Treatment of Langerhans Cell Histiocytosis with bony involvement

Introduction: Patients with Langerhans Cell Histiocytosis (LCH or Eosinophi lic granuloma) were assessed from the orthopaedic point of view to give rec ommendations for the management of the disease. Material and Methods: The r esults of 36 cases of histologically proven bony manifestations out of 48 t reated cases were reviewed. A retrospective analysis of our treated cases w ith bony manifestations of LCH between 1970 and 1995 was performed. Results : Twenty-two cases exhibited isolated bony manifestations, 18 were monoosto tic and 4 were polyostotic. We treated 14 cases with multi-organ disease in cluding bony manifestations of LCH. In the cases of exclusive bony manifest ations reactivations were rare and usually occurred in other bones. Conclus ions: In order to assure stability local control is the general goal of ort hopaedic treatment. In isolated lesions control can be achieved by excochle ation and filling with cancellous bone or prednisolon instillation. Multipl e lesions should be treated primarily by systemic drugs and operative proce dures are only necessary if severe local problems occur. Additionally, we r ecommend interdisciplinary cooperation between ortopedic surgeon, pediatris t and pathologist.