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KMID : 0613319990050010017
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Journal of the Korean Bone and Joint Tumor Soceity
1999 Volume.5 No. 1 p.17 ~ p.22
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Radiographic Classification and its Clinical Features for Metaphyseal Cortical Defect of the Distal Femur
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Park Il-Hyung
Oh Chang-Wug
Min Woo-Kie
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Abstract
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Over 60 cases were enlisted, but only 31 cases among 24 patients we eligible with a minimum follow-up of 1 year and complete medical documents with imaging data. There were 18 boys and 6 girls, and 7 patients had bilateral lesions. The age of the patients ranged from 2 to 20 years(mean:10.5 years). At their first visit, most lesions had a highly characteristic location and radiographic appearance of radiolucent lesion(s) ranging from 1 to 3cm, except for one case of 5.5 cm in the posteromedial corner of distal femoral metaphysis. The margins were generally well-defined, although some were ill-defined. After reviewing our cases from the viewpoint of clinical course and radiographic patterns, we divided these lesions into two types. Type Ⅰ is the osteolytic lesion excavated into the posteromedial aspect of the distal femur without cortical defect; and type Ⅱ is the buldged out lesion of the femur with cortical irregularity into the surrounding soft tissues. Both types have distinctive clinical courses. Type Ⅰ lesions were easy to make a definite diagnosis with plain radiographs alone, but in type Ⅱ, it was sometimes very difficult to differentiate it from malignant tumors or chronic localized osteomyelitis. For this lesion, Gd-enhanced MRI was the most effective method for differential diagnosis. In this study, biopsy was not necessary to confirm the diagnosis. Clinical symptoms of type Ⅰ were very minor or even absent. Many of them were accidentally found after minor trauma around the knee joint. Clinical symptoms disappeared far earlier than radiographical lesions. No treatment such as restriction of activity or drugs was necessary. For type Ⅱ, the clinical symptoms were more accentuated and lasted longer, and it was necessary to restrict the activity for a certain period in many cases. However, all were self-limited.
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KEYWORD
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Femur, Metaphyseal cortical defects
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