Limitations and Strengths
Nonossifying fibroma, tumor, intraoperative bleeding, fibrous dysplasia, enchondroma, cysts
BONE LESION, NONOSSIFYING FIBROMA, TUMOR, PATHOLOGIC FRACTURE, RECURRENCE, PATHOLOGICAL FRACTURES, BONE LESIONS, FIBROUS DYSPLASIA, CAVITY, FIBROMA, ENCHONDROMA, INTRAOPERATIVE BLEEDING
The present study included children needing intralesional curettage and cavity filling for a benign bone lesion. These were typically an SBC or ABC in a load-bearing area or with a pathologic fracture. Two patients had nonossifying fibroma, and 1 each had fibrous dysplasia and enchondroma. Nonossifying fibroma and fibrous dysplasia may have features similar to an ABC. A limitation of this study was the inclusion of multiple tumor types that differ in their intrinsic recurrence rates, which resulted in sample heterogeneity. Therefore, we performed a multivariable analysis that adjusted for the type of lesion as well as a subgroup analysis of the 24 patients with an ABC, which showed results similar to those in the overall study population. More than half of our patients (27 of 51) presented with a pathologic fracture before the intralesional tumor surgery, which was performed after a short delay in order to reduce intraoperative bleeding. The inclusion of patients with and without a pathologic fracture, and patients with and without internal fixation, increased the heterogeneity of the patient population further, representing a second limitation. However, pathological fractures and need for internal fixation are typical features of benign bone lesions and their management. A third limitation was the size of the cohort. Fourth, the reliability of the modified Neer classificationAll 51 participating children reached the minimum 2-year follow-up. The curettage was performed in the same way in all patients irrespective of the type of the lesion. Researchers and families were not blinded to the treatment as bioactive glass and allograft have different imaging characteristics. Results were analyzed using the intention-to-treat principle. Our patients were consecutively treated at 4 academic medical centers. The treatment protocol was standardized. MRI was acquired twice to diagnose recurrent lesions.The ideal filling material for bone cysts after curettage is theoretically autograft bone