Interventions
femoral head allograft, tumor, femoral head allograft or bioactive glass
TUMOR, CAVITY, PATHOLOGIC FRACTURE
The patients randomized to the allograft group received fresh-frozen morselized femoral head allograft and those randomized to the bioactive glass group received BG-S53P4 granules (Bonalive; Bonalive Biomaterials, Turku, Finland) as filling material at the end of the procedure. BG-S53P4 gained European approval for orthopaedic use as a bone graft substitute in 2006.All procedures were performed by 5 experienced pediatric orthopaedic surgeons (3 to 20 procedures per surgeon). A cortical window, 15 × 20 mm in size, was made with an osteotome (Video 1). The tumor mass was curetted and sent for pathologic examination. Using a headlight for illumination, the contents of the cyst were removed systematically with curets and its lining membrane was removed using a high-speed burr. Phenol (5%) was applied to the cyst cavity with cotton swabs and neutralized with saline solution. The cyst volume was measured intraoperatively using saline solution. The cyst was then filled with morselized femoral head allograft or bioactive glass, depending on the randomization. The largest granule size, 2 to 3.15 mm, was used for ≥10-mL cavities in the femur, tibia, pelvis, and humerus. If the volume of the cavity was <10 mL, the intermediate granule size, 1 to 2 mm, was utilized. If the cyst was in the hand area, then the smallest granule size, 0.5 to 0.8 mm, was used. Intraoperative fluoroscopy was used to ensure that the entire cyst was filled properly. Locking-plate osteosynthesis was used in high-risk locations (such as proximal femur) to prevent a pathologic fracture.