Femoral cyst

Bone dysplasia in the growth zone often manifests itself as a solitary or aneurysmal cyst. The femur cyst in the overwhelming majority is diagnosed as a juvenile, solitary benign tumor. The CCM on statistics in 30% is formed precisely in this zone, since in principle it is inherent in the development of long tubular bones. Os femoris is considered the largest and longest of all the skeletal bones of the body, the femur consists of the body, the proximal and distal epiphysis.

The femur cyst is defined at the age of 5 to 15 years, less often in adult patients. Primary localization is the proximal metaphysis (ending) of the femur without crossing the boundaries of the cartilaginous epiphyseal line. Unlike other dystrophic destructive osteopathies, the cyst of the bone never affects the joint, which is 100% confirmed by an X-ray examination. Cortical tissue in the cyst development zone is much thinner, but preserved. The cyst of the femoral bone may be small - 2-3 centimeters in diameter, but with prolonged asymptomatic course of the process, the formation can develop to gigantic proportions, up to the spread throughout the bone.

In the clinical sense, the bony cyst of the thigh can manifest itself with such signs:

• The onset of cyst development is asymptomatic.
• There are no violations in the mineral metabolism and in the blood.
• Progressive deformity of the thigh is manifested by thickening in the growth zone of the cyst without shortening the limb and the bone itself.
• Soft tissue without signs of atrophy.
• Skin without changes.
• The bony cyst of the hip, which developed to gigantic proportions, can cause minor transient pains that increase in motion. The volume of movement of the lower limbs is not limited, the pain is tolerable.
• The first symptoms can manifest in a pathological fracture caused by a sharp movement, less often - a mild trauma or bruise.
• X-ray shows the focus in the center of the femur with a characteristic large-mesh pattern.
• The cyst has a rounded regular shape, less often its shape is defined as spindle-shaped or pear-shaped. The contours of the neoplasm are clear, smooth.
• The bone cyst is characterized by a decrease in the cortical layer of the bone without signs of pathological destruction and periosteal reaction.

The diagnosed cyst of the hip bone is to be removed. Currently, more than half of patients with ACC or CCM in the femur go through an operation that is considered to be the most effective method of treating tumor-like bone pathologies. Depending on the size of the cyst, its type, age and health, the patient undergoes either a resection or exocclusion of the damaged bone area, then the cyst is filled with allografts. Transosseous osteosynthesis restores normal length and function of the femur, the recovery period lasts from one year to one and a half years.

[1], [2], [3], [4], [5], [6]

Bone femur cyst

The etiology of the bony cyst of the hip has not been completely clarified and is the subject of constant medical discussions. Based on statistical data obtained from embryologists, most orthopedists and surgeons are inclined to the version of dysplasia of bone growth sites, in which the normal division of cartilaginous tissue is disrupted. An abnormal process of differentiation of cartilaginous cells is perceived by the body as pathological, and macrophages, lymphocytes are included in the work. Enzymatic neutralization of "unrecognized" cells occurs with the participation of the vascular system, while the intensity of the process depends on the age-specific features of human physiology. Most often, the bony cyst of the hip is defined at the age of 7-13 years, solitary cysts prevail in boys.

This "struggle" with the undifferentiated tissues of the bone growth zone is confirmed by long-term clinical observations - both radiological and histological. The most characteristic reaction of the lymphatic system in the form of the formation of cystic cavities for proximal growth sites, including - the femur. In the thigh can be formed as aneurysmal, and solitary cysts, statistical information about their frequency is so contradictory that it is impossible to provide them as objective.

Treatment of the bony cyst of the hip depends on the duration of development of the pathology, the size of the cyst, the symptoms and age of the patient. In children, a pathological fracture of the femoral neck is often a paradoxical way of reducing the cystic cavity and the gradual restoration of bone tissue. Adult patients, in whom the cyst of bone is diagnosed extremely rarely and 99% is aneurysm, are able to more adequately transfer surgical treatment, the tumor is subject to prompt removal.

General recommendations for the treatment of femoral cyst in children:

• Decompression cysts larger than 2 centimeters. Puncturing the wall, rinsing the cavity to purify the cyst from the enzymes and products of decay of bone tissue, to neutralize the fibrinolysis process.
• Large-size cysts are punctuated several times within six months, in 2-4 weeks, possibly longer. Aneurysmal cysts are pierced several times in the regime after 7-10 days. The total number of punctures can reach 10-15 procedures.
• The washed cavity of the cyst can be filled with drugs that have an antiproteolytic effect (countercranial).
• Stabilization of lysosomal membranes, restoration of collagenosis is carried out with the help of corticosteroids.

This method of conservative treatment in an uncomplicated process makes it possible to avoid surgery. If the therapy is successful, the first positive signs of neoplasm repair are visible already in the 2nd month, the duration of complete cyst repair can reach 12-24 months. In adults, conservative therapy often does not have an effect, but, on the contrary, provokes relapses, so it shows an operation to remove the femoral cyst. In addition, the reparative capacity of the bone system in adults is much lower than in children, and only surgical treatment can give the desired result. The choice of the method of operation is determined by the surgeon, based on radiological data and other diagnostic information. It is expedient to complete, radical removal of defecate and parallel plastic - replacing the removed part of the bone with an auto-material or alloplastic substances. With successful treatment, the full motor activity of the hip joint can recover after 2-3 years.

[7], [8], [9], [10], [11]

Cyst of femoral head

In the femur, aneurysmal cysts develop most often, mainly in girls, in the ratio to boys - 80/20%. To understand how the aneurysmal cyst of the femoral head is being formed, one should remember the structure of the thigh and the role of the head in the supporting and motor functions.

The caput femoris (head) is located in the zone of the proximal epiphysis and has a typical joint surface with a small depression (fossa) in the middle - fovea capitis ossis femoris. The head and body of the bone are joined by a specific zone - the neck of the femur. Like all joints, the female femoris functions as a kind of lever in the hip joint, which helps the movements of a person. Normally, the hip joint should look like a hemisphere with the correct concentric insertion of the femoral head into the acetabulum. The abnormal position of the female femoris in the child is partially compensated for by gait and by turning the foot (socks inward or outward). In general, the formation of the cyst of the femoral head, in addition to the main etiological factors, can be influenced by the blood supply system of the joint, which is carried out by the vessels of the joint capsule and intraosseous vessels located in the metaphysis. Thus, an aneurysmal cyst most often develops in connection with pathological dysplasia of bone tissue, vascular bed and as a result of microcirculation disturbances in the metaphysis. The cyst of the femoral head is not able to germinate into the cartilaginous tissue and affect the epiphysis, which distinguishes it from the osteoblastoklastomy, which is related in clinical manifestations.

Developing in the bone tissue of caput femoris, the cyst can for a long time not give a clinically pronounced symptomatology. Transient painful sensations are not seen by the child until the manifestation of a clear sign of destructive bone damage - a pathological fracture.

Possible symptoms that indicate the development of the cyst of the head of the femur in a child? •

• Transient pain in the knee.
• Minor pain in the groin.
• Pain in the pelvic region.
• Transient lameness.
• Periodic disruption of the child's gait (outward turn of the leg).
• A pathological fracture in the area of the neck of the hip from minor trauma or a sharp turn of the trunk.

Radiographically, the cyst is defined as a swelling of the bone, the cortical layer is considerably thinned, the cyst cavity looks like a rounded elongated formation with calcareous inclusions.

The tactics of treatment for finding a cyst of the femoral head in a child may be different, but most often surgeons begin with conservative therapy and immobilization of the hip with all of the recommendations that follow from this for fractures of the bones. If a pathological fracture occurred in the neck area of the femur, dynamic monitoring of the cyst development takes place within 1-1.5 months, which, as a rule, begins to be repaired. Signs of repair of the cyst cavity are an indication for further immobilization for 1-2 months, the entire period of the hip joint condition is controlled by radiography. If the control pictures do not show positive dynamics, the destructive process in the bone progresses, the cyst cavity increases, then surgical treatment is performed. As a rule, regional or segmental resection of the damaged bone zone is carried out within the boundaries of healthy tissues, in parallel the defect is filled with homotransplants. In the surgical treatment of tumor-like formations in the thigh area, relapses occur rarely and most often they are associated with technical errors during the operation (incomplete resection of the cyst and damaged tissues). The prognosis of treatment of the cyst of the femoral head is favorable, however, the recovery period is difficult and long: the patient has to limit movements during the year.

[12], [13], [14]

Femoral neck cyst

Bone cyst as an independent nosological unit is relatively rare, but it is most common among patients of childhood. As for the cervical cyst, such cases are rare, in addition, this pathology is confused in 50% of cases with other tumor-like diseases of the osseous system - chondroma, osteoblastoklastoma, lipoma, especially if the cyst leads to a pathological fracture.

Collum ossis femoris (neck of femur) is part of the proximal epiphysis, directed upward, medially, it connects the femur head with other structural parts of the hip joint. This is a rather narrow bone, compressed in the frontal plane and forming an angle with the axis of the thigh. The femoral neck is most vulnerable in females, especially during menopause or in pathological osteoporosis, but this part of the osseous system can be damaged by various osteodystrophic diseases in children.

The symptoms of developing bony cysts are not specific, which is typical for any type of cyst - ACC or CCM. However, a child or an adult may periodically display such signs:

• Aching pain in the hip joint.
• Pain can increase with prolonged walking, in a child after active sports.
• The patient completely unconsciously tries to rely on the objects (chair, table) standing regularly.
• The gait may be disturbed.
• The X-ray image clearly shows the cavity, almost completely occupying the length of the neck of the femur with normal visual indices of the remaining parts of the hip joint.
• The cavity of the cyst can reach large sizes and interfere with the movements of the legs (restriction of the volume of movements).
• The cyst bone often provokes transient pain in the knee.
• A long developing cyst and its aggressive course provokes a significant destruction of bone tissue and a pathological fracture of the femoral neck.

Diagnosis of the bony cyst of the neck of the femur is considered difficult, complex, since the tumor-like formations in principle do not have the characteristic symptoms and signs. Differentiation of cysts is important in the sense of choosing a therapeutic tactic that can be conservative or surgical. To clarify the diagnosis helps radiography, computed tomography, ultrasound joint.

Conservative treatment is indicated if the cyst is not accompanied by a fracture. The hip joint is immobilized, the patient is laid completely at rest for a long time. If the dynamic observation does not show any positive results, and the cyst continues to increase, an operation is performed - exocclusion of the cystic cavity and parallel plastic of the removed part (autotency, allotransplant) along the Adams arc or total filling of the defect.

The same actions are indicated for a pathological bone fracture, the cyst is subject to observation and the course of the immobilization process, then in the absence of a positive dynamo it is removed within the boundaries of healthy tissues. In addition, the choice of surgical method can depend on the plane of the fracture of the femoral neck - lateral or medial. Medial fractures always occur inside the joint, in the joint zone of the cervix and the femoral head. Lateral (lateral or vertebral) are considered extraarticular and are treated more successfully. Bone alloplasty, grafts help to remodel bone within 1.5-2 years, in children this process occurs faster if all medical recommendations and restriction of motor activity are observed.

[15], [16], [17],

Treatment of the femur cyst

Treatment of bone cysts is still a serious problem, as there are no common standards and algorithms for both conservative therapy and surgical intervention. Principles and tactics of treatment of the femoral cyst cysts are determined individually depending on the type of tumor - SCC or ACC, the age of the patient, the duration of the pathological process and other parameters.

Conservative treatment of cystic hip can be used for patients aged 3 to 15 years, also the choice of a conservative method depends on the activity of the development of the cyst and on the histological analysis of the contents of the tumor. Relapses of pathology are a direct indication of an operation that can be carried out in such ways: 

• Intraosseous cyst resection within healthy tissues followed by alloplasty of the defect.
• Regional resection.
• Segmental resection of the cyst.
• Cryotherapy.
• Curettage cysts.

The basis of conservative treatment of the femur cyst is the reduction of abnormal hydrostatic pressure in the cavity with the help of multiple drainage and neutralization of fibrinolysis by the introduction of drugs into the cyst.

Puncture of the cyst is a perforation of the cavity with thin needles, such a procedure performed in a certain mode (after 2-3 weeks) helps to reduce the tumor and allows you to hope that the disease will be stopped. If 2-3 punctures do not give the desired result, the cyst in the hip bone is scraped, the defect is filled with the transplant. To speed up the process and prevent refracture, sometimes more complex methods of bone grafting are used. During treatment, the patient must comply with bed rest and limit movement as much as possible to reduce the burden on the damaged bone. The process of rehabilitation and rehabilitation can last up to a year and a half, children are restored faster due to a more active capacity for reparation.