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Percutaneous injection of calcium phosphate composite in pediatric unicameral bone cysts: a minimum 5-year follow-up study

  • Marco Turati
  • Marco BigoniEmail author
  • Lilia Brahim
  • Emeline Bourgeois
  • Giovanni Zatti
  • Ahmad Eid
  • Jacques Griffet
  • Aurélien Courvoisier
Original Article
  • 5 Downloads

Abstract

Background

Unicameral bone cyst (UBC) is a common lesion in skeletally immature patients. Multiple treatments are proposed as curettage and autologous bone graft, percutaneous local corticoids injections, decompression with internal fixation, and injection of bioresorbable cement. Decompression, curettage, and percutaneous bioresorbable cement injection showed interesting results, but until now, no long-term follow-up was reported in pediatric patients with UBC.

Methods

We retrospectively evaluated 13 pediatric patients with UBC treated with curettage, decompression, and injection of a calcium phosphate composite (CPC) at a single institution with an average F-U of 5.46 years (range 5–7 years). Functional outcomes were evaluated according to the Musculoskeletal Tumour Society (MSTS) Score. Radiographic healing was assessed with the modified Neer Outcome Rating System. Complications were recorded.

Results

The mean MSTS score was 29.61 (range 28–30). No joint limitation or any pain was recorded. All patients returned to their previous level of activity. Complete healed cysts were observed in 76.9% of patients (10 of 13) and partially healed in 23.1% (3 of 13). Three fractures of the humerus occurred without any further consequence. In two cases, CPC overflow in the surrounding soft tissues was reported on post-operative X-rays, but at last follow-up, no CPC remained in the soft tissues.

Conclusion

Our observations suggest that the use of curettage, decompression, and injection of CPC results in a high rate of good clinical outcomes with low recurrence rates and complications in the pediatric population with UBC at a long-term follow-up.

Keywords

Unicameral bone cyst Calcium phosphate cement Bone substitute Pediatrics Percutaneous injection 

Notes

Funding

None.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standard.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Wilkins RM (2000) Unicameral bone cysts. J Am Acad Orthop Surg 8(4):217–224CrossRefGoogle Scholar
  2. 2.
    Gentile J, Weinert C, Schlechter J (2013) Treatment of unicameral bone cysts in pediatric patients with an injectable regenerative graft: a preliminary report. J Pediatr Orthop 33(3):254–261CrossRefGoogle Scholar
  3. 3.
    Pretell-Mazzini J, Murphy RF, Kushare I, Dormans JP (2014) Unicameral bone cysts: general characteristics and management controversies. J Am Acad Orthop Surg 22(5):295–303.  https://doi.org/10.5435/JAAOS-22-05-295 CrossRefPubMedGoogle Scholar
  4. 4.
    Bigoni M, Turati M, Gandolla M, Augusti CA, Pedrocchi A, La Torre A, Piatti M, Gaddi D (2017) Balance in young male soccer players: dominant versus non-dominant leg. Sport Sci Health 13(2):253–258CrossRefGoogle Scholar
  5. 5.
    Bigoni M, Zanchi N, Turati M (2017) Healing potential and surgical treatment of anterior cruciate ligament rupture in pediatric population. Sport Sci Health 13:1–2.  https://doi.org/10.1007/s11332-017-0375-4 CrossRefGoogle Scholar
  6. 6.
    Turati M, Afonso D, Salazard B, Maillet Declerck M, Bigoni M, Glard Y (2015) Bilateral osteochondrosis of the distal tibial epiphysis: a case report. J Pediatr Orthop Part B 24(2):154–158CrossRefGoogle Scholar
  7. 7.
    Spence KF, Sell KW, Brown RH (1969) Solitary bone cyst: treatment with freeze-dried cancellous bone allograft. A study of one hundred seventy-seven cases. J Bone Jt Surg 51(1):87–96CrossRefGoogle Scholar
  8. 8.
    Neer CS, Francis KC, Marcove RC, Terz J, Carbonara PN (1966) Treatment of unicameral bone cyst. A follow-up study of one hundred seventy-five cases. J Bone Jt Sur 48(4):731–745CrossRefGoogle Scholar
  9. 9.
    Scaglietti O, Marchetti PG, Bartolozzi P (1979) The effects of methylprednisolone acetate in the treatment of bone cysts. Results of three years follow-up. J Bone Jt Surg Br Vol 61-B(2):200–204CrossRefGoogle Scholar
  10. 10.
    Hagmann S, Eichhorn F, Moradi B, Gotterbarm T, Dreher T, Lehner B, Zeifang F (2011) Mid- and long-term clinical results of surgical therapy in unicameral bone cysts. BMC Musculoskelet Disord 12:281.  https://doi.org/10.1186/1471-2474-12-281 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Yildirim C, Mahirogullari M, Kuskucu M, Akmaz I, Keklikci K (2010) Treatment of a unicameral bone cyst of calcaneus with endoscopic curettage and percutaneous filling with corticocancellous allograft. J Foot Ankle Surg 49(1):93–97.  https://doi.org/10.1053/j.jfas.2009.08.005 CrossRefPubMedGoogle Scholar
  12. 12.
    Cho HS, Oh JH, Kim HS, Kang HG, Lee SH (2007) Unicameral bone cysts: a comparison of injection of steroid and grafting with autologous bone marrow. J Bone Jt Surg Br 89(2):222–226.  https://doi.org/10.1302/0301-620X.89B2.18116 CrossRefGoogle Scholar
  13. 13.
    Wright J, Yandow S, Donaldson S, Marley L (2008) A randomized clinical trial comparing intralesional bone marrow and steroid injections for simple bone cysts. J Bone Jt Surg 90(4):722–730CrossRefGoogle Scholar
  14. 14.
    Canavese F, Wright JG, Cole WG, Hopyan S (2011) Unicameral bone cysts: comparison of percutaneous curettage, steroid, and autologous bone marrow injections. J Pediatr Orthop 31(1):50–55.  https://doi.org/10.1097/BPO.0b013e3181ff7510 CrossRefPubMedGoogle Scholar
  15. 15.
    de Sanctis N, Andreacchio A (2006) Elastic stable intramedullary nailing is the best treatment of unicameral bone cysts of the long bones in children?: prospective long-term follow-up study. J Pediatr Orthop 26(4):520–525CrossRefGoogle Scholar
  16. 16.
    Roposch A, Saraph V, Linhart WE (2000) Flexible intramedullary nailing for the treatment of unicameral bone cysts in long bones. J Bone Jt Surg 82-A(10):1447–1453CrossRefGoogle Scholar
  17. 17.
    Van Lieshout EM, Van Kralingen GH, El-Massoudi Y, Weinans H, Patka P (2011) Microstructure and biomechanical characteristics of bone substitutes for trauma and orthopaedic surgery. BMC Musculoskelet Disord 12:34.  https://doi.org/10.1186/1471-2474-12-34 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Maestretti G, Cremer C, Otten P, Jakob R (2007) Prospective study of standalone balloon kyphoplasty with calcium phosphate cement augmentation in traumatic fractures. Eur Spine J 16(5):601–610CrossRefGoogle Scholar
  19. 19.
    Grafe I, Baier M, Nöldge G, Weiss C, Da Fonseca K, Hillmeier J, Libicher M, Rudofsky G, Metzner C, Nawroth P, Meeder P-J, Kasperk C (2008) Calcium-phosphate and polymethylmethacrylate cement in long-term outcome after kyphoplasty of painful osteoporotic vertebral fractures. Spine (Phila 1976) 33(11):1284–1290CrossRefGoogle Scholar
  20. 20.
    Fillingham YA, Lenart BA, Gitelis S (2012) Function after injection of benign bone lesions with a bioceramic. Clin Orthop Relat Res 470(7):2014–2020.  https://doi.org/10.1007/s11999-012-2251-5 CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Hou HY, Wu K, Wang CT, Chang SM, Lin WH, Yang RS (2011) Treatment of unicameral bone cyst: surgical technique. J Bone Jt Surg Am 93(Suppl 1):92–99.  https://doi.org/10.2106/JBJS.J.01123 CrossRefGoogle Scholar
  22. 22.
    Thawrani D, Thai CC, Welch RD, Copley L, Johnston CE (2009) Successful treatment of unicameral bone cyst by single percutaneous injection of alpha-BSM. J Pediatr Orthop 29(5):511–517.  https://doi.org/10.1097/BPO.0b013e3181aad704 CrossRefPubMedGoogle Scholar
  23. 23.
    Thawrani D, Thai C, Welch R, Copley L, Johnston C (2009) Successful treatment of unicameral bone cyst by single percutaneous injection of alpha-BSM. J Pediatr Orthop 29(5):511–517CrossRefGoogle Scholar
  24. 24.
    Jaffe HL, Lichtenstein L (1942) Solitary unicameral bone cyst: with emphasis on the roentgen picture, the pathologic appearance and the pathogenesis. Arch Surg 44(6):1004–1025CrossRefGoogle Scholar
  25. 25.
    Traub F, Eberhardt O, Fernandez F, Wirth T (2016) Solitary bone cyst: a comparison of treatment options with special reference to their long-term outcome. BMC Musculoskelet Disord 17:162–162CrossRefGoogle Scholar
  26. 26.
    Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ (1993) A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res (286):241–246Google Scholar
  27. 27.
    Garceau GJ, Gregory CF (1954) Solitary unicameral bone cyst. J Bone Jt Surg Am 36(A:2):267–280CrossRefGoogle Scholar
  28. 28.
    Campanacci M, Capanna R, Picci P (1986) Unicameral and aneurysmal bone cysts. Clin Orthop Relat Res (204):25–36Google Scholar
  29. 29.
    Dormans JP, Sankar WN, Moroz L, Erol B (2005) Percutaneous intramedullary decompression, curettage, and grafting with medical-grade calcium sulfate pellets for unicameral bone cysts in children: a new minimally invasive technique. J Pediatr Orthop 25(6):804–811 (pii:00004694-200511000-00019) CrossRefGoogle Scholar
  30. 30.
    Ollivier M, Turati M, Munier M, Lunebourg A, Argenson JN, Parratte S (2016) Balloon tibioplasty for reduction of depressed tibial plateau fractures: preliminary radiographic and clinical results. Int Orthop 40(9):1961–1966.  https://doi.org/10.1007/s00264-015-3047-5 CrossRefPubMedGoogle Scholar
  31. 31.
    Ooms EM, Wolke JG, van de Heuvel MT, Jeschke B, Jansen JA (2003) Histological evaluation of the bone response to calcium phosphate cement implanted in cortical bone. Biomaterials 24(6):989–1000 (pii:S0142961202004386) CrossRefGoogle Scholar
  32. 32.
    Ooms EM, Wolke JG, van der Waerden JP, Jansen JA (2002) Trabecular bone response to injectable calcium phosphate (Ca-P) cement. J Biomed Mater Res 61(1):9–18.  https://doi.org/10.1002/jbm.10029 CrossRefPubMedGoogle Scholar
  33. 33.
    Ooms EM, Egglezos EA, Wolke JG, Jansen JA (2003) Soft-tissue response to injectable calcium phosphate cements. Biomaterials 24(5):749–757 (pii:S0142961202004088) CrossRefGoogle Scholar
  34. 34.
    Libicher M, Vetter M, Wolf I, Noeldge G, Kasperk C, Grafe I, Da Fonseca K, Hillmeier J, Meeder PJ, Meinzer HP, Kauffmann GW (2005) CT volumetry of intravertebral cement after kyphoplasty. Comparison of polymethylmethacrylate and calcium phosphate in a 12-month follow-up. Eur Radiol 15(8):1544–1549.  https://doi.org/10.1007/s00330-005-2709-x CrossRefPubMedGoogle Scholar
  35. 35.
    Bigoni M, Turati M, Zatti G, Gandolla M, Sacerdote P, Piatti M, Castelnuovo A, Rigamonti L, Munegato D, Franchi S, Portinaro N, Pedrocchi A, Omeljaniuk RJ, Locatelli V, Torsello A (2018) Intra-articular cytokine levels in adolescent patients after anterior cruciate ligament tear. Mediat Inflamm 2018:4210593.  https://doi.org/10.1155/2018/4210593 CrossRefGoogle Scholar
  36. 36.
    Turati M, Glard Y, Afonso D, Griffet J, Bigoni M (2016) Osteochondral alteration in a child treated with levetiracetam: a rare case of juvenile osteochondritis dissecans of the talar head. J Pediatr Orthop Part B 26:189–192CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Paediatric Orthopedic SurgeryUniversity Hospital Grenoble-Alpes, University Grenoble-AlpesGrenobleFrance
  2. 2.Orthopedic Department, San Gerardo HospitalUniversity of Milano-BicoccaMonzaItaly
  3. 3.Department of Medicine and SurgeryUniversity of Milano-BicoccaMonzaItaly

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