J Korean Orthop Assoc.  2009 Aug;44(4):455-460.

Intramedullary Decompression for the Treatment of Unicameral Bone Cysts in Children

Affiliations
  • 1Department of Orthopaedic Surgery, Ewha Womans University School of Medicine, Seoul, Korea. yhyun@ewha.ac.kr

Abstract

PURPOSE
The present study aims at evaluating our results of intramedullary decompression of the unicameral bone cysts in children with using flexible nail(s) or titanium cannulated screws. MATERIALS AND METHODS: We treated fourteen children with unicameral bone cysts by intramedullary decompression. Eleven cases were in the metaphysis of long bones (seven in the proximal humerus amd four were in the proximal femur), which were all treated by flexible intramedullary nailing; while a cancellous screw was axially placed in three cysts of the short bones (all in the calcaneus). The mean age of the patients at the time of surgery was 11.8 years, and the mean duration of follow-up was 16.7 months. The final outcome was radiographically classified into the four categories of Capanna et al.,; completely healed, healed with residual radiolucency, recurred or having no response. RESULTS: All of the cysts In the long bones responded to treatment. Seven cysts healed completely, and three healed with residual radiolucent areas visible on radiographs. One cyst, which initially appeared completely healed, recurred after the removal of nails. The healing period varied from three to 36 months. For the calcaneal cysts, there was no definite sign of effective consolidation in all three cases. CONCLUSION: Intramedullary decompression by flexible nailing for the treatment of unicameral bone cyst of a long bone was effective in providing early stability and for accelerating consolidation of the cyst. Its surgical intervention is minimal, and the result is predictable. Our trial of placing a screw in the calcaneal cysts was unsuccessful according to the short term follow-up.

Keyword

Unicameral bone cyst; Intramedullary decompression

MeSH Terms

Bone Cysts
Child
Decompression
Follow-Up Studies
Humans
Humerus
Nails
Titanium
Titanium

Figure

  • Fig. 1 (A) A typical unicameral bone cyst with pathological fracture in the proximal humerus of a 15 year old boy. Fracture healed at 3 months. But it refractured at 4 months. (B) At 8 months, we tried the steroid injection, which was not effective until 12 months. (C) So we inserted a Titaium Elastic Nail for the continuous intramedullary decompression. (D) It healed at 21 months after nailing.

  • Fig. 2 (A) A unicameral bone cyst in proximal femur of a 6 year old girl, which was incidentally found without fracture. (B) After fixation with two Titanium Elastic Nails, it appeared to be completely healed at only 3 months. (C) The nails were removed at 6 months. (D) But at 16 months it partially recurred at the same location. Final result of this case was classified as the 'recurrence after healing'.

  • Fig. 3 (A) A calcaneal cyst in a 15 year old boy. A steroid injection was not successful until 6 months. (B) A cancellous screw was placed through the cyst in axial fashion. We anticipated the decompression of cyst with subsequent healing, which was not occurred until 12 months.


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