11/1/2014 Professor Freih Abuhassan - University of Jordan 1 Giant Aneurysmal Bone Cyst
Jul 08, 2015
11/1/2014Professor Freih Abuhassan - University
of Jordan 1
Giant Aneurysmal Bone Cyst
F.R.C.S.(Eng.), F.R.C.S.(Tr.& Orth.)
Professor of Orthopaedics
Giant Aneurysmal Bone Cyst
11/1/2014 2Professor Freih Abuhassan - University
of Jordan
Patient profile:A 9-years old male child, MF, Overweight.
Chief complaint:
Progressive painless swelling of the right distal thigh of 14 m duration
Referred to us on the
17th Nov. 200811/1/2014 3
Professor Freih Abuhassan - University
of Jordan
History of present illness:
4th Sep. 2007, had pain in the distal femur after a fall while playing.
Diagnosed as pathological fracture of the distal femur.
11/1/2014 4Professor Freih Abuhassan - University
of Jordan
4th Sep. 2007
11/1/2014 5Professor Freih Abuhassan - University
of Jordan
Treated by complete POP for 3 M
4th Dec. 2007
11/1/2014 6Professor Freih Abuhassan - University
of Jordan
19th Jan. 2008
Trivial trauma Supracondylar distal
femur fractures treated by POP for
7 weeks
11/1/2014 7Professor Freih Abuhassan - University
of Jordan
19th Jan. 200811/1/2014 8
Professor Freih Abuhassan - University
of Jordan
5th Mar. 200811/1/2014 9
Professor Freih Abuhassan - University
of Jordan
Past medical history
=History of two surgical biopsies with
blood transfusion
Diagnosis: Aneurysmal bone cyst
11/1/2014 10Professor Freih Abuhassan - University
of Jordan
Patient offered the following
advices outside JUH
1- Above Knee Amputation
2- Resection and Joint replacement
3- To be treated abroad
Patient was wheel chair dependent
since the start of treatment.11/1/2014 11
Professor Freih Abuhassan - University
of Jordan
6th June 2008
Lesion contineued to grow
11/1/2014 12
Professor Freih Abuhassan - University
of Jordan
26th Sep. 2008
11/1/2014 13Professor Freih Abuhassan - University
of Jordan
Physical examination:
General: no abnormality detected
Right lower limb:
= Diffuse swelling of the knee and lower thigh with
10 cm diameter difference form the left thigh
(firm, not tender, not pulsatile)
=Decreased knee ROM due to the bulky swelling
=Normal distal NV examination
17th Nov. 2008
11/1/2014 14Professor Freih Abuhassan - University
of Jordan
11/1/2014 15Professor Freih Abuhassan - University
of Jordan
11/1/2014 16Professor Freih Abuhassan - University
of Jordan
11/1/2014 17Professor Freih Abuhassan - University
of Jordan
Laboratory investigation
CBC
KFT
LFT
ESR
CRP
All were Normal11/1/2014 18
Professor Freih Abuhassan - University
of Jordan
17th Nov. 2008
11/1/2014 19Professor Freih Abuhassan - University
of Jordan
11/1/2014 20Professor Freih Abuhassan - University
of Jordan
11/1/2014 21Professor Freih Abuhassan - University
of Jordan
11/1/2014 22Professor Freih Abuhassan - University
of Jordan
11/1/2014 23Professor Freih Abuhassan - University
of Jordan
11/1/2014 24Professor Freih Abuhassan - University
of Jordan
Surgery at JUH
19th Nov. 2008
Local curretage of the cyst +
application of monoplanar external
fixator + Circular Ex.Fix. (across
the knee joint) Ilizarov Frame.
First stage
11/1/2014 25Professor Freih Abuhassan - University
of Jordan
Problems1- Difficult to apply Tourniquet
2- Lateral Scar of previous surgery
3-Soft bone (prolonged disuse)
4-Extensive bleeding
5-Overweight
6-Residual defect after resection.
11/1/2014 26Professor Freih Abuhassan - University
of Jordan
Packing the cyst after surgery to stop
bleeding.
Received in the perioperative period
= 5.5 L R/L
= 4 U PRBC’s
= 10 U FFP
Role of anaesthetic team
in the management 11/1/2014 27
Professor Freih Abuhassan - University
of Jordan
=Transferred to the ICU and kept
there till 24/11
=Initially DIC W/up +ve
=21st Nov. 2008 R/O pack
11/1/2014 28Professor Freih Abuhassan - University
of Jordan
11/1/2014 29Professor Freih Abuhassan -
University of Jordan
Histopathology
ABC11/1/2014 30
Professor Freih Abuhassan - University
of Jordan
11/1/2014 31Professor Freih Abuhassan -
University of Jordan
11/1/2014 32Professor Freih Abuhassan -
University of Jordan
11/1/2014 33Professor Freih Abuhassan -
University of Jordan
11/1/2014 34Professor Freih Abuhassan -
University of Jordan
= Under tourniquet, Anterior approach,
Complete resection of the cyst.
=Turbid hematoma was found inside
the cavity.
=Delay reconstruction of the bone
defect till results of C&S.
=Bone cement spacer was inserted.
16th Dec. 20082nd stage Surgery
11/1/2014 35Professor Freih Abuhassan - University
of Jordan
11/1/2014 36Professor Freih Abuhassan -
University of Jordan
11/1/2014 37Professor Freih Abuhassan -
University of Jordan
Cultures: no bacterial growth
Gram stain:
only WBC’s & RBC’s, no bacteria
11/1/2014 38Professor Freih Abuhassan - University
of Jordan
Reconstructive Procedure
11/1/2014 39Professor Freih Abuhassan - University
of Jordan
3nd stage Surgery
23rd Dec. 20081. Removal of Cement spacer
2. Strut tibial autograft from the mid
ipsilateral tibia, to femur and
stabilized by long screws to the
ilizarov frame.
3. Application of ilizarov to tibia +
bone marrow inserted.
11/1/2014 40Professor Freih Abuhassan - University
of Jordan
11/1/2014 41Professor Freih Abuhassan - University
of Jordan
11/1/2014 42Professor Freih Abuhassan - University
of Jordan
11/1/2014 43Professor Freih Abuhassan - University
of Jordan
11/1/2014 44Professor Freih Abuhassan -
University of Jordan
23rd Dec. 200811/1/2014 45
Professor Freih Abuhassan -
University of Jordan
11/1/2014 46Professor Freih Abuhassan - University
of Jordan
11/1/2014 47Professor Freih Abuhassan - University
of Jordan
5th Jan. 2009
Admitted as a case popliteal fossa
swelling to R/O organised hematoma
U/S: no definite fluid collection but
significant soft tissue edema.
= Percutaneous evacuation of hematoma,
=R/O Orthofix and application of long
Ilizarov plate externally and fixed to the
graft by Schanz screws11/1/2014 48
Professor Freih Abuhassan - University
of Jordan
Followed regularly in OPD
Partial weight bearing was started
in the on 21st Jan. 2009.
Now FWB on crutches
11/1/2014 49Professor Freih Abuhassan - University
of Jordan
25th March 2009
11/1/2014 50Professor Freih Abuhassan -
University of Jordan
11/1/2014 51Professor Freih Abuhassan -
University of Jordan
With Ilizarov family
11/1/2014 52Professor Freih Abuhassan -
University of Jordan
ABCIn 1942, Jaffe and Lichtenstein
first described ABC when they
discovered "a peculiar blood
containing cyst of large size.
11/1/2014 53Professor Freih Abuhassan - University
of Jordan
Benign Aggressive Bone
Tumor Locally destructive yet do not
metastasize or show malignant
changes at a cellular levelcellular
level
ABC, GCT, CMF,
Chondroblastoma,
Osteoblastoma.11/1/2014 54
Professor Freih Abuhassan - University
of Jordan
WHO
Blood-filled spaces of variable
size,separated by CT containing
trabeculae of bone or osteoid
tissue and osteoclast giant cells
ABCs represent 1%–2% of all
primary bone lesions
11/1/2014 55Professor Freih Abuhassan - University
of Jordan
Giant Cell tumour
Aneurysmal bone cyst
Telangiectatic osteosarcoma
Secondary ABC –upto 35% of all ABCs
Most commonly due to GCT (39%)
D.Dx
11/1/2014 56Professor Freih Abuhassan - University
of Jordan
No bone is immune
11/1/2014 57
Giant Humerus ABC
11/1/2014 58Professor Freih Abuhassan -
University of Jordan
Giant femur ABC
11/1/2014 59Professor Freih Abuhassan - University
of Jordan
Giant ABCs
11/1/2014 60Professor Freih Abuhassan -
University of Jordan
Local recurrence rate after
classic surgical procedures
(curettage and grafting) is about
11.8%–30.8%
Treatment depends on
site & size of the lesion.
11/1/2014 61Professor Freih Abuhassan - University
of Jordan
11/1/2014 62Professor Freih Abuhassan - University
of Jordan