Гений oртопедии (Dec 2023)
Aneurismal bone cyst of the medial cuneiform bone: a case report of a new surgical approach and literature review
Abstract
Introduction An aneurysmal bone cyst (ABC) is a rare, non-neoplastic, destructive, hemorrhagic, and expansile lesion accounting for 1 % of all bone tumors. ABC of the foot is very rare. Patients with foot ABC usually complain of pain and swelling of the affected area. Radiographs and MRI may be helpful in the diagnosis of ABC. No single surgical procedure has gained wide acceptance in the treatment of foot ABC. Purpose To show new effective surgical approach in the treatment of patient with ABC of the medial cuneiform bone. Material and methods We present the case of a 47-year-old woman with a 10-months history of pain and swelling in her right foot. Postoperative histopathological evaluation of resected tissues confirmed the diagnosis of ABC. An en bloc resection (total extraction of the remnant of the medial cuneiform bone) was performed and the defect was replaced with a fibular bone graft from the right leg. Allograft (Bio-Ost®) was placed along the autograft. Tibialis anterior tendon was attached to the fibular bone graft. We performed fixation of the foot and ankle using the Ilizarov original apparatus for prevention of bone graft instability and opportunity for early weight-bearing on the operated foot. Results The postoperative period was uncomplicated with complete healing of the bone defect without recurrence after 12 months of observation. AOFAS score increased significantly from 34 points preoperatively to 92 at 1-year follow-up. Discussion The optimal treatment of this lesion is still under discussion. Different treatment modalities have been described in the literature: wide resection, curettage with or without adjuvants, arterial embolization, intralesional sclerotherapy. Biological reconstruction using bone graft seems to be the best option, but fractures and nonunion are common complications of bone grafting. Conclusion The combination of Ilizarov external fixation and bone grafting provided favorable conditions for the healing of foot bone defect due to ABC without complications, allowed mobility and early weight-bearing of the patient. Recurrence was not detected radiologically. Harvesting of the fibular bone graft did not affect the position of the foot and its movements. Our surgical approach should be considered as a treatment option in similar cases.
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