Addressing an aneurysmal bone cyst occupying anxiety the majority of the talus podiatry today

An aneurysmal bone cyst is a benign tumor commonly affecting beck’s anxiety inventory test pdf the metaphysis of long bones but it can occur in beck’s anxiety inventory test pdf any bone. These bone cysts typically cause localized pain and swelling that beck’s anxiety inventory test pdf leads to limitation of physical activity. In time, this neoplasm can lead to pathologic fractures and biomechanical strain. A high index of suspicion for aneurysmal bone cyst is beck’s anxiety inventory test pdf warranted when patients present with chronic ankle pain.Surgical intervention is necessary before this benign tumor expands to beck’s anxiety inventory test pdf articular surfaces, which will limit the rearfoot complex. 1,2

Aneurysmal bone cyst of the lower extremity, particularly the talus, is not widely reported in the literature due to its beck’s anxiety inventory test pdf rare occurrence.


With this in mind, we present a case of a young female who was beck’s anxiety inventory test pdf diagnosed with an aneurysmal bone cyst occupying the majority of beck’s anxiety inventory test pdf the talus bone. We subsequently performed intralesional curettage and utilizing bone graft infused beck’s anxiety inventory test pdf with platelet-rich plasma to achieve excellent results and complete resolution of beck’s anxiety inventory test pdf symptoms.

A 21-year-old female was referred to our practice by another podiatric beck’s anxiety inventory test pdf physician in november 2017 with chronic foot and ankle pain beck’s anxiety inventory test pdf for four years. She stated the pain had significantly worsened over the last beck’s anxiety inventory test pdf six months, and pointed to the entire ankle and rearfoot as the beck’s anxiety inventory test pdf source of her pain. The patient had discomfort with palpation, manipulation and range of motion within the rearfoot complex. Prior to presenting to our practice,the patient already had multiple sets of X-rays and multiple mris. Her X-rays revealed a large osseous void encompassing the majority of beck’s anxiety inventory test pdf the talar head and neck, and half of the talar body. The MRI revealed a hemorrhagic cyst, which occupied the majority of the talus. The cyst alsoextended to the subchondral region anteriorly at the beck’s anxiety inventory test pdf articulation with the navicular and with the sustentaculum tali at beck’s anxiety inventory test pdf the medial subtalar joint (see figure 1).

She had been utilizing a CAM walker boot for stability beck’s anxiety inventory test pdf and symptom relief. The patient related anxiety associated with her condition along with beck’s anxiety inventory test pdf limitation of quality of life and activity leveldue to pain. We discussed conservative and surgical treatments with the patient, who chose to proceed with surgical intervention. The proposed surgical plan was for excision and curettage of beck’s anxiety inventory test pdf the bony cyst, and subsequent packing of the area with platelet-rich plasma (PRP)-infused bone graft. Pertinent steps to achieving ‘complete resolution of the aneurysmal bone cyst’

After ensuring general anesthesia and supine positioning for the patient, we performed an ankle arthrotomy to expose the dorsal talar beck’s anxiety inventory test pdf head and neck. The bone had a dark, abnormal color and was fragile. We created a window was in the talusdorsally at the beck’s anxiety inventory test pdf talar neck and found the bone was filled with mostly beck’s anxiety inventory test pdf sanguinous fluid (see figure 2). The entire head, neck and most of the body of the talus was beck’s anxiety inventory test pdf void of bony trabeculae. We suctioned the bloody fluid, curetted the bony cavity thoroughly and sent the sample to beck’s anxiety inventory test pdf pathology for evaluation.

The pathology report revealed that the lesion consisted of lamellar beck’s anxiety inventory test pdf bone as well as multiple cystic membranes with areas of beck’s anxiety inventory test pdf fibrosis and giant cells, findings that were consistent with an aneurysmal bone cyst (see figure 3). After completing the curettage, we obtained platelet-rich plasma from the patient, prepared and mixed it with corticocancellousbone graft. We subsequently packed the talar void with the bone graft/PRP mixture. After completing the procedure, we had the patient utilize a posterior splint non-weightbearing.

Computed tomography (CT) nine weeks after the procedure showed maintenance of the talar beck’s anxiety inventory test pdf dome contour along with bone graft incorporation (see figure 4). At this point, we allowed weightbearing in a protected boot. At seven months postoperatively, we gave the patient clearance to resume full activities and beck’s anxiety inventory test pdf exercise. Radiographs revealed excellent incorporation of the talar bone graft with beck’s anxiety inventory test pdf complete resolution of the aneurysmal bone cyst (see figure 5). At 14 months, the patient denies any limitations or pain.

Clinicians have described aneurysmal bone cysts as benign, osteolytic, locally expansive and aggressive lesions. However, their nature and histogenesis are still unclear. Some authors believe an aneurysmal bone cyst is due to beck’s anxiety inventory test pdf local vascular disturbances that consist of blood-filled channels that leads to increased pressure. 1,2 others propose that they could result from a traumatic beck’s anxiety inventory test pdf injury trigger but the mechanism is unknown. 3 oliveira and colleagues have proposed a chromosomal component for beck’s anxiety inventory test pdf the basis of aneurysmal bone cyst development as well. 4

Aneurysmal bone cyst favors the metaphysis of long bones and beck’s anxiety inventory test pdf can occur in patients of all ages. However, 75 to 90 percent of cases occur before patients reach beck’s anxiety inventory test pdf their third decade of life. 5 the majority of the tumors that appear in the beck’s anxiety inventory test pdf foot are in the metatarsals and calcaneus. Lesions such as aneurysmal bone cysts of the talus are beck’s anxiety inventory test pdf extremely rare. 6,7

Pain is the most common reason patients seek medical treatment beck’s anxiety inventory test pdf for these lesions. Many will have ankle swelling and pain arising from an beck’s anxiety inventory test pdf increase in intraosseous pressure. 8 podiatrists should suspect an aneurysmal bone cyst if they beck’s anxiety inventory test pdf see an expansive, lytic metaphyseal lesion with an “eggshell” sclerotic rim and a “soap bubble” appearance on plain radiographs. 2 while the cortex is usually intact, it may be thin. The osteolytic core may exhibit a honeycomb pattern. 9 A bone biopsy, which usually reveals osteolucent bonewith multiloculated giant cells and inflammatory beck’s anxiety inventory test pdf cells among red blood cells, is essential for diagnosing an aneurysmal bone cyst.

Regardless of the etiology, treatment of an aneurysmal bone cysts consists of debridement of beck’s anxiety inventory test pdf the lytic area with subsequent use of an adjunctive bone beck’s anxiety inventory test pdf graft. Bone grafting is recommended to provide mechanical support as well beck’s anxiety inventory test pdf as to eliminate the dead space and reduce aneurysmal bone beck’s anxiety inventory test pdf cyst recurrence. 10,11 what other case reports have revealed about treatment and beck’s anxiety inventory test pdf recurrence

Sharma and colleagues reported on an aneurysmal bone cyst located beck’s anxiety inventory test pdf at the talar head and neck, which they managed with intralesional curettageand bone graft. 6 they allowed the patient to bear weight at 12 beck’s anxiety inventory test pdf weeks and the authors report no evidence of recurrence at beck’s anxiety inventory test pdf the two year follow-up. 6 shazly and colleagues discussed the use of arthroscopic curettage beck’s anxiety inventory test pdf and bone grafting in two patients with aneurysmal bone cysts. 12 these patients returned to activity at 11 weeks and beck’s anxiety inventory test pdf no recurrence was evident at their one-year follow-up. 12

Vosoughi and colleagues present a case, which involved recurrence of an aneurysmal bone cyst eight months beck’s anxiety inventory test pdf after primary curettage and autologous bone grafting. 13 the patient had a second curettage, bone grafting and tibiotalocalcaneal arthrodesis. 13 the study authors noted an arthrodesis was necessary to beck’s anxiety inventory test pdf maintain the integrity of the lower extremity.

While our aforementioned patient’s intraosseous lesion occupied the majority of the talus bone beck’s anxiety inventory test pdf and extended to the articular surfaces, the lesion existed more anteriorly within the talus, sparing the tibiotalar and subtalar joints. Our patient responded very well to bone grafting and PRP beck’s anxiety inventory test pdf incorporation. She was able to resume activity without pain or limitations. The talonavicular joint does show early signs of degenerative arthritis beck’s anxiety inventory test pdf but the patient remains asymptomatic and did not require a beck’s anxiety inventory test pdf primary arthrodesis.

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