الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Cryotherapy is used as a local physical adjuvant to the intralesional excision of the active, aggressive benign and low-grade malignant bone tumors. The goal of this additional treatment to curettage and burr drilling is to reduce the recurrence rate by freezing of the remaining tumor cells at the margin of the lesion22.
Marcove2, the pioneer of the cryosurgery of bone tumors was the first to use it in the treatment of metastatic carcinoma of the humerus in 1969. Then he described the ”direct pour ” method which included a large incision, curettage of the tumor cavity and pouring of the liquid nitrogen into the cavity several times to freeze it below -20oc. This method had been advocated to be a physical adjuvant in aim to decrease the incidence of the local recurrence and decrease the need for extensive resection and reconstruction of the bone.
However, Marcove revealed a high complication rate (51%) that included fractures, infections, skin necrosis, neurapraxia3.
The aim of this review is to evaluate the incidence of complications following the cryosurgery and to trace the leading causes of them and how can be managed to achieve the benefits of cryosurgery of bone tumors.
Ten studies (from 1968 to 2017) had been identified for analysis. 328 patients had been treated by the same technique ”direct pour ” or the open method which was described by Marcove2.
The analysis discussed the incidence of the possible complications that may result from the cryosurgical technique which included the local recurrence, fractures, infections, skin necrosis, transient neurapraxia, physeal damage and joint destruction.
The analysis showed a local recurrence was related to inadequate curettage, insufficient numbers of freezing thawing cycles30, no control of time of freezing and the liquid nitrogen itself is gravity dependent and cannot reach all corners of the cavity.
Fracture27 was explained by lack of the internal fixation or no use of the cementation and bone grafting. Infection32 happened due to lack of irrigation and retained necrotic bony fragments. Skin necrosis and neurapraxia due to direct contact with liquid nitrogen15. Joint destruction was due to direct extension of the lesions or due to damage by the liquid nitrogen. Physeal damage was reported in younger patients and it was controversial23, 33, whether the direct invasion of the lesions is responsible or damaged during the cryosurgery.
However the refinement of the technique and considering the crucial steps in the cryosurgery and provide good results21. Exposure of the tumor cavity must be parallel to the longitudinal axis of the limb to decrease the stress riser effect, adequate curettage and burr drilling, filling the cavity entirely for 2- 3 cycles, retraction and protection of the surrounding soft tissues, monitoring of the temperature within the cavity and surrounding environment and the continuous irrigation with warm saline2. Meticulous application of these steps can provide the lowest incidence rate of the complications19.