engleski

Cystic-like lesions of proximal femur associated with fractures in children and adolescents - diagnostic and therapeutic dilemma

AIM: To report our experience in diagnosing and treating fractures of the proximal femur due to various cystic-like pathologic processes. METHODS: In the period from 1998 to 2011, thirteen male patients were diagnosed and treated for a pathologic fracture of the proximal femur. The median age of the patients at time of surgery was 13 years (range, 3 to 19). In 7 patients, diagnosis of the hip fracture led to the discovery of the underlying pathologic process. In the remaining 6 patients, the hip fracture occurred after the pathologic process of the bone was diagnosed. The diagnoses were as follows ; a simple bone cyst (7 patients), an aneuris matic bone cyst (1 patient), fibrous dysplasia (2 patients), Ewing sarcoma (2 patients) and chondrosarcoma (1 patient). RESULTS: Methods of fracture fixation included plates and screws, Kirschner wires, intramedullary rodding, and external fixators. Two patients with Ewing sarcoma had a resection followed by insertion of endoprostheses. Two patients, one suffering from Ewing sarcoma and other from chondrosarcoma, died. All other patients were followed until union of fracture. No serious complications occurred. DISCUSSION: Various pathologic processes, benign as well as malignant, can present themselves as cystic-like lesions of the proximal femur. Although rare, it is important to consider all of these in differential diagnosis, due to potentially serious complications and even fatal outcome. Recognizing underlying pathology before a fracture occurs is a challenge for the orthopedic surgeon. The treatment of these fractures requires addressing the pathologic process that caused the fracture, and treating the fracture itself by various methods of fixation. Special considerations are required because of potential serious complications such as prolonged time to bone union, secondary leg length discrepancy and avascular necrosis.

Cystic-like lesions; fracture; proximal femur; children; adolescents

nije evidentirano