The surgical Treatment and Outcome of Pathological Fracture in Patients with Giant Cell Tumor of Bone

Tomoaki Torigoe, Atsuhiko Terakado, Yoshiyuki Suehara, Taketo Okubo, Tatsuya Takagi, Kazuo Kaneko, Yasuo Yazawa

.

DOI: 10.4236/ss.2011.25051                

Abstract

Between 1992 and 2008, we treated 35 patients with giant cell tumor (GCT) of bone, seven of the 35 pre-sented with a pathological fracture. The fractures were located in the femur in five, and in the humerus and radius in one patient each. The surgical treatments were curettage in six cases and wide resection in the distal radius case. Two of the seven patients developed local recurrence, giving a local recurrence rate of 29%. The local recurrence rate in GCT patients without a pathological fracture was 21%. There was a tendency for there to be a higher recurrence rate associated with fractured GCT, but no statistically significant difference was observed between the two groups. Therefore, it was considered that a pathological fracture was not a risk factor for local recurrence in GCT.

Keywords

Giant Cell Tumor of Bone, Pathological Fracture

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	J. A. Bramer, A. A. Abudu, R. J. Grimer, S. R. Carter, and R. M. Tillman, “Do Pathological Fractures Influence Survival and Local Recurrence Rate in Bony Sarcomas?” European Journal of Cancer, Vol. 43, No. 13, September 2007, pp. 1944-1951. doi:10.1016/j.ejca.2007.07.004
[2]	S. P. Scully, H. T. Temple, R. J. O’Keefe, H. J. Mankin and M. Gebhardt, “The Surgical Treatment of Patients with Osteosarcoma Who Sustain a Pathologic Fracture,” Clinical Orthopaedics and Related Research, No. 324, March 1996, pp. 227-32. doi:10.1097/00003086-199603000-00028
[3]	H. R. Blackley, J. S. Wunder, A. M. Davis, L. M. White, R. Kandel and R. S. Bell, “Treatment of Giant-Cell Tu-mors of Long Bones with Curettage and Bone-Grafting,” Journal of Bone and Joint Surgery American Volume, Vol. 81, No. 6, June 1999, pp. 811-820.
[4]	D. C. Dahlin, R. E. Cupps and E. W. Johnson Jr., “Giant-Cell Tumor: A Study of 195 Cases,” Cancer, Vol. 25, No. 5, May 1970, pp. 1061-1070. doi:10.1002/1097-0142(197005)25:5<1061::AID-CNCR2820250509>3.0.CO;2-E
[5]	F. M. Klenke, D. E. Wenger, C. Y. Inwards, P. S. Rose and F. H. Sim, “Recurrent Giant Cell Tumor of Long Bones: Analysis of Surgical Management,” Clinical Or-thopaedics and Related Research, No. 469, April 2011, pp. 1181-1187. doi:10.1007/s11999-010-1560-9
[6]	F. Vult von Steyern, H. C. Bauer, C. Trovik, A. Kivioja, P. Bergh, P. Holmberg J?rgensen, G. Foller?s and A. Rydholm, “Treatment of Local Recurrences of Giant Cell Tumour in Long Bones after Curettage and Cementing. A Scandinavian Sarcoma Group Study,” Journal of Bone and Joint Surgery British Volume, Vol. 88, No. 4, April 2006, pp. 531-535. doi:10.1302/0301-620X.88B4.17407
[7]	P. J. McGrath, “Giant-Cell Tumour of Bone: An Analysis of Fifty-Two Cases,” Journal of Bone and Joint Surgery British Volume, Vol. 54, No. 2, May 1972, pp. 216-229.
[8]	S. E. Larsson, R. Lorentzon and L. Boquist, “Giant-Cell Tumor of Bone. A Demographic, Clinical, and Histopa-thological Study of All Cases Recorded in the Swedish Cancer Registry for the Years 1958 through 1968,” Journal of Bone and Joint Surgery American Volume, Vol. 57, No. 2, March 1975, pp. 167-73.
[9]	M. Campanacci, N. Baldini, S. Boriani and A. Sudanese, “Giant-Cell Tumor of Bone,” Journal of Bone and Joint Surgery American Volume, Vol. 69, No. 1, January 1987, pp. 106-114.
[10]	F. M. Klenke, D. E. Wenger, C. Y. Inwards, P. S. Rose and F. H. Sim, “Giant Cell Tumor of bone: Risk Factors for Recurrence,” Clinical Orthopaedics and Related Re-search, Vol. 469, No. 2, February 2011, pp. 591-599. doi:10.1007/s11999-010-1501-7
[11]	S. D. Pals and R. M. Wilkins, “Giant Cell Tumor of Bone Treated by Curettage, Cementation, and Bone Grafting,” Orthopedics, Vol. 15, No. 6, June 1992, pp. 703-708.
[12]	G. H. Prosser, K. G. Baloch, R. M. Tillman, S. R. Carter and R. J. Grimer, “Does Curettage without Adjuvant Therapy Provide Low Recurrence Rates in giant-Cell Tumors of Bone?” Clinical Orthopaedics and Related Research, No. 435, June 2005, pp. 211-218. doi:10.1097/01.blo.0000160024.06739.ff
[13]	S. P. Scully, M. A. Ghert, D. Zurakowski, R. C. Thomp-son and M. C. Gebhardt, “Pathologic Fracture in Osteo-sarcoma: Prognostic Importance and Treatment Implica-tions”, Journal of Bone and Joint Surgery American Vo-lume, Vol. 84, No. 1, January 2002, pp. 49-57.
[14]	A. Abudu, N. K. Sferopoulos, R. M. Tillman, S. R. Carter and R. J. Grimer, “The Surgical Treatment and Outcome of Pathological Fractures in Localised Osteosarcoma,” Journal of Bone and Joint Surgery British Volume, Vol. 78, No. 5, September 1996, pp. 694-698.
[15]	K. L. Cooper, J. W. Beabout and D. C. Dahlin, “Giant Cell Tumor: Ossification in Soft-Tissue Implants,” Radiology, Vol. 153, No. 3, December 1984, pp. 597-602.
[16]	R. J. O’Donnell, D. S. Springfield, H. K. Motwani, J. E. Ready, M. C. Gebhardt and H. J. Mankin, “Recurrence of Giant-Cell Tumors of the Long Bones after Curettage and Packing with Cement,” Journal of Bone and Joint Surgery American Volume, Vol. 76, No. 12, December 1994, pp. 1827-1833.
[17]	D. J. McDonald, F. H. Sim, R. A. McLeod and D. C. Dahlin, “Giant-Cell Tumor of Bone,” Journal of Bone and Joint Surgery American Volume, Vol. 68, No. 2, February 1986, pp. 235-242.
[18]	K. E. Dreinh?fer, A. Rydholm, H. C. Bauer and A. Kreicbergs, “Giant-Cell Tumours with Fracture at Diag-nosis. Curettage and Acrylic Cementing in Ten Cases,” Journal of Bone and Joint Surgery Britihs Volume, Vol. 77, No. 2, March 1995, pp. 189-193.