The Clinical and Radiological Outcome of Stages 1 and 2 Enneking Benign Bone Lesions with Pathological Fracture

Abstract Background Presentation of benign lesions with a pathological fracture may be confusing to general orthopedic surgeons regarding missing a fracture in a pathological bone, the need for special care for these lesions, and the potential for healing of these fractures. The objective of this work was to evaluate the clinical and radiological outcomes of the treatment of patients with stages 1 and 2 Enneking benign bone-tumors presented with pathological fractures. Methods This retrospective study included 66 patients who presented with a pathological fracture through stage 1 or 2 Enneking benign bone lesions and were received at the emergency unit of the orthopedic department between 2014 and 2018. Demographic data and patient's evaluation were collected. Lesion-size (length, width, and depth) was calculated from the X-ray. Surgical intervention was planned in 28 patients. The indication for surgery was either fracture fixation or curettage of the lesion with or without augmentation. There were no repeated surgeries or local recurrences. The filling of the cavity was classified according to modified Neer's classification. Results Sixty-six patients, 45 males, and 21 females were included. Forty-two affections were right while 24 were left. The mean age was 14.9 ± 8.6 (range, 3-40) years. The most common radiological diagnoses were simple bone-cysts 43.9% (n = 29), followed by non-ossifying fibroma 27.3% (n =18). The mean length of the lesions was 4.4 ± 2.6 (range, 1 - 12) cm, width was 1.6 ± 0.8 (range, 0.3- 4.5) cm, and depth was 1.8 ± 0.9 (range, 0.3 - 5) cm. The mean follow-up was 24.15 ± 18.7 months. Minor complications occurred in 7 patients (10.6%). Fifty-four out of 65 lesions (83%) showed either almost complete or partial filling of the lesions. There was no significant difference regarding the filling of the lesions according to the modified Neer's classification between those who were treated conservatively and those who underwent surgical intervention P-value = 0.783. Conclusion Careful diagnosis of a pathological fracture through stages 1 and 2 Enneking benign bone tumors is essential before initiating treatment. These fractures have good potential for bone healing and a low incidence of complications even with conservative treatment. Special surgical care of the lesion is not mandatory in all situations and should be individualized. Level of evidence: Level III, retrospective.