PMC7489159_01
Preoperative X-ray, computed tomography and magnetic resonance imaging appearance.
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F1
Through computed tomography and magnetic resonance imaging, a cavitated, multiloculated lesion was observed, with fluid levels inside and with a mild inflammatory reaction of adjacent soft tissues (Figure 1).
Intraoperative images. (a) Surgical exposure of aneurysmal bone cyst. (b) Resection. (c) Impregnation with lauromacrogol solution. (d) Subperiostal fibular graft measurement. (e) Placement of intramedullary titanium stem in autograft. (f) Retrograde-anterograde graft placement and stabilization under light compression.
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The reconstruction of the resulting critical bone defect (4.5 cm in length) was performed by free autologous bone graft taken subperiosteally from the diaphysis of the ipsilateral fibula (Figure 2).
Immediate postoperative X-ray appearance.
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F3
Its stabilization was achieved by means of a 2 mm intramedullary titanium nail (TEN, Synthes , GmbH, Oberdorf, Switzerland) introduced in a retrograde-anterograde manner, leaving the lateral end subcutaneous (Figure 3).
Aneurysmal bone cysts present large spaces filled with blood (black stars), separated by fibrovascular tissue with a degenerated calcifying fibromyxoid tissue, osteoid, bone, inflammatory, and giant cells (black arrows) (H-E x10).
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Histopathological analysis confirmed the diagnosis of ABC, with free resection margins (Figure 4).
Postoperative follow-up. (1 m): One month postoperatively. (5 m): Five months postoperatively. (14 m): Fourteen months postoperatively, observe fibular reconstruction; (18 m): Eighteen months postoperatively.
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The clinical and radiographic evolution was satisfactory (Figure 5), evidencing a satisfactory radiographic incorporation and consolidation of the graft at five months postoperatively.