جراحة العظام / علاج العظام في الاردن / افضل دكتور عظام في الاردن / افضل اخصائي عظام في الاردن / استشاري عظام/افضل استشاري عظام في الاردن /جراحة عظام / /عمليات تطويل العظام في الاردن / اطباء العظام في الاردن / دكتور طب عظام في الاردن / الاطباء في الاردن / خلع ورك / عمليات اليزاروف في الاردن /علاج الكسور /خلع الولادة / تركيب المفصل / اوجاع العظام /افضل طبيب عظام اطفال في الاردن / استشاري اطفال عظام في الاردن / /علاج خلع الكتف / علاج التواء الكاحل / التواء الكاحل / علاج الام العظام / علاج هشاشة العظام / ارقام اطباء عظام في الاردن / مشاكل العظام والمفاصل /مستشار جراحة العظام والمفاصل والكسور/مستشار جراحة عظام الأطفال.

1. Giant Aneurysmal Bone Cyst
11/1/2014
Professor Freih Abuhassan - University
of Jordan 1

2. Giant Aneurysmal Bone Cyst
F.R.C.S.(Eng.), F.R.C.S.(Tr.& Orth.)
Professor of Orthopaedics
Professor Freih Abuhassan - University
11/1/2014 2
of Jordan

3. Patient profile:
A 9-years old male child, MF, Overweight.
Chief complaint:
Progressive painless swelling of the
right distal thigh of 14 m duration
Referred to us on the
17th Nov. 2008
Professor Freih Abuhassan - University
11/1/2014 3
of Jordan

4. History of present illness:
4th Sep. 2007, had pain in the distal femur
after a fall while playing.
Diagnosed as pathological fracture of
the distal femur.
Professor Freih Abuhassan - University
11/1/2014 4
of Jordan

5. 4th Sep. 2007
Professor Freih Abuhassan - University
11/1/2014 5
of Jordan

6. Treated by complete POP for 3 M
4th Dec. 2007
Professor Freih Abuhassan - University
11/1/2014 6
of Jordan

7. 19th Jan. 2008
Trivial trauma  Supracondylar distal
femur fractures treated by POP for
7 weeks
Professor Freih Abuhassan - University
11/1/2014 7
of Jordan

8. 19th Jan. 2008
Professor Freih Abuhassan - University
11/1/2014 8
of Jordan

9. 5th Mar. 2008
Professor Freih Abuhassan - University
11/1/2014 9
of Jordan

10. Past medical history
=History of two surgical biopsies with
blood transfusion
Diagnosis: Aneurysmal bone cyst
Professor Freih Abuhassan - University
11/1/2014 10
of Jordan

11. Patient offered the following
advices outside JUH
1- Above Knee Amputation
2- Resection and Joint replacement
3- To be treated abroad
Patient was wheel chair dependent
since the start of treatment.
Professor Freih Abuhassan - University
11/1/2014 11
of Jordan

12. Lesion contineued to grow
6th June 2008
Professor Freih Abuhassan - University
of Jordan
11/1/2014 12

13. 26th Sep. 2008
Professor Freih Abuhassan - University
11/1/2014 13
of Jordan

14. Physical examination:
17th Nov. 2008
General: no abnormality detected
Right lower limb:
= Diffuse swelling of the knee and lower thigh with
10 cm diameter difference form the left thigh
(firm, not tender, not pulsatile)
=Decreased knee ROM due to the bulky swelling
=Normal distal NV examination
Professor Freih Abuhassan - University
11/1/2014 14
of Jordan

15. Professor Freih Abuhassan - University
11/1/2014 15
of Jordan

16. Professor Freih Abuhassan - University
11/1/2014 16
of Jordan

17. Professor Freih Abuhassan - University
11/1/2014 17
of Jordan

18. Laboratory investigation
CBC
KFT
LFT
ESR
CRP
All were Normal
Professor Freih Abuhassan - University
11/1/2014 18
of Jordan

19. 17th Nov. 2008
Professor Freih Abuhassan - University
11/1/2014 19
of Jordan

20. Professor Freih Abuhassan - University
11/1/2014 20
of Jordan

21. Professor Freih Abuhassan - University
11/1/2014 21
of Jordan

22. Professor Freih Abuhassan - University
11/1/2014 22
of Jordan

23. Professor Freih Abuhassan - University
11/1/2014 23
of Jordan

24. Professor Freih Abuhassan - University
11/1/2014 24
of Jordan

25. Surgery at JUH
19th Nov. 2008
First stage
Local curretage of the cyst +
application of monoplanar external
fixator + Circular Ex.Fix. (across
the knee joint) Ilizarov Frame.
Professor Freih Abuhassan - University
11/1/2014 25
of Jordan

26. Problems
1- Difficult to apply Tourniquet
2- Lateral Scar of previous surgery
3-Soft bone (prolonged disuse)
4-Extensive bleeding
5-Overweight
6-Residual defect after resection.
Professor Freih Abuhassan - University
11/1/2014 26
of Jordan

27. Packing the cyst after surgery to stop
bleeding.
Received in the perioperative period
= 5.5 L R/L
= 4 U PRBC’s
= 10 U FFP
Role of anaesthetic team
in the management
Professor Freih Abuhassan - University
11/1/2014 27
of Jordan

28. =Transferred to the ICU and kept
there till 24/11
=Initially DIC W/up +ve
=21st Nov. 2008 R/O pack
Professor Freih Abuhassan - University
11/1/2014 28
of Jordan

29. Professor Freih Abuhassan -
11/1/2014 29
University of Jordan

30. Histopathology
ABC
Professor Freih Abuhassan - University
11/1/2014 30
of Jordan

31. Professor Freih Abuhassan -
11/1/2014 31
University of Jordan

32. Professor Freih Abuhassan -
11/1/2014 32
University of Jordan

33. Professor Freih Abuhassan -
11/1/2014 33
University of Jordan

34. Professor Freih Abuhassan -
11/1/2014 34
University of Jordan

35. 16th Dec. 2008
2nd stage Surgery
= Under tourniquet, Anterior approach,
Complete resection of the cyst.
=Turbid hematoma was found inside
the cavity.
=Delay reconstruction of the bone
defect till results of C&S.
=Bone cement spacer was inserted.
Professor Freih Abuhassan - University
11/1/2014 35
of Jordan

36. Professor Freih Abuhassan -
11/1/2014 36
University of Jordan

37. Professor Freih Abuhassan -
11/1/2014 37
University of Jordan

38. Cultures: no bacterial growth
Gram stain:
only WBC’s & RBC’s, no bacteria
Professor Freih Abuhassan - University
11/1/2014 38
of Jordan

39. Reconstructive Procedure
Professor Freih Abuhassan - University
11/1/2014 39
of Jordan

40. 3nd stage Surgery
23rd Dec. 2008
1. Removal of Cement spacer
2. Strut tibial autograft from the mid
ipsilateral tibia, to femur and
stabilized by long screws to the
ilizarov frame.
3. Application of ilizarov to tibia +
bone marrow inserted.
Professor Freih Abuhassan - University
11/1/2014 40
of Jordan

41. Professor Freih Abuhassan - University
11/1/2014 41
of Jordan

42. Professor Freih Abuhassan - University
11/1/2014 42
of Jordan

43. Professor Freih Abuhassan - University
11/1/2014 43
of Jordan

44. Professor Freih Abuhassan -
11/1/2014 44
University of Jordan

45. 23rd Dec. 2008 Professor Freih Abuhassan -
11/1/2014 University of Jordan
45

46. Professor Freih Abuhassan - University
11/1/2014 46
of Jordan

47. Professor Freih Abuhassan - University
11/1/2014 47
of Jordan

48. 5th Jan. 2009
Admitted as a case popliteal fossa
swelling to R/O organised hematoma
U/S: no definite fluid collection but
significant soft tissue edema.
= Percutaneous evacuation of hematoma,
=R/O Orthofix and application of long
Ilizarov plate externally and fixed to the
graft by Schanz screws
Professor Freih Abuhassan - University
11/1/2014 48
of Jordan

49. Followed regularly in OPD
Partial weight bearing was started
in the on 21st Jan. 2009.
Now FWB on crutches
Professor Freih Abuhassan - University
11/1/2014 49
of Jordan

50. 25th March 2009
Professor Freih Abuhassan -
11/1/2014 50
University of Jordan

51. Professor Freih Abuhassan -
11/1/2014 51
University of Jordan

52. With Ilizarov family
Professor Freih Abuhassan -
11/1/2014 52
University of Jordan

53. ABC
In 1942, Jaffe and Lichtenstein
first described ABC when they
discovered "a peculiar blood
containing cyst of large size.
Professor Freih Abuhassan - University
11/1/2014 53
of Jordan

54. Benign Aggressive Bone
TuLmoocar lly destructive yet do not
metastasize or show malignant
changes at a cellular levelcellular
level
ABC, GCT, CMF,
Chondroblastoma,
Osteoblastoma.
Professor Freih Abuhassan - University
11/1/2014 54
of Jordan

55. ABCs represent 1%–2% of all
primary bone lesions
WHO
Blood-filled spaces of variable
size,separated by CT containing
trabeculae of bone or osteoid
tissue and osteoclast giant cells
Professor Freih Abuhassan - University
11/1/2014 55
of Jordan

56. D.Dx
Giant Cell tumour
Aneurysmal bone cyst
Telangiectatic osteosarcoma
Secondary ABC –upto 35% of all ABCs
Most commonly due to GCT (39%)
Professor Freih Abuhassan - University
11/1/2014 56
of Jordan

57. No bone is immune
11/1/2014 57

58. Giant Humerus ABC
11/1/2014 Professor Freih Abuhassan - 58
University of Jordan

59. Giant femur ABC
Professor Freih Abuhassan - University
11/1/2014 59
of Jordan

60. Giant ABCs
Professor Freih Abuhassan -
11/1/2014 60
University of Jordan

61. Treatment depends on
site & size of the lesion.
Local recurrence rate after
classic surgical procedures
(curettage and grafting) is about
11.8%–30.8%
Professor Freih Abuhassan - University
11/1/2014 61
of Jordan

62. Professor Freih Abuhassan - University
11/1/2014 62
of Jordan