P071 Osteoid osteoma in children: About 15 cases

Background Osteoid osteoma (OO)also called osteoblastoma, if the localization is in the spine, is a benign osteoblastic tumor of variable clinical expression, depending on the location of the lesion. It represents 2% to 3% of bone tumours and 15% of benign bone tumours in children. It affects mainly older children and adolescents and most often occurs in the lower limb, especially the femur. The diagnosis is radio-clinical. The aim of this study is to demonstrate the effectiveness of surgical removal of the tumor, the therapeutic difficulty in certain osteoarticular localizations and finally the radio-clinical evolution after surgery. Material & methods We report the radio-clinical outcomes of a series of 15 children (4 girls/11 boys; aged of 03–14 years) with OO operated in our department, over a period of 08 years (2011–2019). Results The OO is located in most of cases of the lower limbs: acetabulum (1 case); femoral neck (3 cases); femoral diaphysis (2 cases); tibial diaphysis (4 cases); distal metaphysis of the tibia (1 case); talus (1 case) and in the spine (3 cases: vertebral body of T3, the posterior arch of T12 and the sacrum S3). Nocturnal pain yielding to aspirin, was the main symptom. It was associated with lameness when walking in patients with location of OO in the lower limbs. Diagnosis was delayed in patients with localization of OO in the spine (after 3 years) and in the talus (after 2 years). Imaging (standard Rx, CT scan and MRI) allowed the diagnosis of OO in all cases (nidus and cocarde image) and assessed the loco-regional impact (compression of the spinal canal in the sacral location; eccentricity of the femoral epiphysis, in the acetabular location, scoliosis in the spinal location). Thirteen children received surgical treatment under fluoroscopic guidance, which consisted of: A surgical abstention was decided in 2 cases: an inaccessible location at the bottom of the acetabulum and the T3 thoracic vertebral body localization in a 6-year-old girl. 12 operated children have good outcomes. However, 03 children experienced post-therapy problems: lumbar pain radiating towards the left thigh in the girl with sacral location (S3) despite the large laminectomy; a relapse 7 months later in the child with the femoral neck localization; A valgus misalignment of the right knee after removal of the OO of the proximal metaphysis of the tibia with a relapse 3 months later. Conclusion OO is a rare, benign tumor. However, certain locations can lead to diagnostic difficulties, loco-regional, organic and functional repercussions and certain constraints on their therapeutic management. Modern imaging helps to improve the care of these patients, both in terms of early diagnosis (scintigraphy, CT scan and MRI) and therapeutic precision (photo-coagulation, radiofrequency ablation).

Outcomes of Surgery for Enchondromas within the Hand

Background. Enchondromas are the most common benign bone tumours found in the hand. They are usually accidentally diagnosed on an X-ray, because they grow asymptomatically. In some cases, a pathological fracture of the involved phalanx may be the first sign. The objective of this study was to assess the results of operative treatment of enchondromas involving hand phalanges and metacarpals. Material and methods. The study group consisted of 24 patients, 16 women (67%) and 8 men, (33%), aged a mean of 31 years, who were operated on at our centre. The surgery consisted in curettage, and - in most cases - filling the bone defect with either a bone graft or a bone substitute. Follow-up assessment was performed over the telephone in 17 patients (79% of the group) at a mean of 2 years after surgery. Results. Half of the patients were asymptomatic and fully recovered functionally, whereas the other half complained of some not troublesome symptoms such as scar discomfort, limitation of finger movement or cold sensitivity. No differences were observed with regard to the material used for filling of the bone defect following curettage. Two cases of recurrence were noted after surgery: one in the bone substitute group and one in the bone graft group. Conclusions. 1. Enchondromas are the most common benign bone tumours encountered in bones of the hand. 2. The first line treatment in these lesions is curettage and filling of the bone defect with a bone sub­stitute or cancellous bone graft. 3. Both the results of the present study and literature data show that the approach to managing the tu­mour cavity after curettage has no significant effect on outcomes, which are essentially satisfactory.

Fibrocartilagenous dysplasia in distal femur: A rare histopathological finding

Fibrocartilaginous dysplasia (FCD) or massive cartilaginous differentiation in fibrous dysplasia are interchangeably used terms. It is a rare variant of fibrous dysplasia (FD) which is benign, lytic, and expansile bone lesion and causes progressive deformity in the bones and may lead to pathological fracture. Radiologically, FCD may confused with cartilaginous benign and malignant bone tumours. FCD usually shows calcification in imaging. Surgical curettage or corrective osteotomy and histopathological examination of these lesions is necessary to differentiate it from other cartilaginous tumours. Here we report case of fibrocartilaginous dysplasia of distal femur in a 4-year-old male child.

Diagnosis and staging of malignant bone tumours in children: what is due and what is new?

Purpose Although malignant bone tumours in children are infrequent, it is important to know how to properly diagnose and stage them, in order to establish an adequate treatment. Methods We present a review of the diagnostic workflow of malignant bone tumours in children, including history and clinical examination, imaging, laboratory tests and biopsy techniques. Moreover, the two most commonly used staging systems are reviewed. Results History, clinical examination and laboratory tests are nonspecific for diagnosing malignant bone tumours in children. Radiographs remain the mainstay for initial diagnosis, with MRI the modality of choice for local assessment and staging. Fluorine-18 labelled fluoro-deoxy-glucose-positron emission tomography scans provide a noninvasive method to assess the aggressiveness of the tumour and to rule out metastasis and is replacing the use of the bone scintigraphy. Biopsy must be always performed under the direction of the surgeon who is to perform the surgical treatment and after all diagnostic evaluation has been done. Staging systems are useful to study the extent of the tumour and its prognosis. They are expected to evolve as we better understand new molecular and genetic findings. Conclusion When a malignant bone tumour is suspected in a child, it is essential to make a correct diagnosis and referral to an experienced centre. Following an appropriate workflow for diagnosis and staging facilitates, prompt access to treatment improves outcomes. Level of Evidence Level V Expert opinion

Reconstruction for bone tumours of the shoulder and humerus in children and adolescents

Reconstructions for paediatric bone tumours of the shoulder girdle and humerus are intended to optimize placement of the hand in space. Given the longevity of paediatric survivors of sarcoma, durability is an important planning consideration. Here, I review a subset of approaches based on anatomical site with an emphasis on function and longevity. Often, biological reconstructions that combine living bone with tendon repairs and transfers best address those goals.