DOS BULLETIN - Dansk Ortopædisk Selskab
DOS BULLETIN - Dansk Ortopædisk Selskab DOS BULLETIN - Dansk Ortopædisk Selskab
2010-378_DOS nr. 3 2010 29/09/10 10:08 Side 100 A Bone Cyst Treated With Corticosteroid Installation In An Osteopetrotic Child Zaid Al-Aubaidi, Niels Wisbech Pedersen Odense university hospital Background: Osteopetrosis was first described in 1904 by Albers- Schoenberg, as a phenomenon of increased radiographic density of the bones. To our knowledge bone cyst formation in osteopetrotic patients has not previously been described. Bone cyst can weaken the bones even more and result in a fracture, which is very difficult to treat in this kind of patients Purpose: We report a case of a child with autosomal dominant osteopetrosis and a subtrochanteric bone cyst. The cyst was treated in a minimal invasive manner with percutaneous bone drilling and local corticosteroid injection. The cyst resolved completely Methods: 12 years old boy, with a family history of autosomal dominant osteopetrosis. An X-ray showed cystic changes in the proximal right femur. Because of pain and the increased risk of a pathological subtrochanteric fracture, we treated the patient by percutaneous drilling of the sclerotic cystic wall, aspiration and local injection with 80mg Depo- Medro twice. Findings: X –ray control after 8 months showed complete healing of the cyst and the patient had total remission of the complains. Conclusion: Other treatment options would be curettage and bone transplantation. The present case demonstrates that bone cysts in children suffering from osteopetrosis can be treated successfully with installation of corticosteroid and we recommend this treatment as first choice. 100
2010-378_DOS nr. 3 2010 29/09/10 10:08 Side 101 Effect on Implant Fixation of Simvastatin Applied Locally in a PDLLA Coatning Mette Sorensen, Jørgen Baas, Marianne T. Vestermark, Joan E. Bechtold, Kjeld Søballe Orthopardic Research Lab. and Department of Orthopaedics, Aarhus University Hospital; Orthopaedic Biomechanics Lab, Excelen Center for Bone and Joint Research and Education, Minneapolis MN USA Background: About 2% of the population >60 years has a total hip replacement. A solid initial fixation of the implant improves the longevity and it is desirable with a stable primary fixation of the implant in order to avoid revision. Statins acts by inhibiting the HMG coenzyme A reductase and by increasing the expression of BMP2, a potent growth factor inducing bone formation in vivo. Local application of statin has showed to be beneficial in fracture healing and may also improve implant fixation. Purpose: We hypothesized that locally applied simvastatin would improve implant fixation. Methods: Twelve dogs each received four experimental implants, two in the proximal part of each humerus. Ti implants measuring 6x10mm were used. The four groups were: Ti implant, Ti implant+coating, Ti implant+PDLLA+simvastatin (0.1 mg) and Ti implant+PDLLA+simvastatin (1.0 mg). All implants were surrounded by a 1.0mm gap. After four weeks the specimens were prepared for biomechanical push- out testing yielding max sheer strength, max sheer stiffness and energy absorption. Statistical analysis by oneway Anova and paired t-test. Findings: After four weeks the implants coated with PDLLA +/- simvastatin showed a significant decrease in all biomechanical parameters compared to the uncoated Ti implants. The implants coated with PDL- LA+simvastatin showed improved implant fixation compared to the implant coated with PDLLA alone, most pronounced in the high dose group, however not significant. Conclusion: This study indicates that there may be a beneficial effect of locally applied simvastatin in regards to implant fixation compared to only PDLLA coated implants but not when comparing to bare Ti implants. The study also suggests that the biodegradable PDLLA coating is not appropriate for delivering biological active agents to the implant-bone interface 101
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2010-378_<strong>DOS</strong> nr. 3 2010 29/09/10 10:08 Side 100<br />
A Bone Cyst Treated With Corticosteroid Installation<br />
In An Osteopetrotic Child<br />
Zaid Al-Aubaidi, Niels Wisbech Pedersen<br />
Odense university hospital<br />
Background: Osteopetrosis was first described in 1904 by Albers-<br />
Schoenberg, as a phenomenon of increased radiographic density of the<br />
bones. To our knowledge bone cyst formation in osteopetrotic patients<br />
has not previously been described. Bone cyst can weaken the bones even<br />
more and result in a fracture, which is very difficult to treat in this kind<br />
of patients<br />
Purpose: We report a case of a child with autosomal dominant osteopetrosis<br />
and a subtrochanteric bone cyst. The cyst was treated in a minimal<br />
invasive manner with percutaneous bone drilling and local corticosteroid<br />
injection. The cyst resolved completely<br />
Methods: 12 years old boy, with a family history of autosomal dominant<br />
osteopetrosis. An X-ray showed cystic changes in the proximal right<br />
femur. Because of pain and the increased risk of a pathological subtrochanteric<br />
fracture, we treated the patient by percutaneous drilling of<br />
the sclerotic cystic wall, aspiration and local injection with 80mg Depo-<br />
Medro twice.<br />
Findings: X –ray control after 8 months showed complete healing of the<br />
cyst and the patient had total remission of the complains.<br />
Conclusion: Other treatment options would be curettage and bone transplantation.<br />
The present case demonstrates that bone cysts in children suffering<br />
from osteopetrosis can be treated successfully with installation of<br />
corticosteroid and we recommend this treatment as first choice.<br />
100