SURGISPON® Assisted Surgery for Aneurysmal Bone Cyst in Proximal Tibia

Aneurysmal bone cysts (ABCs) are uncommon bone lesions, and the solid variant (S-ABC) is even rarer, accounting for less than 10% of all ABCs. Despite its rarity, S-ABC presents a significant diagnostic challenge due to its resemblance to neoplastic lesions. In this context, the treatment strategy becomes crucial, and the use of gelatin sponge emerges as a noteworthy adjunct in surgical management.

The Diagnostic Journey

An 11-year-old boy presented with swelling and pain in the right proximal tibia. Despite suspicions of telangiectatic osteosarcoma (TO) based on radiological findings, the final diagnosis was S-ABC. The histopathological features indicated extensive new bone formation, which complicated the diagnostic process but guided the treatment strategy.

Surgical Treatment and the Role of Gelatin Sponge (SURGISPON®)

The patient underwent extended curettage and bone grafting, a procedure where the use of gelatin sponge played a pivotal role. During the surgery, gelatin sponge (SURGISPON®, Aegis Lifesciences) was used to pack the bone graft harvested from the ipsilateral iliac crest and fibular shaft. The sponge serves multiple purposes:

Hemostasis: SURGISPON®promotes hemostasis by absorbing blood and facilitating clot formation, which is crucial in surgeries involving bone curettage where bleeding can be significant.

Bone Graft Stabilization: SURGISPON®provides structural support and stabilization for the bone graft, aiding in its integration and preventing displacement.

Scaffold for Bone Formation: SURGISPON®acts as a scaffold for new bone formation. Over time, the sponge is resorbed, and the bone graft replaces it, promoting healing and bone regeneration.

Fig.1: Surgical Illustration [1]

 

Postoperative Outcome

Following surgery, the patient had an uneventful recovery. At one-year follow-up, he was asymptomatic, and radiographs showed reformation of the severed fibula, indicating successful bone graft integration with minimal morbidity.

Fig.2: A) Pre-operative X-ray B) Postoperative X-ray showed healed lesion [1]

Conclusion

In conclusion, the case of S-ABC in the right proximal tibia serves as a reminder of the complexities in diagnosing and treating rare bone lesions. The incorporation of gelatin sponge in surgical management demonstrates its value as a versatile tool in orthopedic surgery, contributing to successful outcomes and patient well-being.

References

[1] Panicker JI, Babu BC, Mohan V, Dhruvan SP, Jojo A, Surendran Pillai D, et al. Solid Aneurismal Bone Cyst of Proximal Tibia with Resemblance Telangiectatic Osteosarcoma – A Case Report. Kerala Journal of Orthopaedics. 2021 Jun 1;34(1):35–40. Doi: 10.52314/kjo.2021.v34i1.41