title: Use of extended curettage with osteotomy and fenestration followed by reconstruction with conservation of muscle insertion in the treatment of Enneking stage II locally aggressive bone tumor of the proximal extremities: resection and treatment of bone tumors.
abstract: BACKGROUND
  The purpose of this study was to investigate the clinical efficacy of extended resection with osteotomy, fenestration and conservation of muscle (tendon) insertion in the treatment of bone tumors.
  
  
  METHODS
  A total of 15 patients with locally aggressive bone tumors (Enneking stage II) in the adjacent muscle (tendon) insertion of the proximal extremity were enrolled in the present study (mean age of 29 years). Extended curettage of lesions with osteotomy, fenestration and/or conservation of muscle (tendon) insertion and internal fixation with a bone graft or bone cement was performed at stage I. Postsurgical brace protection was used for 4 to 12 weeks and the patients were periodically followed-up by X-ray and functional assessment. Recurrence, postsurgical Enneking score and outcome rating were assessed.
  
  
  RESULTS
  Treated cases included 15 patients aged 29 ±7.75 years (range, 18 to 42) with a male to female ratio of 8:7. Six had a femoral tumor and nine had a humeral tumor. These tumors comprised three chondroblastomas, five giant-cell tumors and seven aneurysmal bone cysts. Follow-up for 48 ±12.95 months (range, 25 to 72) revealed that 13 of 15 (87%) patients exhibited no recurrence. Local recurrence was observed in a patient with an aneurysmal bone cyst (nine months) and one with a giant-cell tumor (12 months). Mean Enneking scores were 27 ±4.07 (range, 18 to 29). Except for the patient with the recurrent giant-cell tumor, all patients reported good (13%, 2 out of 15) or very good (80%, 12 out of 15) outcomes. Very good outcomes were reported in 92% of patients (12 out of 13) without recurrence.
  
  
  CONCLUSIONS
  The procedures used in this study achieved high clinical efficacy, complete lesion removal, reduced recurrence and good restoration of joint function in patients with primary locally aggressive Enneking stage II bone tumors of the proximal extremities.
authors.affiliation: Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Feiyan
authors.initials: F
authors.lastname: Chen
authors.forename: Jun
authors.initials: J
authors.lastname: Xia
authors.forename: Siqun
authors.initials: S
authors.lastname: Wang
authors.forename: Yibing
authors.initials: Y
authors.lastname: Wei
authors.forename: Jianguo
authors.initials: J
authors.lastname: Wu
authors.forename: Gangyong
authors.initials: G
authors.lastname: Huang
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.forename: Jingsheng
authors.initials: J
authors.lastname: Shi
mesh_terms: D000293:Adolescent; D000328:Adult; D017824:Bone Cysts, Aneurysmal / Q000473:pathology / Q000601:surgery; D001859:Bone Neoplasms / Q000473:pathology / Q000601:surgery*; D003475:Curettage; D005260:Female; D005269:Femur / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D018212:Giant Cell Tumor of Bone / Q000473:pathology / Q000601:surgery; D006801:Humans; D006811:Humerus / Q000473:pathology / Q000601:surgery*; D008297:Male; D018482:Muscle, Skeletal / Q000473:pathology / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D010027:Osteotomy; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures; D013524:Surgical Flaps; D013710:Tendons / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult