Introduction: Both enchondromas and chondrosarcomas are mesenchymal neoplasms which originate from cartilage cells, and they occur mainly in the extremities. Both these tumours are resistant to chemotherapy and radiotherapy, and surgery is the only treatment option. In the last few years limb saving procedures have become the treatment of choice. Intra-operative cryosurgery has been introduced as a local adjuvant therapy for skeletal benign and low-grade malignant tumours. It is applied after curettage of the lesion to destroy any remaining tumour cells, and to enlarge the oncological margin of resection. Since the introduction of cryosurgery as an adjuvans, oncological and functional results of this extremity sparing surgery are significantly enhanced. Patients and Methods: A retrospective study was conducted to evaluate the oncological and functional results, and the complications of cryosurgical treatment. Data were prospectively collected from the tumour register and patient records. Functional scores of the affected limbs were assessed according to the Musculo-Skeletal Tumour Society scoring system. Results: Between 1994 and 2003 123 patients (47 men, 76 women, average age 49 years; range 13–83 yrs) were treated with curettage and cryosurgery for an Enneking stage 3 enchondroma (75 patients) or a low-grade chondrosarcoma (55 patients). The minimal follow up was two years, and the average follow up 50 months (range 24–119 months). At follow up three recurrences had occurred in patients treated for enchondroma. One residual tumour was diagnosed in a patient with chondrosarcoma grade Ib. All patients were treated again with curettage and cryosurgery and disease free at the latest follow-up. Of the 37 complications the most common were a fracture at the surgical site (18), fracture of osteosynthesis (6), 3 wound infection (3), delayed soft tissue healing (3), and transient nerve palsy (3). Functional MSTS scores increased in time to an average of 28 points (94%) at two year follow up. No significant difference in scores were found regarding to localisation of the lesion, age or gender. A significant discrepancy in functional scores was observed between patients who did suffer from one or more complications and patients who did not. Conclusion: We believe that the use of cryosurgery is an excellent adjuvant therapy after curettage to achieve local control of aggressive enchondromas and low grade chondrosarcomas. It avoids the need for segmental resection, making reconstruction of the bony defect easier and therefore results in excellent functional outcome. Due to the initial high fracture rate osteosynthesis at the surgical site is used more often, and weight baring mobilisation is postponed until full consolidation is reached

Background. Cryosurgery is a well established modality in the treatment of benign aggressive and low grade malignant tumours. In this setting it allows for intra-lesional resection and preservation of function without compromising oncological outcome. Here we present the outcome of 87 patients treated with cryosurgery for low-grade chondrosarcoma of bone. Materials and methods. 87 patients were treated between 1988 and 2005. The mean age was 51 years (range, 8-77 years), and included 47 females and 40 males. Minimal follow-up was two years. Patients were treated for lesions of the distal femur (n = 30), proximal humerus (n = 33), proximal femur (n = 5), proximal tibia (n = 10), and the remaining sites included the iliac bone, distal tibia, forearm, carpal and tarsal bones (n=10). Patients were treated with intralesional curettage through a cortical window, adjuvant burr drilling, cryotherpay and reconstruction with cement or bone graft and hardware fixation when that was clinically indicated. Results. Post operative pathology reports showed high grade sarcomas in two patients, which underwent subsequent wide resection and prosthetic replacement and are excluded from this report. No local recurrence was noted after minimal follow up of two years in the remaining 85 patients. Post-operative complications included; fractures (n=4) of which two needed surgical fixation, superficial wound infection (n=5), delayed wound healing due to “cold burns” (n=6), degenerative arthritis which necessitated joint replacement (n=3), all more than 10 years after initial tumour resection. Functional outcome was rated as good or excellent in 76 patients (89%). Five patients had moderate function (6%), all of them with tumours of the proximal humerus and no outcome was available for 4 patients (5%). Conclusions. Low complication rates, good functional outcome and very low local recurrence rates can be obtained when cryoablative surgery is performed for low grade chondrosarcomas of bone

The presentation of this huge monoinstitutional cumulative experience in bone tumor cryosurgery serves as an illustration of our basic phylosophycal concent: “No man-made implants are even close to God’s natural implants yet”. The result is the concept of conservation surgery in which cryotherapy plays the major role. Materials and Methods: During the period of 1/88 to 12/02 (15 years, FUT 2→17 years, median=6 years) 440 cryosurgical procedures were performed in 405 people. There were 214 male and 191 female patients. The age range was 5 to 80 years but most were between 20 and 59 years. 2/3 of the series included a variety of primary benign aggressive and low grade malignant lesions and 1/3 included primary high grade and metastatic bone tumors. The anatomical location is highly variable and includes almost every bone of the skeleton. Two methods of bone cryosurgery will be presented (including combinations of them and other adjuvants or techniques): The open system according to Marcove and our Closed System. Results and Complications: Overall local recurrence (LR) rate=8%, fractures=1%, infections=2%, skin burns= 1.3%. There were 3 cases of temporary nerve palsies and 2 cases of late OA of an adjacent joint. Functional outcome in 372 NED patients is almost 100% good and excellent (AMSTS, Enneking’s scoring system). Summary: Bone cryosurgery is a safe, reliable and inexpensive technique of conservative limb, joint and even epiphysis sparing surgery in the suitable types of bone tumors, eliminating temporarily or permanently the need for resection surgery

Introduction: Cryosurgery of bone tumors using direct pour of liquid nitrogen has the advantage of joint preservation associated with good local tumor control. However, this technique does not allow accurate control of the temperature or of the overall time of freezing. Additionally, this is a gravity-dependent procedure that cannot be applied in all shapes and locations of tumor cavities. The authors report their experience with a novel cryosurgical technique that allows accurate determination of the temperature and freezing time as well as freezing of any geometry of tumor cavity. Materials and Methods: From 1997 to 2000, 58 patients who were diagnosed with 13 malignant and 45 benign-aggressive bone tumors underwent argon-based cryoablation. This technique included tumor removal by means of curettage and burr-drilling, filling the tumor cavity with a gel medium, insertion of metal probes into this medium, and computer-controlled delivery of argon gas through the metal probes, and reconstruction of the tumor cavity with cemented hardware. All patients were followed for more than two years. Results: None had skin necrosis, infection, thromboembolic complication, or neurapraxia. Fractures occurred in two patients (3.4%) and local tumor recurrence in two patients (3.4%), who were successfully treated with a second closed cryoablation. Conclusions: The current study focuses on the concept and surgical technique of argon-based and computer-controlled, closed cryoablation of bone tumors. The main advantages of this system are the ability to control the freezing temperature and overall freezing time and the use of a gel medium, which evenly conducts the cold temperature throughout the tumor cavity and allows cryoablation of various cavital geometry and positions. The current technique of argon-based cryoablation is simple and easy to perform. It achieves good local tumor control and is associated with a low rate of complication. The authors recommend its use as an alternative to the traditional direct pour technique of cryosurgery

This is a retrospective study of 14 cases from clinical records and the Bone Tumour Registry over the last 20 years. The mean follow-up time was 27 months (3 to 60). Two of the cases were referred elsewhere for final treatment and the relevant clinical records were obtained by correspondence with the treating doctor. Most tumours occurred about the knee, with two in the distal femur and five involving the proximal tibial metaphysis. Three were in the forearm and one in the humerus. Once diagnosis had been made on clinical and radiological grounds, the tumours were curetted. Cryosurgery was used in four cases and phenol in two. Structural integrity was restored by autogenous bone grafting in most cases. Two of these were vascularised free grafts. Two patients had arthrodeses (one ischiofemoral and one wrist) and two were referred for custom-made joint replacements. There was only one local recurrence. Of the adverse outcomes, three required late amputations, one for varus malunion and recurrence, and two for nonunion and chronic sepsis. Giant cell tumour of bone has a low rate of recurrence. The treatment challenge is to avoid sepsis and graft collapse. Large bone grafts often fail to incorporate fully, which can lead to angular deformities. A combination of bone cement, reinforced with Ender rods with bone cement to the subchondral surface, promises to be a more satisfactory method in and around the knee

Multiple myeloma may be associated with extensive bone destruction, impending or present pathological fracture, and intractable pain. However, surgical intervention is rarely indicated since local bone crises are effectively managed with chemotherapy and radiotherapy in the majority of the patients. The current retrospective analysis of patients who eventually required surgical intervention emphasized indications for surgery, surgical technique, and functional and oncological outcomes. Materials and Methods: Between 1982 and 2000, the authors operated on 18 patients with multiple myeloma. There were 11 females and 7 males whose age ranged from 4 to 67 years (median, 59 years). Anatomic locations: proximal humerus – 5, proximal femur – 4, distal femur – 5, proximal tibia – 3. One patient had total femur involvement. Preoperatively, 11 patients were treated with chemotherapy and 4 received radiotherapy. Seven patients were referred with a bone lesion as their initial presentation and, therefore, did not receive pre-operative treatment. Indications for surgery: pathological fractures – 11 patients, impending pathological fractures – 5 patients, and intractable pain in 2 patients. Surgeries included 12 marginal resections with cryosurgery and 6 wide resections with endoprosthetic reconstructions. Postoperative radiotherapy was given to three patients and chemotherapy to 11. Follow-up included physical and radiological evaluation and functional evaluation according to the American Musculoskeletal Tumor Society System. Results: Fifteen patients (83%) survived more than 1 year and 12 patients (66%) survived more than 2 years after surgery. There were no postoperative deep wound infections, thromboembolic complications, or local tumor recurrences. Functional outcome was good to excellent in 14 patients (78%), moderate in 3 (16%), and poor in one patient (6%). Conclusions: Multiple myeloma rarely may require surgical intervention because of impending or present pathological fracture or intractable pain. The relatively prolonged survival of patients with multiple myeloma justifies an aggressive surgical approach. Resection of these tumors was shown to be safe, reliable, and associated with good local tumor control and functional outcome

Introduction and Objectives: Giant cell tumour (GCT) of the bone is an “aggressive tumor characterized by highly-vascularized tissue consisting of ovoid or fusiform cells and the presence of numerous gigantic osteoclast-like cells distributed uniformly throughout the tumor tissue” (WHO). The aim of this report is to present our experience over the past 19 years (1983–2002) with GCT of the bone treated in our unit. Materials and Methods: From January 1983 to January 2002, we have treated 67 cases of GCT of the bone, excluding all cases with less than 12 months of follow up. Age at presentation ranged 10 to 17 years. There was a higher incidence from 20 to 40 years of age. There was a moderately higher rate in women compared to men (1.5:1). The most common locations were the distal epiphysis of the femur, proximal epiphysis of the tibia, and the distal end of the radius. This type of tumour generally localises to the epiphysis and subsequently invades the metaphysis. Localization to the axial skeleton is rare. Radiologic diagnosis was achieved by simple local radiology, CT scan, and MRI. Histopathologic diagnosis was done by means of biopsy using a trocar guided by an image intensifier. In cases of central localization, we obtained the sample by CT-guided biopsy. The treatment of choice is aggressive curettage (high-velocity burr) and filling with frozen cancellous chips. Radiation therapy is useful in cases of localization that are not accessible by surgery. Results: GCT of the bone possesses several unique characteristics, which make it different from other intermediate tumors: a high rate of recurrence (up to 50%), the possibility of sarcomatous degeneration, and the possibility of pulmonary metastasis (even in non-malignant cases). We believe the ideal treatment is resection of the bone where the tumour is located (useful on the head of the fibula, distal end of the ulna, ribs, some bones of the hand and feet, and the patella). In view of its usual localization near the knee (50%), our usual treatment is aggressive curettage (high-speed burr) and filling with frozen cancellous chips. We have treated 26 recurrent cases out of 67 patients treated in our unit (38.8%). Of these, approximately 50% were referred from other centres. Treatment of recurrence has generally been aggressive curettage and addition of allografts. Sarcomatous degeneration occurred in 3 cases (4.5%), all of which were high grade sarcomas of the malignant fibrous histiocytoma type. One case survived following amputation of the extremity, and the other 2 cases died as a result of pulmonary metastasis. Discussion and Conclusions: Alternative local treatment methods exist for GCT of the bone such as cryosurgery, phenolization, and cementing. However, we cannot comment on these methods due to a lack of experience with them. The aim of all these methods is to cauterize the tumour bed. We prefer aggressive curettage and filling with cancellous bone in an attempt to use a more biological treatment

Aims

Aneurysmal bone cysts (ABCs) are locally aggressive lesions typically found in the long bones of children and adolescents. A variety of management strategies have been reported to be effective in the treatment of these lesions. The purpose of this review was to assess the effectiveness of current strategies for the management of primary ABCs of the long bones.