Aneurysmal bone cyst has a variable radiological appearance and should be considered in the differential diagnosis of any uni-locular or multi-locular radiolucent lesion. No role for conservative management as it is a surgical problem. ABC in the extremities can be managed by curettage and different kind of bone grafts. Recurrence rate is high especially in a young age with open growth plates. The use of liquid nitrogen as an adjuvant measure after extended curettage decrease tumor recurrence rate.
Patients and Methods
A case series of 25 patients with aneurismal bone cyst involving different anatomic locations in the skeleton who were evaluated and staged according to Enneking et al. system as 20 active benign lesions and 5 aggressive benign lesions. Extended curettage was achieved in all the patients followed by application of liquid nitrogen for 2 cycles and lastly reconstruction of the cavity by bone graft. The mean age at surgery was 14. 7 years at operation (3–35 years). The average follow-up was 48 months (range, 24-72 months).
The Musculoskeletal tumor Society (MTS) score described by Enneking et al. was used to assess functional outcome. At least follow-up the functional score ranges from 70% to 94%, with an average of 86%. One case developed local recurrence and managed by second operation. 2 cases developed superficial post-operative wound infection and treated conservatively.
Extended curettage of aneurismal bone cyst with adjuvant cryotherapy had similar results to those of marginal resection and that no major bony reconstruction was required. We recommend the use of cryotherapy as an adjuvant to the surgical treatment of aneurismal bone cysts. It provides local tumor control. Combination with bone grafting achieved consolidation of the lesion in all our patients with no major complications.