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Pathological fracture of a solitary bone cyst in the calcaneus: a case series and literature review

  • Orthopaedic Surgery
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Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Solitary bone cysts in the calcaneus (calcaneal bone cysts) are often asymptomatic. Pathological fractures are rare, and few reports are available concerning its risk assessment. Therefore, the indication for operative interventions remains debatable, and further discussion on the treatment of symptomatic cysts and pathological fractures in calcaneal bone cysts is necessary.

Materials and methods

Clinical data of 21 patients with calcaneal bone cysts (16 men and five women) was retrospectively reviewed. The average age was 13.3 (range, 7–23) years. Clinical data, such as concerning symptoms, radiological findings, pathological findings and outcomes, were investigated, and the pathogenesis of symptomatic cysts was studied.

Results

Thirteen cysts were symptomatic, and eight were incidentally discovered. Computed tomography revealed no fracture in 12 cases, microfracture in eight and complete fracture in one. The areas under the curves of the receiver operating characteristic curves calculated to establish an association between cyst size and symptoms and cyst size and pathological fractures (microfracture and complete fracture) were 0.78 and 0.71, respectively. Symptomatic cysts and pathological fractures were associated with the cyst ratio (cyst size/calcaneus ≥ 0.20). On magnetic resonance imaging (MRI), fluid levels were observed in 11 of 21 (52%) patients. At the time of surgery, blood from the haemorrhage was aspirated from 15 of 21 (71%) cysts.

Conclusions

Orthopaedic surgeons should be aware that the cyst ratio is associated with clinical symptoms and pathological fractures. MRI and gross findings revealed haemorrhage in the cystic fluid. In calcaneal bone cysts, repeated microfractures and spontaneous healing might occur.

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No funding was received for conducting this study.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-ku, Osaka, 545-8585, Japan

    Manabu Hoshi, Tadashi Iwai, Naoto Oebisu, Akiyoshi Shimatani, Naoki Takada & Hiroaki Nakamura

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  1. Manabu Hoshi
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  2. Tadashi Iwai
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  3. Naoto Oebisu
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  4. Akiyoshi Shimatani
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  5. Naoki Takada
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  6. Hiroaki Nakamura
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Contributions

Conceptualisation: MH; methodology: TI; formal analysis and investigation: NO, NT; writing—original draft preparation: MH; writing—review and editing: AS and supervision: HN.

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Correspondence to Manabu Hoshi.

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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 standards.

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Hoshi, M., Iwai, T., Oebisu, N. et al. Pathological fracture of a solitary bone cyst in the calcaneus: a case series and literature review. Arch Orthop Trauma Surg 143, 1155–1162 (2023). https://doi.org/10.1007/s00402-021-04202-6

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