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

Case presentation 1 N.S 8yrs Male Hausa Muslim Gwale LGA Kano Date of Admission; 01-09-2015

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

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

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.

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

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

Investigation

Diagnosis Aneurysmal bone cyst/ ? Unicameral bone cyst

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.

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

Immediate post operative X-ray

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

7 months post surgery

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..

Case presentation 2 N.M 4yrs Male Fulani Muslim Portharcourt, River state Date of Admission: 17-02-2017

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

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

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.

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

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

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

Investigation

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

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

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

Child is 1 week post op, still on admission.