Abstract
Giant cell tumours are rare bone tumours that are characteristically benign but locally aggressive, most frequently occurring in the distal femur with pathological fractures being common. This paper investigates relationships between tumour size and cortical breach on initial X-rays and subsequent treatment. The X-rays of 54 patients with distal femoral giant cell tumours were reviewed. The volumes of the tumour, distal femur and a ratio between the two parameters were estimated. The presence of a cortical breach, discrete fracture and Campanacci grade was recorded. X-rays revealed intact cortical rim in 20 patients (37%), cortical breach in 22 patients (41%) and discrete fracture in 12 patients (22%). There was a significant difference in the ratio of tumour volume to distal femoral volume between the discrete fracture group and the cortical breach group. No significant differences in rates of local recurrence were demonstrated. Extended curettage was effective for intact and cortical breach groups; however, patients in the fracture group often required radical treatment.
Résumé
Les tumeurs à cellules géantes sont des tumeurs rares et dont la caractéristique est d’être à la fois bénigne et agressive localement. Elles surviennent le plus fréquemment au niveau de l’extrémité inférieure du fémur entraînant des fractures pathologiques. Ce travail a pour but de mettre en relation certaines caractéristiques de la tumeur, taille, effraction corticale, en fonction des radios initiales et du traitement pratiqué. 54 patients présentant une tumeur à cellules géantes de l’extrémité inférieure du fémur ont été revus. Une relation a été établie entre le volume de la tumeur et le volume de l’extrémité inférieure du fémur de même que la présence d’une effraction corticale ou d’une discrète fracture. La classification de Campanacci a été utilisée. Résultats : les radios ont révélé qu’il existait une corticale intacte chez 20 patients (37% des cas), une effraction corticale chez 22 patients (41% des cas) et une discrète fracture chez 12 patients (22% des cas). Il existe des différences significatives dans la relation du volume tumoral osseux et fémoral distal pour les patients présentant une effraction corticale ou une discrète fractur. Par contre, nous n’avons pas retrouvé de différences significatives de ces éléments pour les récidives locales. Un curetage extensif est nécessaire et suffisant pour les patients présentant une corticale intacte ou une effraction corticale par contre, chez les patients présentant une fracture, il est souvent nécessaire de faire un traitement radical.
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Jeys, L.M., Suneja, R., Chami, G. et al. Impending fractures in giant cell tumours of the distal femur: incidence and outcome. International Orthopaedics (SICO 30, 135–138 (2006). https://doi.org/10.1007/s00264-005-0061-z
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DOI: https://doi.org/10.1007/s00264-005-0061-z