Extended Curettage for Benign Bone Lesions

Benign bone lesions present a unique challenge to the practicing orthopaedist. They are a not uncommon problem that often present in the pediatric or young adult population. The most common diagnoses include giant cell tumor of bone, aneurysmal bone cysts, unicameral (simple) bone cysts, metaphyseal fibrous defects, and fibrous dysplasia. Appropriate surgical intervention must balance acceptable recurrence rates and surgical morbidity in line with their benign diagnosis. Historically, early surgical invention had unacceptably high recurrence rates. A more aggressive surgical approach to these lesions significantly decreased recurrence rates but surgical morbidity rose to levels considered unacceptable for benign lesions. Extended curettage offers a satisfactory compromise with decreased recurrence rates and significantly less surgical morbidity. Extended curettage is a technique of intralesional excision where the margins of the excision are extended by a surgical, chemical, or thermal adjuvant. Adjuvant options include phenol, liquid nitrogen, high-speed burr, cementation with polymethylmethacrylate, and argon-beam coagulation. The technique described here uses a combination of high-speed burr, argon-beam coagulation, and cementation to treat benign bone lesions resulting in an acceptable recurrence rate and acceptable rate of surgical morbidity.