Use of Cem-Ostetic® for Treatment of Non-Ossifying Fibroma
Patient is a 13-year-old male who presented with insidious onset of right tibial and ankle pain. Radiographic work-up demonstrated presence of an eccentric metaphyseal lytic defect of the distal right tibia consistent with a non-ossifying fibroma.
Patient was taken to the operating room for intralesional resection and curettage. After sterile prep and drape of the right lower extremity, a 4cm longitudinal paralateral incision was made lateral to the distal tibial crest. A cortical window was produced with a high speed burr. The lesion was grossly debrided through the defect to normal appearing cancellous bone. The cavity was irrigated with 500ml of 3% hydrogen peroxide solution followed by 500ml of bacitracin solution. 10ml of Cem-Ostetic® putty was then injected via a 60ml piston syringe into the cavity. The putty was allowed to harden. The wound was then irrigated with bulb syringe and bacitracin solution. The wound was closed in standard fashion in multiple layers and a sterile dressing applied followed by a long leg splint. Postoperative films demonstrated good filling of the operative defect with the putty.
The patient had an unremarkable postoperative course. The patient was maintained non weightbearing for 2 months and partial weightbearing in a case boot for 1 month. He achieved excellent knee and ankle range of motion and experience rapid resolution of pain. X-rays demonstrated progressive consolidation and healing of the defect over a 12-month period. (Figure 1-4). There was no evidence of local recurrence.
The case demonstrates the potential for use of Cem-Ostetic® as an injectable bone graft substitute for the treatment of benign bone lesions in the distal tibia.
Figure 1. AP X-ray of distal tibia and fibula demonstrating cortical window and bone remodeling 4 months post treatment.
Figure 2. AP X-ray of distal tibia and fibula 6 months post treatment demonstrating bone consolidation with the defect.
Figure 3 and 4. AP and lateral X-rays of left tibia 1 year post treatment demonstrate healing of the lesion with new bone formation.