A comparative study for the treatment of simple bone cysts of the humerus: open curettage and bone grafting either without instrumentation or with intramedullary nailing

Abstract

Functional and radiographic outcomes, in addition to complication and reoperation rates of open curettage and grafting without instrumentation or with intramedullary nailing, in the treatment of simple bone cysts (SBCs) of the humerus were compared. Thirty-seven children [25 males, 12 females; median age=9.5 years (range, 3-17 years)] with humeral SBC were treated with curettage and grafting without instrumentation (group 1, 21 patients) or with intramedullary nailing (group 2, 16 patients). The pathological fracture rate was 85.7% in group 1 and 87.5 in group 2. The follow-up duration ranged from 26 to 85 months. The average last follow-up Musculoskeletal Tumor Society functional scores for groups 1 and 2 were 28.9 and 29.5 (P>0.05). Higher, but statistically insignificant (P>0.05), complete or significant partial radiographic healing rates were achieved in group 2 (100%) compared with group 1 (76.2%). The overall complication rate of the entire study population was 21.6% (19%; 4/21 in group 1; 25%; 4/16 in group 2). The reoperation rates for groups 1 and 2 were 9.5% (2/21; one for partial cyst healing, one for recurrence) and 56.25% (9/16; one for surgical complication, eight for implant removal). Surgical intervention is indicated for selected patients with SBCs. Even though perfect functional results were possible with open curettage and grafting, continuous intramedullary decompression with elastic nails led to a higher radiographic healing rate in the treatment of humeral SBCs. Open curettage and grafting with or without intramedullary nailing was associated with a high number of complications, but the rate of reoperation for complications was very low.

Comparison of curettage and bone grafting combined with elastic intramedullary nailing vs curettage and bone grafting in the treatment of long bone cysts in children

“…The average age of onset is 8 to 14 years old. [1–5] Simple bone cysts mostly occur in males, and the male-to-female ratio is 2:1 to 4:1 [1–3,6,7] ; pain caused by intercurrent pathological fracture is often the first symptom, and 63% to 87% [1,3] of cysts are combined with pathological fracture before surgery. According to the Neer evaluation criterion, bone cysts can be divided into a latent stage and an active stage, in which the active stage accounts for 37.9% to 57.9%.…”

Evaluation of immediate and delayed surgery for pathological fracture due to unicameral bone cysts in children

“…A comparison of the complications in this study proved that early operation, including curettage, bone graft and ESIN, could achieve the same results as a delayed operation. Erol et al 21 also reported that a very similar combination treatment of curettage, grafting and ESIN, achieved a high cure rate in humerus UBCs. The extended curettage and grafting stimulated bone formation and ESIN not only contributed to continuous drainage of the cyst but also provided stability to the pathological fractures.…”

“…The extended curettage and grafting stimulated bone formation and ESIN not only contributed to continuous drainage of the cyst but also provided stability to the pathological fractures. 21 …”

“…The extended curettage and grafting stimulated bone formation and ESIN not only contributed to continuous drainage of the cyst but also provided stability to the pathological fractures. 21 Finally, open surgery allows full observation of the cavity of the cyst, ensuring that adequate allograft bone is used to fill the cavity, because insufficient allograft bone may lead to inadequate healing of the UBC and eventual recurrence. 14 Another advantage of open surgery is the opportunity to perform a confirmatory biopsy.…”

Method of Transosseous Through-and-Through Drainage of Bone Cysts

“…Bone-replacement plastic surgery is traumatic and it is associated with long-term transplant restructuring and numerous complications such as shortening development, false joints, deformity and muscle wasting [15,16]. The current trend involves withdrawal of resection bone plastic surgery.…”