1. MANAGEMENT OF ANEURYSMAL BONE CYST
PINK TEAM
HOSPITAL PRESENTATION
Case presentations
DR OSAGBEMIRO A.A
17/03/2017

2. Case presentation 1 N.S 8yrs Male Hausa Muslim Gwale LGA Kano
Date of Admission;

3. Presenting complaints
Recurrent pain (L) upper thigh and limping × 3yrs

4. History Presenting complaints
Upper (L) thigh pain and limping started insidiously. No history of trauma or fall.
Pain is aching in nature, aggravated by movement, relieve by rest and use of analgesics
No hx of fever, cough, weight loss, drenching night sweat. No loss of appetite, no hx of swelling or dischage
Not a known SCDx

5. History Presenting complaints 2
Presented 3yrs prior to presentation at the onset of symptom but was lost to follow up after pain subsided
Represented due to increase severity of the pain
Had TBS intervention with no improvement.
No hx of surgery or blood transfusion.
1st of 4 children in a monogamous family
Father – trader, mother- full housewife.

6. Physical examination
Young boy, not in painful distress, not pale , anicteric, afebrile
Vital signs; pulse= 94/min, T= 36.2⁰C
RR=22 cycles/min

7. MSS Both limb in normal attitude
(L) thigh : no swelling , no discharging sinus or scarification marks
There is tenderness in the proximal (L) thigh
Normal ROM in the hip and knee
Distal neurovascular status intact

8. Investigation

9. Diagnosis
Aneurysmal bone cyst/ ? Unicameral bone cyst

10. Investigation FBC WBC=6.4×10ᶟ/µl (lym=39.6%, Neu=50.1%) Hgb=10.7g/dL
PLT= 309×10ᶟ/µl
ESR= 9mm/hr
Hb genotype= AA
GXMatch 2 units of blood.

11. 2nd day on admission
Curettage, bone grafting, antibiotic beads insertion and prophylactic fixation with 9 holes locking plate
Intra operative findings
No swelling or deformity
Cystic lesion in the proximal femur
Intact thin cortex
Cyst contains hemorrhagic fluid ≈25ml, with septations
Sample sent for Histology

12. Immediate post operative X-ray

13. Discharged home and followed up on outpatient bases on NWB
Histology result suggestive of bone cyst- anuerysmal bone cyst.

14. 7 months post surgery

15. Counselled and had removal of implant
NWB for 1st 2weeks, then graduated weight bearing
Has not come for follow up since removal of implant 7months ago..

16. Case presentation 2 N.M 4yrs Male Fulani Muslim
Portharcourt, River state
Date of Admission:

17. Presenting complaints
(L) hip pain × 3/12
Inability to bear weight on (L)lower limb×1/7

18. History of presenting complaints
(L) hip pain started after a fall at home while playing
It was aggravated by walking and relieve by rest and use of analgesic.
The pain later became intermittent, with pain free period
There was associated limping, no hx of swelling or discharge
There was no fever, cough, night sweat, weight loss . No refusal of feeds

19. Child initially presented in this hospital and was managed conservatively with analgesics and followed up on out patient
1/7 prior to admission , child fell while dancing at home , sustained closed injury to the (L) hip with inability to bear weight.

20. Not a known SCDx
No hx of previous surgery, hospital admission, no blood transfusion
2nd of 3 children in a monogamous family
Mother – full housewife
Father- bussinessman

21. Examination
Young boy, in painful distress, not pale, anicteric ,afebrile
Vital sign: PR= 102beats/min, RR=24cycle/min, T= 36.3⁰C

22. MSS (L) lower limb in attitude of external rotation
Swelling and tenderness in proximal thigh.

23. Investigation

25. Diagnosis
(L) Intertrochanteric pathological # 2⁰ to ? Unicameral bone cyst or anuerysmal bone cyst

26. FBC
WBC= 8.7×10ᶟ/µl (L=63%, N=28%, M=7%, E=2%)
Hb= 11.3g/dL
E/U--- normal
GXMatch 2 unit of blood

27. Had open reduction and internal fixation with reconstruction plate, bone grafting and antibiotic beads insertion
Intra operative findings
Pathological # around intertrochanteric area
Thinned out cortices with wide cavity

29. Child is 1 week post op, still on admission.