Pathological fractures of long bones of the skeleton in children and adolescents in benign tumors and tumor-like diseases

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Abstract

This article provides an analysis of 82 patients for the period from 2000 to 2018 aged 5 to 18 years with pathological fractures of the long bones of the skeleton on the basis of benign tumors and tumor-like diseases. Most often, fractures were observed with a solitary bone cysts — 24, an aneurysmal bone cyst — 19, fibrous dysplasia — 20, neosteogenic fibroma — 7, Ollier’s disease — 6, osteofibrous dysplasia — 2, giant-cell tumor — 3, hemangioma — 1. On the basis of the Department of Pediatric Bone Pathology and Adolescent Orthopedics of N.N. Priorov National Medical Research Center of Traumatology and Orthopedics all patients underwent a comprehensive physical exams and surgical treatment. The clinical and radiological picture was studied and the features of the course of pathological fractures were revealed depending on the nosology of the tumor process. It is shown that when a pathological fracture occurs, the treatment approach should be individualized depending on the location of the focus, the patient’s age and nosology.

About the authors

A. I. Snetkov

N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics

Author for correspondence.
Email: citollotd@gmail.com

Sc.D. (medicine), Professor, Head of the Department of Pediatric Bone Pathology and Adolescent Orthopedics (Department 11)

Russian Federation, Moscow

S. Yu. Batrakov

N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics

Email: citollotd@gmail.com

Ph.D. (medicine), associate professor, orthopedic surgeon, Department of Pediatric Bone Pathology and Adolescent Orthopedics (Department 11)

Russian Federation, Moscow

A. D. Akinshina

N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics

Email: citollotd@gmail.com

Ph.D. (medicine), orthopedic surgeon, Department of Pediatric Bone Pathology and Adolescent Orthopedics (Department 11)

Russian Federation, Moscow

V. A. Gorelov

N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics

Email: vasiander@gmail.com

orthopedic surgeon, graduate student

Russian Federation, Moscow

S. G. Balametov

N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics

Email: samirlez-gin25@mail.ru

orthopedic surgeon, graduate student

Russian Federation, Moscow

References

  1. Ревелл П.А. Патология кости. Пер. с англ. Н.А. Раевской M.: Медицина; 1993. [Revell Р.A. Patologiya kosti. Per. sangl. N.A. Raevskoj. Moskva: Medicina; 1993. (In Russ.)].
  2. Зацепин С.T. Костная патология взрослых. M.: Медицина; 2001. [Zacepin S.Т. Kostnaya patologiya vzroslyh. Moskva: Medicina; 2001. (In Russ.)].
  3. Пташников Д.А., Усиков В.Д., Засульский Ф.Ю. Паталогические переломы. Практическая онкология. 2006;7(2):49-52. [Ptashnikov D.A., Usikov V.D., Zasul’skij F.Yu. Patalogicheskie perelomy. Prakticheskaya onkologiya. 2006;7(2):49-52. (In Russ.)].
  4. Элъ-Ажаб И.А. Патологические переломы длинных костей при опухолях и опухолеподобных заболеваниях у взрослых: Клиника, диагностика, лечение. Дисс.... канд. мед. наук. М.: ЦИТО им. Н.Н. Приорова; 2002. [Еl'-Azhab I.А. Patologicheskie perelomy dlinnyh kostej pri opuholyah i opuholepodobnyh zabolevaniyah u vzroslyh: Klinika, diagnostika, lechenie. Diss.... kand. med. nauk. Moskva: CNITO im. N.N. Priorova; 2002. (In Russ.)].
  5. Тарасов A.H. Криохирургия патологических переломов. Дисс.... д-ра мед. наук. Самара: СамГМУ; 2007. [Tarasov А.N. Kriohirurgiya patologicheskih perelomov. Diss.... dokt. med. nauk. Samara: SamGMU; 2007. (In Russ.)].
  6. Рейнберг C.A. Рентгенодиагностика заболеваний костей и суставов. 2 т. 4-е изд., испр. и доп. М.: Медицина; 1964. [Rejnberg S.A. Rentgenodiagnostika zabolevanij kostej i sustavov. 2t. 4-e izd., ispr. i dop. Moskva: Medicina; 1964. (In Russ.)].
  7. Волков M.B. Болезни костей у детей. М.: Медицина; 1974. [Volkov М.Ѵ. Bolezni kostej u detej. Moskva: Medicina; 1974. (In Russ.)].
  8. Корж A.A., Бердников В.А. Ампутация конечностей и экспресс-протезирование. Киев: Здоров’я; 1977. [Korzh А.А., Berdnikov V.A. Amputaciya konechnostej i ekspress-protezirovanie. Kiev: Zdorov’ya; 1977. (In Russ.)].
  9. Крысюк А.П., Куценко Т.А., Сивак Н.Ф., Шамраи А.Е. Характеристика коагуляционной активности крови у больных с аневризмальными кистами костей. Ортопедия, травматология и протезирование. 1983;7:51-3. [Krisyuk А.Р., Kucenko Т.А., Sivak N.F., Shamraj А.Е. Harakteristika koagulyacionnoj aktivnosti krovi u bol'nyh s anevrizmal’nymi kistami kostej. Ortopediya, travmatologiya i protezirovanie. 1983;7:51-3. (In Russ.)].
  10. Крысюк А.П., Куценко Т.А., Сивак Н.Ф. Метод лечения аневризмальных кист костей. Ортопедия и травматология. 1984;11:59-61. [Krisyuk А.Р., Kucenko Т.А., Sivak N.F. Metod lecheniya anevrizmal’nyh kist kostej. Ortopediya i travmatologiya. 1984;11:59-61. (In Russ.)].
  11. Бережный А.П. Кисты костей у детей и подростков (клиника, диагностика и лечение). Методические рекомендации Минстерства здравоохранения СССР, Главного управления лечебно-профилактической помощи детям и матерям. М.: ЦИТО; 1985. [Berezhnyj А.Р. Kisty kostej u detej i podrostkov (klinika, diagnostika i lechenie). Metodicheskie rekomendacii Minsterstva zdravoohraneniya SSSR, Glavnogo upravleniya lechebno-profilakticheskoj pomoshchi detyam i materyam. Moskva: CITO; 1985. (In Russ.)].
  12. Capanna R. Contrast examination as a prognostic factor in the treatment of solitary bone cyst by cortisone injection. Skeletal Radiol. 1984; 12:97.
  13. Lefranc J. Evolution a distace des kustes osseux de I enfant et de i adolescent. Chir. Pediatr. 1985;26:133.
  14. Grafe G. Therapie Verhaltcn und Ergebnisse bci juvenilen Knochenzys-ten. Juvenile Knochenzysten. Einhorn-Presse Verlag; 1996.
  15. Green J.A. Embolization in the treatment of aneurysmal bone cysts. J. Pediatr. Orthop. 1997;17(4):440-3.
  16. Farber J.M., Stanton R.P. Treatment options in unicameral bone cysts. Orthopedics. 1990;13(l):25-32.
  17. Ahn J.I., Park J.S. Pathological fractures secondary to unicameral bone cysts. Int Orthop. 1994;18(l):20-2.
  18. Chuo C.Y., Fu Y.C., Chien S.H., Lin G.T., Wang G.J. Management strategy for unicameral bone cyst. Kaohsiung J. Med Sci. 2003; 19(6):289-95.
  19. Givon U.N., Sher-Lurie A., Schindler A., Ganel J. Titanium elastic nail-a useful instrument for thetreatment of simple bone cyst. Pediatr. Orthop. 2004;24(3):317-18.
  20. Шолохова Н.А. Хирургическое лечение доброкачественных опухолей и опухолеподобных заболеваний внутри- и околосуставной локализации у детей и подростков. Дисс.... канд. мед. наук. М.: ЦИТО им. Н.Н. Приорова; 2010. [Sholohova N.A. Hirurgicheskoe lechenie dobrokachestvennyh opuholej i opuholepodobnyh zabolevanij vnutri i okolosustavnoj lokalizacii u detej i podrostkov. Diss.... kand. med. nauk. Moskva: CITO im. N.N. Priorova; 2010. (In Russ.)].
  21. Alkalay D., Kollender Y., Mazes M., Meller I. Giant cell tumors with intraarticular fracture. Two-stagelocal excision, cryosurgery and cementation in 5 patientswith distal femoral tumor followed for 2-4 years. ActaOrthop. Scand. 1996;67(3):291-4.
  22. Иванов А.В., Волыков П.Г., Плотников Г.А., Ардашев И.П. Оперативное лечение энхондром кисти с использованием миниимплантатов «Synthes», Швейцария. VII съезд травматологов-ортопедов России: тезисы докладов. Т. 2. Новосибирск; 2002. [Ivanov А.V., Volykov P.G., Plotnikov G.A., Ardashev І.Р. Operativnoe lechenie enhondrom kisti s ispol’zovaniem miniimplantatov «Synthes», Shvejcariya. VII s»ezd travmatologov-ortopedov Rossii: tezisy dokladov. T. 2. Novosibirsk; 2002. (In Russ.)].
  23. Карпенко И.А., Носов О.Б., Петров С.В. Новые аспекты хирургического лечения опухолей коротких трубчатых костей, осложненных переломами. Современные технологии диагностики, лечения и реабилитации повреждений и заболеваний кисти. Вторая юбилейная научно-практическая международная конференция: тезисы докладов. М.; 2005. [Karpenko L.A., Nosov О.В., Petrov S.V. Novye aspekty hirurgicheskogo lecheniya opuholej korotkih trubchatyh kostej, oslozhnennyh perelomami. Sovremennye tekhnologii diagnostiki, lecheniya i reabilitacii povrezhdenij i zabolevanij kisti. Vtoraya yubilejnaya nauchno-prakticheskaya mezhdunarodnaya konferenciya: tezisy dokladov. Moskva; 2005. (In Russ.)].
  24. Тарасов A.H. Лечебная тактика при патологических переломах (обзор литературы). Травматология и ортопедия России. 2009;2:150-6. [Tarasov А.N. Lechebnaya taktika pri patologicheskih perelomah (obzor literatury). Travmatologiya i ortopediya Rossii. 2009;2:150-6. (In Russ.)].
  25. Wirbel R., Maier M., Mutschler W., Marzi I. Pathologische Frakturbei osteofibroser Dysplasie. Unfallchirurg. 2001; 104(5): 456-8.
  26. Махсон А.Н. О концепции адекватной хирургии применительно к больным с опухолями плечевого и тазового поясов конечностей. Первый интернациональный симпозиум пластической и реконструктивной хирургии в онкологии. М.; 1997. [Mahson A.N. О koncepcii adekvatnoj hirurgii primenitel’no k bol’nym s opuholyami plechevogo i tazovogo poyasov konechnostej. Pervyj intemacional’nyj simpozium plasticheskoj i rekonstruktivnoj hirurgii v onkologii. Moskva; 1997. (In Russ.)].
  27. Шаповалов B.M. Опыт лечения больных с доброкачественными опухолями костей конечностей и таза. Человек и его здоровье: материалы X Российского национального конгресса. СПб.; 2005. [Shapovalov V.M. Opyt lecheniya bol’nyh s dobrokachestvennymi opuholyami kostej konechnostej i taza. Chelovek i ego zdorov’e: materialy X Rossijskogo nacional’nogo kongressa. Sankt-Peterburg; 2005. (In Russ.)].
  28. Куфтырев Л.М., Болотов Д.Д. Способ лечения кистозного поражения дистального эпиметафиза бедренной кости. Гений ортопедии. 2003;2:88-90. [Kuftyrev L.M., Bolotov D.D. Sposob lecheniya kistoznogo porazheniya distal’nogo epimetafiza bedrennoj kosti. Genij ortopedii. 2003;2:88-90. (In Russ.)].
  29. Снетков А.И., Батраков С.Ю., Морозов A.K. и др. Диагностика и лечение доброкачественных опухолей и опухолеподобных заболеваний костей у детей. Под редакцией академика РАН С.П. Миронова. М.: ГЭОТАР-Медиа; 2017. [Snetkov A.I., Batrakov S. Yu., Morozov A.K. i dr. Diagnostika i lechenie dobrokachestvennyh opuholej i opuholepodobnyh zabolevanij kostej u detej. Pod redakciej akademika RAN S.P. Mironova. M.: GEOTAR-Media; 2017. (In Russ.)].

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2. Fig. 1. Patient К.,9 years old. Diagnosis: Pathological fracture of the left humerus due to bone cysts. a — radiograph of the left humerus in a plaster cast; б — radiograph of the left humerus 6 weeks after removal of the plaster cast. X-ray consolidation of the fracture, and signs of repair of the bone cyst.

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3. Fig. 2. Patient К.,10 years old. Diagnosis: Pathological fracture of the right humerus due to bone cysts. a — radiograph of the right humerus before surgery; б — radiograph of the right humerus in 2 projections after surgery: marginal resection of the right humerus, combined alloplasty; в — the x-ray of the right humerus in 2 projections after 12 months from the time of surgery. X-ray consolidation of the fracture and inorganotypic transplant reconstruction are noted. There are no signs of relapse.

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4. Fig. 3. Patient К.,18 years old. Diagnosis: pathological fracture of the distal part of the right femur with displacement of fragments on the basis of aneurysmal cyst. a — radiographs of the right femur in 2 projections before surgery; б — radiographs of the right femur in 2 projections after surgery: open reduction, marginal resection of the distal part of the right femur, alloplasty of the CT, fixation with a plate and screws; в — radiographs of the right femur in 2 projections result after 18 months. X-ray consolidation of the fracture, inorganotypic restructuring of the grafts is noted. There are no signs of relapse.

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5. Fig. 4. Patient S.,16 years old. Diagnosis: pathological fracture of the lower third of the left tibia due to non-osteogenic fibroma. a — radiographs of the bones of the left tibia in 2 projections before surgery; б — radiographs of the bones of the left lower leg after surgery: open reduction, marginal resection of the lower third of the left tibia, alloplasty, metallosteosynthesis.

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6. Fig. 5. Patient М.,14 years old. Diagnosis: pathological fracture of the left femur neck due to fibrous dysplasia. a — radiographs of the left hip joint in direct and axial projections before surgery; б — radiographs of the left hip joint in the direct and axial projections after surgery: edge resection of the proximal part of the left femur, alloplasty, metallosteosynthesis with a DHS plate.

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7. Fig. 6. Patient А.,10 years old. Diagnosis: pathological fracture of the left tibia bones in the middle third with a displacement of osteofibrotic dysplasia on the soil. a — radiographs of the left leg in two projections before surgery; б — radiographs of the left tibia in direct projection after surgery: open reposition of the left tibia, alloplasty, metallosteosynthesis.

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8. Fig. 7. Patient G.,17 years old. Diagnosis: pathological fracture of the distal metaepiphysis of the right radial bone on the basis of a giant cell tumor. a — radiographs of the right forearm in 2 projections before surgery; б — radiographs of the right forearm in 2 projections after surgery: marginal resection of the distal part of the right radial bone, electrocoagulation, autoplasty from the wing of the right iliac bone.

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9. Fig. 8. Patient /.,15 years old. Diagnosis: pathological fracture of the middle third of the left humerus due to Ollier disease. a — radiographs of the left humerus before surgery; б — radiographs of the left humerus after surgery: open reduction, marginal resection of the lower and middle third of the left humerus, alloplasty, metallosteosynthesis.

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10. Fig. 9. Patient А.,18 years old. Diagnosis: pathological fracture of the left tibia against the background of hemangioma. a — radiographs of the left tibia in 2 projections before surgery; б — radiographs of the left tibia in 2 projections after the operation: marginal resection of the left tibia, alloplasty, osteosynthesis with a plate and screws; в — radiographs of the left tibia in 2 projections, the result after 16 months. X-ray consolidation of the fracture, inorganotypic restructuring of the grafts is noted. There are no signs of a relapse of the disease.

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