This single-center retrospective case series evaluated long-term outcomes after surgical treatment of proximal humeral chondroblastoma in pediatric patients. Data were collected from diagnostic and pathology records at West China Hospital for cases treated between January 1, 2008 and January 1, 2018. After exclusion of one patient lost to follow-up, 17 pathologically confirmed patients with a minimum follow-up of seven years (mean 8.9 ± 1.6 years) were included. The study was approved by the institutional ethics committee and informed consent was obtained.
The primary aim was to assess 7-year outcomes following intralesional curettage, cavity electrocauterization and bone grafting, with a focus on tumor recurrence, upper limb shortening, functional performance and postoperative complications.
All 17 patients underwent open intralesional curettage of the lesion performed by two experienced pediatric orthopedic surgeons. After gross tumor removal with curettes, a high-speed burr was used to extend and clean the cavity. Intraoperative fluoroscopy and endoscopy confirmed adequate curettage. The cavity was then electrocauterized using an electrotome in spray coagulation mode at 80 W, with endoscopic confirmation of ablation of the cavity surface. Bone grafting was performed according to defect size: 15 patients received autogenous iliac crest grafts and 2 patients received a combination of autogenous iliac graft and artificial bone material.
Postoperatively, the operated extremity was immobilized in a well-padded splint for at least four weeks with no weight bearing. Follow-up visits were scheduled every two weeks for the first two months, every two months in the first year, every six months in the second year, and then every two years.
Clinical outcomes included assessment of tumor recurrence by clinical signs and X-ray, surveillance for lung metastasis by chest radiograph, measurement of upper limb length (acromion to lateral humeral epicondyle), and functional assessment with the Musculoskeletal Tumor Society (MSTS) score and the Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH) scale. Two independent pediatric orthopedic surgeons performed clinical measurements in a blinded fashion; MSTS and Quick DASH evaluations at the 7-year follow-up were conducted independently by a pediatric rehabilitation therapist and a pediatric orthopedic surgeon. Upper limb shortening was defined as ≥1 cm discrepancy compared with the contralateral side; radiographic contralateral measurements were not acquired to avoid additional radiation exposure.
Statistical analysis used SPSS 20. Continuous variables are presented as mean ± SD; comparisons used independent-samples or paired-samples t tests where appropriate, and Fisher’s exact test for categorical data. Statistical significance was set at P < 0.05.
The cohort comprised 17 patients (10 males, 7 females) with a mean age of 10.9 ± 1.8 years (range 8–14). Presenting features included pain in all 17 patients, local swelling in 3 patients and limited adjacent joint motion in 6 patients. Mean symptom duration prior to treatment was 6.7 ± 2.8 months (range 2–12). Twelve patients had a preoperative working diagnosis of chondroblastoma based on clinical and imaging features; five were not diagnosed preoperatively. All patients underwent biopsy before definitive surgery.
Postoperative complications included one surgical wound infection that required antibiotics and subcutaneous drainage. No cases of lung metastasis were observed during follow-up.
One patient (1/17, 5.9%; 95% CI reported in the source: 0.1%–28.7%) developed local recurrence nine months after the initial procedure (curettage, electrocauterization and autogenous iliac bone graft) and underwent reoperation with extended curettage. No other recurrences or distant metastases were reported in the cohort during the follow-up period.
Upper limb shortening (≥1 cm) occurred in 9 of 17 patients (52.9%). The mean measured length of the affected limb was 28.7 ± 1.6 cm, with a mean shortening of 1.2 ± 0.9 cm compared with the contralateral limb. Statistical analysis identified a significant association between limb shortening and younger age: mean age in the shortening group was 9.9 ± 1.5 years versus 12.0 ± 1.5 years in the non-shortening group (P = 0.012). No additional interventions were performed for shortening because no obvious functional impairment was reported.
The source reports that 6 cases had lesions extending through the epiphyseal plate and 11 cases had lesions confined to the epiphysis; the relationship of physis involvement to shortening was analyzed in the study but specific statistical details beyond those summarized above were not restated in the abstract and results excerpts provided here.
At final follow-up the overall mean postoperative MSTS score was 27.5 ± 1.4 points. Comparison between the shortening group (27.3 ± 1.4) and the non-shortening group (27.8 ± 1.4) showed no statistically significant difference (P = 0.550).
The overall mean Quick DASH score was 4.8 ± 3.9 (range 0–15.9). There was no statistically significant difference in Quick DASH between the shortening group (5.3 ± 4.5) and the non-shortening group (4.3 ± 2.8; P = 0.452). These results indicate overall good functional outcomes despite frequent occurrence of measurable limb shortening.
The authors conclude that intralesional curettage with cavity electrocauterization and bone grafting is a viable treatment option for pediatric proximal humeral chondroblastoma, providing good long-term functional outcomes. However, this approach does not eliminate the risk of local recurrence. Upper limb shortening was a common complication in this cohort and was associated with younger patient age, but it did not appear to impair final functional scores.
Limitations inherent to the presented data include the retrospective single-center design, a small sample size of 17 patients, and the absence of contralateral radiographic measurements to quantify limb-length discrepancy due to radiation avoidance. Additional details beyond those reported in the source (for example long-term cosmetic concerns, growth modulation management, or comparative efficacy with other adjuvant modalities) were not provided in the article excerpts available.
Overall, the study provides medium-term to long-term clinical and functional data supporting that curettage plus electrocautery and bone grafting yields favorable functional results for proximal humeral chondroblastoma in children, while highlighting a measurable risk of limb shortening and the ongoing but low rate of local recurrence.