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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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References

  1. Ahn JI, Park JS. Pathological fractures secondary to unicameral bone cysts. Int Orthop. 1994;18:20–22.

    Article  PubMed  CAS  Google Scholar 

  2. Altman DG. Practical Statistics for Medical Research. London, UK: Chapman and Hall; 1991:371–384.

  3. Bumci I, Vlahovic T. Significance of opening the medullar canal in surgical treatment of simple bone cyst. J Pediatr Orthop. 2002;22:125–129.

    Article  PubMed  Google Scholar 

  4. Campanacci M, Capanna R, Picci P. Unicameral and aneurysmal bone cysts. Clin Orthop Relat Res. 1986;204:25–36.

    PubMed  Google Scholar 

  5. Chang C, Stanton RP, Glutting J. Unicameral bone cysts treated by injection of bone marrow or methylprednisolone. J Bone Joint Surg Br. 2002;84:407–412.

    Article  PubMed  CAS  Google Scholar 

  6. Chigira M, Maehara S, Arita S, Udagawa E. The aetiology and treatment of simple bone cysts. J Bone Joint Surg Br. 1983;65:633–637.

    PubMed  CAS  Google Scholar 

  7. Chigira M, Shimizu T, Arita S, Watanabe H, Heshiki A. Radiological evidence of healing of a simple bone cyst after hole drilling. Arch Orthop Trauma Surg. 1986;105:150–153.

    Article  PubMed  CAS  Google Scholar 

  8. Cohen J. Simple bone cysts: studies of cyst fluid in six cases with a theory of pathogenesis. J Bone Joint Surg Am. 1960;42:609–616.

    PubMed  Google Scholar 

  9. Cohen J. Intramedullary nailing for the treatment of unicameral bone cysts. J Bone Joint Surg Am. 2001;83:1279–1280.

    PubMed  Google Scholar 

  10. de Palma L, Santucci A. Treatment of bone cysts with methylprednisolone acetate: a 9 to 11 year follow-up. Int Orthop. 1987;11:23–28.

    Article  PubMed  Google Scholar 

  11. de Sanctis N, Andreacchio A. 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. 2006;26:520–525.

    PubMed  Google Scholar 

  12. Fahey JJ, O’Brien ET. Subtotal resection and grafting in selected cases of solitary unicameral bone cyst. J Bone Joint Surg Am. 1973;55:59–68.

    PubMed  CAS  Google Scholar 

  13. Farber JM, Stanton RP. Treatment options in unicameral bone cysts. Orthopedics. 1990;13:25–32.

    PubMed  CAS  Google Scholar 

  14. Garceau GJ, Gregory CF. Solitary unicameral bone cyst. J Bone Joint Surg Am. 1954;36:267–280.

    PubMed  CAS  Google Scholar 

  15. Gebhart M, Blaimont P. Contribution to the vascular origin of the unicameral bone cyst. Acta Orthop Belg. 1996;62:137–143.

    PubMed  CAS  Google Scholar 

  16. Harris EK, Albert A. Survivorship Analysis for Clinical Studies. New York, NY: Marcel Dekker; 1991:29–49.

  17. Hosmer DW, Lemeshow S. Applied Logistic Regression. 2nd ed. New York, NY: John Wiley and Sons; 2000:11–64.

  18. Jaffe HL, Lichtenstein L. Solitary unicameral bone cyst: with emphasis on the roentgen picture, the pathologic appearance and the diagnosis. Arch Surg. 1942;4:1004–1025.

    Google Scholar 

  19. Kanellopoulos AD, Yiannakopoulos CK, Soucacos PN. Percutaneous reaming of simple bone cysts in children followed by injection of demineralized bone matrix and autologous bone marrow. J Pediatr Orthop. 2005;25:671–675.

    Article  PubMed  Google Scholar 

  20. Katz MH. Multivariable Analysis: A Practical Guide for Clinicians. 2nd ed. New York, NY: Cambridge University Press; 2006:96–136.

  21. Killian JT, Wilkinson L, White S, Brassard M. Treatment of unicameral bone cyst with demineralized bone matrix. J Pediatr Orthop. 1998;18:621–624.

    Article  PubMed  CAS  Google Scholar 

  22. Komiya S, Minamitani K, Sasaguri Y, Hashimoto S, Morimatsu M, Inoue A. Simple bone cyst: treatment by trepanation and studies on bone resorptive factors in cyst fluid with a theory of its pathogenesis. Clin Orthop Relat Res. 1993;287:204–211.

    PubMed  Google Scholar 

  23. Lokiec F, Ezra E, Khermosh O, Wientroub S. Simple bone cysts treated by percutaneous autologous marrow grafting: a preliminary report. J Bone Joint Surg Br. 1996;78:934–937.

    Article  PubMed  CAS  Google Scholar 

  24. Mackley JT, Joyce MJ. Unicameral bone cyst (simple bone cyst). Orthop Clin North Am. 1989;20(3):407–415.

    Google Scholar 

  25. McKay DW, Nason SS. Treatment of unicameral bone cysts by subtotal resection without grafts. J Bone Joint Surg Am. 1977;59:515–519.

    PubMed  CAS  Google Scholar 

  26. Mirra JM, Bernard GW, Bullough PG, Johnston W, Mink G. Cementum-like bone production in solitary bone cysts (so-called “cementoma” of long bones): report of three cases. Electron microscopic observations supporting a synovial origin to the simple bone cyst. Clin Orthop Relat Res. 1978;135:295–307.

    Google Scholar 

  27. Neer CS, Francis KC, Johnston AD, Kiernan HA Jr. Current concepts on the treatment of solitary unicameral bone cyst. Clin Orthop Relat Res. 1973;97:40–51.

    Article  PubMed  Google Scholar 

  28. Neer CS 2nd, Francis KC, Marcove RC, Terz J, Carbonara PN. Treatment of unicameral bone cyst: a follow-up study of one hundred seventy-five cases. J Bone Joint Surg Am. 1966;48:731–745.

    Google Scholar 

  29. Oppenheim WL, Galleno H. Operative treatment versus steroid injection in the management of unicameral bone cysts. J Pediatr Orthop. 1984;4:1–7.

    PubMed  CAS  Google Scholar 

  30. Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49:1373–1379.

    Article  PubMed  CAS  Google Scholar 

  31. Roposch A, Saraph V, Linhart WE. Flexible intramedullary nailing for the treatment of unicameral bone cysts in long bones. J Bone Joint Surg Am. 2000;82:1447–1453.

    PubMed  Google Scholar 

  32. Rougraff BT, Kling TJ. Treatment of active unicameral bone cysts with percutaneous injection of demineralized bone matrix and autogenous bone marrow. J Bone Joint Surg Am. 2002;84:921–929.

    PubMed  Google Scholar 

  33. Santori F, Ghera S, Castelli V. Treatment of solitary bone cysts with intramedullary nailing. Orthopedics. 1988;11:873–878.

    PubMed  CAS  Google Scholar 

  34. Scaglietti O, Marchetti PG, Bartolozzi P. Final results obtained in the treatment of bone cysts with methylprednisolone acetate (depo-medrol) and a discussion of results achieved in other bone lesions. Clin Orthop Relat Res. 1982;165:33–42.

    PubMed  Google Scholar 

  35. Shindell R, Huurman WW, Lippiello L, Connolly JF. Prostaglandin levels in unicameral bone cysts treated by intralesional steroid injection. J Pediatr Orthop. 1989;9:516–519.

    PubMed  CAS  Google Scholar 

  36. Shinozaki T, Arita S, Watanabe H, Chigira M. Simple bone cysts treated by multiple drill-holes: 23 cysts followed 2–10 years. Acta Orthop Scand. 1996;67:288–290.

    Article  PubMed  CAS  Google Scholar 

  37. Snyder BD, Hauser-Kara DA, Hipp JA, Zurakowski D, Hecht AC, Gebhardt MC. Predicting fracture through benign skeletal lesions with quantitative computed tomography. J Bone Joint Surg Am. 2006;88:55–70.

    Article  PubMed  Google Scholar 

  38. Spence KF, Sell KW, Brown RH. Solitary bone cyst: treatment with freeze-dried cancellous bone allograft: a study of one hundred seventy-seven cases. J Bone Joint Surg Am. 1969;51:87–96.

    PubMed  CAS  Google Scholar 

  39. Spence KF Jr, Bright RW, Fitzgerald SP, Sell KW. Solitary unicameral bone cysts: treatment with freeze-dried crushed cortical-bone allograft: a review of one hundred and forty-four cases. J Bone Joint Surg Am. 1976;58:636–641.

    PubMed  Google Scholar 

  40. Virchow R. Uber die Bildung von Knochencysten. Monatsberichte der Koniglich Preussischen Akademie der Wissenschafen. 1876;Suppl:369–381.

  41. Wilkins RM. Unicameral bone cysts. J Am Acad Orthop Surg. 2000;8:217–224.

    PubMed  CAS  Google Scholar 

  42. Yandow SM, Lundeen GA, Scott SM, Coffin C. Autogenic bone marrow injections as a treatment for simple bone cyst. J Pediatr Orthop. 1998;18:616–620.

    Article  PubMed  CAS  Google Scholar 

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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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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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