresponding author：

Keywords：

Elastic stable intramedullary nail; Fibrous dysplasia; Bone cyst; Pathological fracture Internal fixation; Child

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Objective To exploere the effectiveness and advantages of elastic stable intramedullary nail (ESIN) combined with curettage and graft for the treatment of benign lesions of humerus complicating by pathological fracture in children. Methods ESIN internal fixation combined with curettage and graft was used to treat benign lesions of the humerus complicating by pathological fracture in 11 children patients between January 2007 and January 2011. Of 11 patients, 7 were boy and 4 were girl, aged from 5 to 14 years (mean, 9.4 years). The disease duration ranged from 2 to 14 days (mean, 6 days). All fractures were closed fracture, which locations were the proximal humerus in 6 cases, the humeral shaft in 4 cases, and the distal humerus in 1 case; benign lesions of the humerus included aneurysmal bone cyst in 1 case, simple bone cyst in 7 cases, and fibrous dysplasia in 3 cases. Based on imaging studies, preoperative diagnosis was almost clear. The time from hospitalization to operation was 3-5 days Results Healing of incision by first intention was obtained in all cases, with no infection. The mean follow-up was 25.6 months (range, 12-36 months). All patients achieved pain relief at 6 weeks postoperatively and fractures healed completely at 3 to 4 months after operation (mean, 3.3 months). No recurrence or re-fracture was observed during follow-up. The ESIN was removed at 10-14 months after operation (mean, 12.5 months). The lesion disappeared completely in 8 cases and partially in 3 cases. No pain of affected limb or motion limitation of shoulder and elbows was observed. One patient had limb shortening of 2 cm at last follow-up, but he had no function problem. According to Neer shoulder and Mayo elbow function scores, the results were excellent in 11 cases. Conclusion It is a good method to treat benign lesions of the humerus complicating by pathological fracture in children to use ESIN internal fixation combined with curettage and graft. After only a single operation intervention, it can provide early mechanical stability and rapid fracture healing and allow early rehabilitation exercise.

Citation： LUO Leiming,LU Xiaobo,GE Jianhua,YE Lizi,WANG Yuanhui.. ELASTIC STABLE INTRAMEDULLARY NAILING FOR TREATMENT OF BENIGN LESIONS OF HUMERUS COMPLICATING BY PATHOLOGICAL FRACTURE IN CHILDREN. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(1): 21-24. doi: Copy

1.	Grzegorzewski A, Pogonowicz E, Sibinski M, et al. Treatment of benign lesions of humerus with resection and non-vascularised, autologous fibular graft. Int Orthop, 2010, 34(8): 1267-1272.
2.	Başarir K, Pişkin A, Güçlü B, et al. Aneurysmal bone cyst recurrence in children: a review of 56 patients. J Pediatr Orthop, 2007, 27(8): 938-943.
3.	Kanellopoulos AD, Mavrogenis AF, Papagelopoulos PJ, et al. Elastic intramedullary nailing and DBM-bone marrow injection for the treatment of simple bone cysts. World J Surg Oncol, 2007, 5: 111.
4.	张世民, 李海丰, 黄轶刚. 骨折分类与功能评定. 北京: 人民军医出版社, 2008: 304-318.
5.	Saraph V, Linhart WE. Modern treatment of pathological fractures in children. Injury, 2005, 36 Suppl 1: A64-74.
6.	Neer CS 2nd, Francis KC, Marcove RC, et al. Treatment of unicameral bone cyst. A follow-up study of one hundred seventy-five cases. J Bone Joint Surg (Am), 1966, 48(4): 731-745.
7.	Mik G, Arkader A, Manteghi A, et al. Results of a minimally invasive technique for treatment of unicameral bone cysts. Clin Orthop Relat Res, 2009, 467(11): 2949-2954.
8.	Capanna R, Campanacci DA, Manfrini M. Unicameral and aneurysmal bone cysts. Orthop Clin North Am, 1996, 27(3): 605-614.
9.	Docquier PL, Delloye C. Treatment of aneurysmal bone cysts by introduction of demineralized bone and autogenous bone marrow. J Bone Joint Surg (Am), 2005, 87(10): 2253-2258.
10.	Sung AD, Anderson ME, Zurakowski D, et al. Unicameral bone cyst: a retrospective study of three surgical treatments. Clin Orthop Relat Res, 2008, 466(10): 2519-2526.
11.	Knorr P, Schmittenbecher PP, Dietz HG, et al. Elastic stable intramedullary nailing for the treatment of complicated juvenile bone cysts of the humerus. Eur J Pediatr Surg, 2003, 13(1): 44-49.
12.	DiCaprio MR, Enneking WF. Fibrous dysplasia. Pathophysiology, evaluation, and treatment. J Bone Joint Surg (Am), 2005, 87(8): 1848-1054.
13.	Enneking WF, Gearen PF. Fibrous dysplasia of the femoral neck. Treatment by cortical bone-grafting. J Bone Joint Surg (Am), 1986, 68(9): 1415-1422.
14.	Shih HN, Su JY, Hsu KY, et al. Allogeneic cortical strut for benign lesions of the humerus in adolescents. J Pediatr Orthop, 1997, 17(4): 433-436.
15.	Tsuchiya H, Morsy AF, Matsubara H, et al. Treatment of benign bone tumours using external fixation. J Bone Joint Surg (Br), 2007, 89(8): 1077-1083.
16.	Rapp M, Svoboda D, Wessel LM, et al. Elastic Stable Intramedullary Nailing (ESIN), Orthoss® and Gravitational Platelet Separation—System (GPS®): an effective method of treatment for pathologic fractures of bone cysts in children. BMC Musculoskelet Disord, 2011, 12: 45.
17.	Atesok K, Liebergall M, Sucher E, et al. Treatment of pathological humeral shaft fractures with unreamed humeral nail. Ann Surg Oncol, 2007, 14(4): 1493-1498.
18.	Ward EF, White JL. Interlocked intramedullary nailing of the humerus. Orthopedics, 1989, 12(1): 135-141.
19.	Pogorelić Z, Furlan D, Biocić M, et al. Titanium intramedullary nailing for treatment of simple bone cysts of the long bones in children. Scott Med J, 2010, 55(3): 35-38.
20.	Kokavec M, Fristakova M, Polan P, et al. Surgical options for the treatment of simple bone cyst in children and adolescents. Isr Med Assoc J, 2010, 12(2): 87-90.
21.	蒋欣, 陈小亮, 王道喜, 等. 儿童四肢长骨病理性骨折手术治疗60例. 临床小儿外科杂志, 2011, 10(5): 337-340.
22.	Finkemeier CG. Bone-grafting and bone-graft substitutes. J Bone Joint Surg (Am), 2002, 84-A(3): 454-464.
23.	Dimitriou R, Jones E, McGonagle D, et al. Bone regeneration: current concepts and future directions. BMC Med, 2011, 9: 66.
24.	Hagmann S, Eichhorn F, Moradi B, et al. Mid- and long-term clinical results of surgical therapy in unicameral bone cysts. BMC Musculoskeletal Disorders, 2011, 12: 281.

1. Grzegorzewski A, Pogonowicz E, Sibinski M, et al. Treatment of benign lesions of humerus with resection and non-vascularised, autologous fibular graft. Int Orthop, 2010, 34(8): 1267-1272.
2. Başarir K, Pişkin A, Güçlü B, et al. Aneurysmal bone cyst recurrence in children: a review of 56 patients. J Pediatr Orthop, 2007, 27(8): 938-943.
3. Kanellopoulos AD, Mavrogenis AF, Papagelopoulos PJ, et al. Elastic intramedullary nailing and DBM-bone marrow injection for the treatment of simple bone cysts. World J Surg Oncol, 2007, 5: 111.
4. 张世民, 李海丰, 黄轶刚. 骨折分类与功能评定. 北京: 人民军医出版社, 2008: 304-318.
5. Saraph V, Linhart WE. Modern treatment of pathological fractures in children. Injury, 2005, 36 Suppl 1: A64-74.
6. Neer CS 2nd, Francis KC, Marcove RC, et al. Treatment of unicameral bone cyst. A follow-up study of one hundred seventy-five cases. J Bone Joint Surg (Am), 1966, 48(4): 731-745.
7. Mik G, Arkader A, Manteghi A, et al. Results of a minimally invasive technique for treatment of unicameral bone cysts. Clin Orthop Relat Res, 2009, 467(11): 2949-2954.
8. Capanna R, Campanacci DA, Manfrini M. Unicameral and aneurysmal bone cysts. Orthop Clin North Am, 1996, 27(3): 605-614.
9. Docquier PL, Delloye C. Treatment of aneurysmal bone cysts by introduction of demineralized bone and autogenous bone marrow. J Bone Joint Surg (Am), 2005, 87(10): 2253-2258.
10. Sung AD, Anderson ME, Zurakowski D, et al. Unicameral bone cyst: a retrospective study of three surgical treatments. Clin Orthop Relat Res, 2008, 466(10): 2519-2526.
11. Knorr P, Schmittenbecher PP, Dietz HG, et al. Elastic stable intramedullary nailing for the treatment of complicated juvenile bone cysts of the humerus. Eur J Pediatr Surg, 2003, 13(1): 44-49.
12. DiCaprio MR, Enneking WF. Fibrous dysplasia. Pathophysiology, evaluation, and treatment. J Bone Joint Surg (Am), 2005, 87(8): 1848-1054.
13. Enneking WF, Gearen PF. Fibrous dysplasia of the femoral neck. Treatment by cortical bone-grafting. J Bone Joint Surg (Am), 1986, 68(9): 1415-1422.
14. Shih HN, Su JY, Hsu KY, et al. Allogeneic cortical strut for benign lesions of the humerus in adolescents. J Pediatr Orthop, 1997, 17(4): 433-436.
15. Tsuchiya H, Morsy AF, Matsubara H, et al. Treatment of benign bone tumours using external fixation. J Bone Joint Surg (Br), 2007, 89(8): 1077-1083.
16. Rapp M, Svoboda D, Wessel LM, et al. Elastic Stable Intramedullary Nailing (ESIN), Orthoss® and Gravitational Platelet Separation—System (GPS®): an effective method of treatment for pathologic fractures of bone cysts in children. BMC Musculoskelet Disord, 2011, 12: 45.
17. Atesok K, Liebergall M, Sucher E, et al. Treatment of pathological humeral shaft fractures with unreamed humeral nail. Ann Surg Oncol, 2007, 14(4): 1493-1498.
18. Ward EF, White JL. Interlocked intramedullary nailing of the humerus. Orthopedics, 1989, 12(1): 135-141.
19. Pogorelić Z, Furlan D, Biocić M, et al. Titanium intramedullary nailing for treatment of simple bone cysts of the long bones in children. Scott Med J, 2010, 55(3): 35-38.
20. Kokavec M, Fristakova M, Polan P, et al. Surgical options for the treatment of simple bone cyst in children and adolescents. Isr Med Assoc J, 2010, 12(2): 87-90.
21. 蒋欣, 陈小亮, 王道喜, 等. 儿童四肢长骨病理性骨折手术治疗60例. 临床小儿外科杂志, 2011, 10(5): 337-340.
22. Finkemeier CG. Bone-grafting and bone-graft substitutes. J Bone Joint Surg (Am), 2002, 84-A(3): 454-464.
23. Dimitriou R, Jones E, McGonagle D, et al. Bone regeneration: current concepts and future directions. BMC Med, 2011, 9: 66.
24. Hagmann S, Eichhorn F, Moradi B, et al. Mid- and long-term clinical results of surgical therapy in unicameral bone cysts. BMC Musculoskeletal Disorders, 2011, 12: 281.

Chinese Journal of Reparative and Reconstructive Surgery

ELASTIC STABLE INTRAMEDULLARY NAILING FOR TREATMENT OF BENIGN LESIONS OF HUMERUS COMPLICATING BY PATHOLOGICAL FRACTURE IN CHILDREN

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