title: Indications for prophylactic osteosynthesis associated with curettage in benign and low-grade malignant primitive bone tumors of the distal femur in adult patients: a case series.
abstract: BACKGROUND
  The aim of the study was to evaluate whether the use of preventive osteosynthesis after curettage in benign and primitive low-grade malignant bone tumor localized in the distal femur in adult patients provides sufficient mechanical stability to the system as to allow weight-bearing and reduce the risk of postoperative fracture. Additionally, lower limb function after curettage and preventive osteosynthesis was evaluated.
  
  
  METHODS
  We analyzed twelve cases of benign and low-grade malignant bone lesions of the distal femur in adult patients treated in our orthopedic department between 2008 and 2011 with curettage, bone filling and preventive osteosynthesis. All patients were treated with curettage with the use of high-speed cutters, plus liquid nitrogen as local adjuvant in low-grade malignant lesions, and filling of the lesion with bone graft or allograft or acrylic cement, followed by osteosynthesis.
  
  
  RESULTS
  No fractures or major complications were observed; good function of the knee was observed.
  
  
  CONCLUSIONS
  We recommend preventive osteosynthesis after curettage in patients with very large lesions (>5 cm, >60 cm3) or high functional requirements, in obese patients, and when local adjuvants are used.
  
  
  METHODS
  Level IV retrospective case-series study.
authors.affiliation: Department of Geriatrics, Neuroscience and Orthopaedics, University Hospital "Agostino Gemelli", Catholic University of the Sacred Heart School of Medicine, L.go A. Gemelli 1, 00168, Rome, Italy. carloperisano@hotmail.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: Perisano
authors.affiliation: Department of Internal Medicine, Division of Medical Oncology, University Hospital "Agostino Gemelli", Catholic University of the Sacred Heart School of Medicine, L.go A. Gemelli 1, 00168, Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Barone
authors.affiliation: Department of Geriatrics, Neuroscience and Orthopaedics, University Hospital "Agostino Gemelli", Catholic University of the Sacred Heart School of Medicine, L.go A. Gemelli 1, 00168, Rome, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Stomeo
authors.affiliation: Department of Geriatrics, Neuroscience and Orthopaedics, University Hospital "Agostino Gemelli", Catholic University of the Sacred Heart School of Medicine, L.go A. Gemelli 1, 00168, Rome, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Di Giacomo
authors.affiliation: Department of Medicine and Health Sciences, University of Molise, Via Francesco De Santis, 86100, Campobasso, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Vasso
authors.affiliation: Department of Medicine and Health Sciences, University of Molise, Via Francesco De Santis, 86100, Campobasso, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Schiavone Panni
authors.affiliation: Department of Geriatrics, Neuroscience and Orthopaedics, University Hospital "Agostino Gemelli", Catholic University of the Sacred Heart School of Medicine, L.go A. Gemelli 1, 00168, Rome, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Maccauro
mesh_terms: D000293:Adolescent; D000328:Adult; D001843:Bone Cements / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000473:pathology* / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods; D003475:Curettage; D005260:Female; D005264:Femoral Fractures / Q000473:pathology* / Q000601:surgery*; D005269:Femur / Q000473:pathology* / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009584:Nitrogen / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome; D016474:Weight-Bearing
chemical_list: D001843:Bone Cements; D009584:Nitrogen
keywords: Bone grafts; Bone tumor; Curettage; Osteosynthesis in bone tumor; Pathological fractures