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Unicameral Bone Cyst: A Retrospective Study of Three Surgical Treatments

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Clinical Orthopaedics and Related Research

Abstract

Between 1979 and 2004, 167 patients younger than 20 years were treated surgically for humeral or femoral unicameral bone cysts with either injection of corticosteroids (steroids), curettage plus bone grafting (curettage), or a combination injection of steroids, demineralized bone matrix, and bone marrow aspirate (SDB) at Children’s Hospital of Boston and Massachusetts General Hospital (mean followup, 7.3 years; range, 1 month–27 years). Outcomes included treatment failure (defined clinically as subsequent pathologic fracture or need for retreatment to prevent pathologic fracture) and complications. Information was obtained from medical records and by telephone questionnaire. After one treatment, 84% of cysts treated with steroids experienced failed treatment versus 64% with curettage and 50% with SDB. For unicameral bone cysts requiring retreatment (regardless of first treatment), 76% retreated with steroids had failed treatment versus 63% with curettage and 71% with SDB. Curettage was associated with the lowest rate of posttreatment pathologic fractures and highest rate of pain and other complications. Multivariate logistic regression indicated treatment with steroids alone and younger age were independent predictors of failure. We believe SDB is a reasonable first treatment for unicameral bone cysts in the humerus and femur in patients younger than 20 years, being less invasive yet comparable to curettage in preventing recurrence.

Level of Evidence: Level IV, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Kevin A. Raskin, MD, and Henry J. Mankin, MD, for valuable help and assistance.

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Authors and Affiliations

  1. Harvard Medial School, Boston, MA, USA

    Anthony D. Sung BS

  2. 330 Brookline Ave, Boston, MA, 02215, USA

    Megan E. Anderson MD

  3. Children’s Hospital Boston, Boston, MA, USA

    Megan E. Anderson MD, David Zurakowski PhD & Mark C. Gebhardt MD

  4. Beth Israel Deaconess Medical Center, Boston, MA, USA

    Megan E. Anderson MD & Mark C. Gebhardt MD

  5. Massachusetts General Hospital, Boston, MA, USA

    Francis J. Hornicek MD, PhD

Authors
  1. Anthony D. Sung BS
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  2. Megan E. Anderson MD
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  3. David Zurakowski PhD
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  4. Francis J. Hornicek MD, PhD
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  5. Mark C. Gebhardt MD
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Corresponding author

Correspondence to Megan E. Anderson MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

One of the authors (ADS) has received funding from the Pasteur Summer Research Program and the Harvard Medical School Office of Enrichment Programs for support of this study.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Sung, A.D., Anderson, M.E., Zurakowski, D. et al. Unicameral Bone Cyst: A Retrospective Study of Three Surgical Treatments. Clin Orthop Relat Res 466, 2519–2526 (2008). https://doi.org/10.1007/s11999-008-0407-0

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  • DOI: https://doi.org/10.1007/s11999-008-0407-0

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