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

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. MATERIALS AND 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. CONCLUSION: We recommend preventive osteosynthesis after curettage in patients with very large lesions (>5 cm, >60 cm(3)) or high functional requirements, in obese patients, and when local adjuvants are used. LEVEL OF EVIDENCE: Level IV retrospective case-series study.