Clin Orthop Surg.  2016 Dec;8(4):484-488. 10.4055/cios.2016.8.4.484.

Recurrence of a Unicameral Bone Cyst in the Femoral Diaphysis

• Kim HS
• Lim KS
• Seo SW
• Jang SP
• Shim JS

• KMID: 2412334
• DOI: http://doi.org/10.4055/cios.2016.8.4.484

Abstract

Diaphyseal unicameral bone cysts of the long bone are generally known to originate near the growth plate and migrate from the metaphysis to the diaphysis during skeletal growth. In the case of unicameral bone cysts of diaphyseal origin, recurrence at the same location is extremely rare. We report a case of recurrence of a unicameral bone cyst in the diaphysis of the femur that developed 8 years after treatment with curettage and bone grafting. We performed bone grafting and lengthening of the affected femur with an application of the Ilizarov apparatus over an intramedullary nail to treat the cystic lesion and limb length discrepancy simultaneously.

Keyword

Femur; Diaphyses; Bone cysts; Recurrence

MeSH Terms

*Bone Cysts/diagnostic imaging/pathology/surgery
Child
*Diaphyses/diagnostic imaging/pathology/surgery
Femoral Fractures/diagnostic imaging/pathology/surgery
*Femur/diagnostic imaging/pathology/surgery
Humans
Male
Recurrence

Figure

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  Fig. 1 (A) Initial plain radiograph showing a concentric osteolytic lesion with cortical thinning and ballooning in the mid-portion of the femur shaft accompanied by a pathologic fracture. (B) Radiograph taken after curettage of the cystic lesion and bone grafting followed by open reduction and internal fixation for the pathologic fracture. (C) Two-year follow-up radiograph showing complete healing of the cystic bone lesion. (D) Seven-year follow-up radiograph showing no recurrence of the cyst in the femur.

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  Fig. 2 Lining of the simple bone cyst composed of fibrous tissue without obvious lining cells (H&E, × 50).

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  Fig. 3 Long bone scanogram obtained at skeletal maturity showing a leg length discrepancy of 3.5 cm.

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  Fig. 4 (A) Eight-year follow-up radiograph showing an impending pathologic fracture caused by a recurrent simple bone cyst in the left femur. (B) Magnetic resonance imaging scan demonstrating a 6.6 cm × 3 cm × 3 cm-sized, well-defined cystic lesion in the left distal femur. (C) Radiograph taken after curettage and autogenous bone grafting combined with internal fixation using an intramedullary nail.

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  Fig. 5 (A) Radiograph taken 1 year after the second surgery showing stability of the lesion despite cortical thinning and ballooning of the femur. (B) Radiograph taken after lengthening of the left femur with an application of the Ilizarov apparatus over the intramedullary nail. (C) Radiograph taken 20 months after distraction osteogenesis showing no evidence of recurrence.

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  Fig. 6 (A) Radiograph taken after hardware removal at 30 months after the distraction osteogenesis. (B) Long bone scanogram obtained at skeletal maturity showing no limb length discrepancy.

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