Intramedullary Nailing Combined with Bone Grafting for Benign Lesions of the Proximal Femur

Abstract

Objective: To evaluate the effectiveness of intramedullary nailing for benign lesions of the proximal femur.

Method: A retrospective analysis was carried out on 68 cases of benign lesions in the proximal femur at our hospital from April 2002 to April 2013 (38 men and 30 women). Mean age at surgery was 35.5 years (range, 22-56 years). The cases were divided into two groups: curettage of the lesion with bone grafting only as the grafting group (32 cases) and internal fixation after removal of the lesion as the fixation group (36 cases). For the grafting group, lesions were scraped out, deactivated and washed thoroughly with normal saline, then the allogeneic bone was implanted. For the fixation group, after the lesions were scraped, the intramedullary nails were implanted, and allogeneic bone was implanted into the scraped cavity with compaction.

Results: Pathological examination showed that 24 out of 68 cases (35.3%) had simple bone cysts (suffered from pathological fracture in 2 cases); 21 (30.9%) fibrous dysplasia; 18 (26.5%) aneurysmal bone cysts; 3 (4.4%) chondroblastoma, 2 (2.9%) out of which were combined with aneurysmal bone cysts. All patients were followed up for 12-96 months (56 months for mean). In the grafting group, 4 patients had postoperative complications (1 pathological bone fractures and 3 deep vein thrombosis), but only 1 patient of the fixation group (deep vein thrombosis) (P < 0.05). The average bedridden time after surgery was 11.4 ± 7.6 days for the grafting group, and for the other group was 7.5 ± 5.4 days ( P < 0.05).

Conclusion: Both treatments are effective for benign lesions in the proximal femur, but the fixation group facilitated the functional recovery of patients and reduced postoperative complications.

Keywords: Benign bone lesion; Bone grafting; Femur; Intramedullary nailing.