Aneurysmal bone cyst of the extremities. Factors related to local recurrence after curettage with a high-speed burr.

BACKGROUND: Aneurysmal bone cyst is a benign, locally destructive lesion of bone. The rates of local recurrence after curettage have varied widely. Therefore, we performed a retrospective study of patients who had had an aneurysmal bone cyst in order to identify the rate of local recurrence and the prognostic factors related to local recurrence after use of contemporary methods of curettage with a high-speed burr. METHODS: We reviewed the cases of forty patients who had been managed by the same surgeon for an aneurysmal bone cyst, as diagnosed on the basis of the latest pathological review, between January 1, 1976, and December 31, 1993. The patients were evaluated with regard to age, gender, the duration and type of symptoms, the presence or absence of pathological fracture, the status of the growth plate, the bone and part of the bone that were involved, the type of operative procedure, the outcome, the radiographic stage, the findings on magnetic resonance imaging and computerized tomography (when it became available) and on bone scintigraphy, and histological parameters. The median duration of follow-up was eighty-seven months (range, fifteen to 267 months). According to the criteria of Enneking, no patient had a stage-1 lesion (one with a surrounding rim of cortical bone), twenty-four had a stage-2 lesion (one with a clearly defined border but no cortical bone), and sixteen had a stage-3 lesion (one with no clearly defined border). RESULTS: Of the forty patients, thirty-four had curettage with use of a high-speed burr. Of these thirty-four, twenty-two had filling of the defect with a cancellous autogenous graft; four, with a cancellous allograft; and three, with polymethylmethacrylate. In five patients, no material was put into the defect. The remaining six patients had resection through the margin of the lesion. Four (12 percent) of the thirty-four patients who had curettage had a local recurrence. No patient who had an excision through the margin of the lesion had a local recurrence. All local recurrences were in skeletally immature girls who were three, four, ten, and eleven years old. Univariate analysis with use of the chi-square, Fisher exact, and Wilcoxon log-rank tests showed that local recurrence was associated only with a young age (p = 0.0036) and open growth plates (p = 0.039). All local recurrences occurred within two years postoperatively, at two, seven, nine, and twenty-four months, and all were treated successfully with a second operation. CONCLUSIONS: Rates of local control of almost 90 percent can be achieved with thorough curettage with use of a mechanical burr and without use of liquid nitrogen, phenol, or other adjuvants in patients who have an aneurysmal bone cyst of an extremity. A young age and open growth plates are associated with an increased risk of local recurrence.

Otitis media with effusion in children: an audiological case series study.

Otitis media with effusion (OME) was studied in detail in 100 children seen at the Ear, Nose and Throat (ENT) Clinic of Port Moresby General Hospital (PMGH) between June 1992 and June 1994. More males were examined than females. The majority of patients were from the National Capital District and Central Province. Pure-tone and impedance audiometry were performed to assess the type, amount and pattern of hearing loss. A characteristic audiogram for OME with improved air conduction (AC) and decreased bone conduction (BC) hearing at 2 KHz and AC loss at both low and high frequencies was established. Bilateral myringotomy and grommet insertion was performed in 30 of these children. Significant improvement in hearing threshold at all frequencies was found, indicating hearing success with surgery. Otitis media with effusion is a disease of considerable public health importance and there is a need to increase public and professional awareness of it in Papua New Guinea.

Hearing loss in Papua New Guinea: a study of outpatients attending Port Moresby General Hospital.

Hearing loss, with its cause, type and degree, was studied in patients who attended the Ear, Nose and Throat (ENT) Outpatient Clinic at the Port Moresby General Hospital for a period of 5 years from 1987 to 1992. It was found that 1150 (18%) of the patient population attending the ENT Clinic had hearing loss. Audiological evaluation was performed in 583 patients. More males presented to the clinic with hearing loss than females. Otitis media was the most common identified cause of hearing loss followed by ear trauma and meningitis/cerebral malaria. Assaults were the major cause of traumatic hearing loss. Lack of awareness on the part of both professionals and parents affected early identification of hearing loss, especially in children, whose development of speech and language was seriously impaired. The need for implementation of suitable rehabilitation measures by the health services is emphasized.

Osteochondroma of the first rib presenting as a prominent clavicle. A report of 2 cases.

We describe and discuss two patients with osteochondromas of the first rib which presented as prominence of the medial end of the clavicle.

Reconstruction of the distal radius by fibula following excision of giant cell tumor.

Thirty giant cell tumors of the distal radius were excised and reconstructed using a nonvascular fibular osteoarticular autograft. Four different surgical techniques for stabilization were used. There were ten recurrences, which could not be correlated with Campanacci's radiological or Jaffe's histological grading. Twenty cases without recurrence were followed up over 1.5-25.5 (average 8.5) years. Average time for incorporation of the graft was 5.2 months. The surgical technique using a radiofibular plate and K wire through the wrist had a low nonunion rate, no graft related complications, good range of movement, and good hand functions.

Measurement of tibial torsion by ultrasound.

A method of measuring tibial torsion with ultrasound, using reference lines on the tibia, was developed and tested on dry adult tibiae. This technique was used for evaluation of a group of children with apparently normal tibiae and another group of children with spina bifida, cerebral palsy, or clubfoot. The study showed that it is possible to measure true tibial torsion (rather than tibiofibular torsion) with ultrasound. The technique was found to be reliable and accurate enough for routine clinical use and had advantages over clinical methods and other radiographic imaging techniques. Values obtained by this technique are higher than those obtained by methods using the bimalleolar axis as the distal reference line.