Giant Cell Tumor With Pathologic Fracture: Should We Curette or Resect?

• Published in: Clinical orthopaedics and related research 2013-03, Vol.471 (3), p.820-829
• Main Authors: van der Heijden, Lizz, Dijkstra, P. D. Sander, Campanacci, Domenico A., Gibbons, C. L. Max H., van de Sande, Michiel A. J.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Bone Neoplasms - complications; Bone Neoplasms - mortality; Bone Neoplasms - pathology; Bone Neoplasms - surgery; Child; China; Conservative Orthopedics; Curettage - adverse effects; Curettage - mortality; Disease-Free Survival; Europe; Female; Fracture Fixation; Fracture Healing; Fractures, Spontaneous - etiology; Fractures, Spontaneous - mortality; Fractures, Spontaneous - pathology; Fractures, Spontaneous - surgery; Giant Cell Tumor of Bone - complications; Giant Cell Tumor of Bone - mortality; Giant Cell Tumor of Bone - pathology; Giant Cell Tumor of Bone - surgery; Humans; Kaplan-Meier Estimate; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Recurrence, Local; Orthopedics; Osteotomy - adverse effects; Osteotomy - mortality; Proportional Hazards Models; Reconstructive Surgical Procedures - adverse effects; Reconstructive Surgical Procedures - mortality; Retrospective Studies; Risk Factors; Sports Medicine; Surgery; Surgical Orthopedics; Symposium: Papers Presented at the 2011 ISOLS Meeting in Beijing; Symposium: Papers Presented at the 2011 ISOLS Meeting in Beijing, China; Time Factors; Treatment Outcome; Tumor; Young Adult
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-012-2546-6

Background Approximately one in five patients with giant cell tumor of bone presents with a pathologic fracture. However, recurrence rates after resection or curettage differ substantially in the literature and it is unclear when curettage is reasonable after fracture. Questions/Purposes We therefore determined: (1) local recurrence rates after curettage with adjuvants or en bloc resection; (2) complication rates after both surgical techniques and whether fracture healing occurred after curettage with adjuvants; and (3) function after both treatment modalities for giant cell tumor of bone with a pathologic fracture. Methods We retrospectively reviewed 48 patients with fracture from among 422 patients treated between 1981 and 2009. The primary treatment was resection in 25 and curettage with adjuvants in 23 patients. Minimum followup was 27 months (mean, 101 months; range, 27–293 months). Results Recurrence rate was higher after curettage with adjuvants when compared with resection (30% versus 0%). Recurrence risk appears higher with soft tissue extension. The complication rate was lower after curettage with adjuvants when compared with resection (4% versus 16%) and included aseptic loosening of prosthesis, allograft failure, and pseudoarthrosis. Tumor and fracture characteristics did not increase complication risk. Fracture healing occurred in 24 of 25 patients. Mean Musculoskeletal Tumor Society score was higher after curettage with adjuvants (mean, 28; range, 23–30; n = 18) when compared with resection (mean, 25; range, 13–30; n = 25). Conclusions Our observations suggest curettage with adjuvants is a reasonable option for giant cell tumor of bone with pathologic fractures. Resection should be considered with soft tissue extension, fracture through a local recurrence, or when structural integrity cannot be regained after reconstruction. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.