Current Trends and Variations in the Treatment of Unicameral Bone Cysts of the Humerus: A Survey of EPOS and POSNA Members

Abstract

Background: A variety of treatment methods have so far been described for unicameral bone cysts (UBC). However, to the best of our knowledge, no particular consensus has yet been reached on when to operatively treat a patient with a humeral UBC. Therefore, members of the European Pediatric Orthopedic Society (EPOS) and Pediatric Orthopedic Society of North America (POSNA) were surveyed to characterize current treatment preferences. Methods: An online electronic questionnaire was sent out to all registered EPOS and POSNA members. The survey comprised 45 questions related to the diagnosis, treatment, and follow-up characteristics of patients with UBCs of the humerus. Particular questions related to the nonoperative or surgical treatment of pathologic proximal humerus and humeral shaft fractures were also included. Results: In total, 444 participants (132 EPOS and 292 POSNA members) responded, of whom 400 were actively involved in UBC treatment. The preferred diagnostic modalities to confirm the diagnosis of a UBC in the humerus were radiographs (88%), MRI in cases of questionable diagnosis (58%) or CT scan (8%). For painless UBCs 67% prefer no treatment at all except when the fracture risk is deemed high (then 53% recommend surgery); 71% of respondents would treat painful UBCs with surgery. Most common surgical techniques comprise curettage (45%), artificial bone substitutes (37%), corticosteroid injection (29%), or intramedullary stabilization (eg, rodding; 24%). Fractured, nondisplaced and mildly displaced proximal humerus UBCs and mildly displaced pathologic humerus shaft fractures are all preferably treated nonoperatively (94%, 91%, 83%, respectively). Severely displaced pathologic proximal humerus fractures are treated less often conservatively (36%) than surgically (40%), and severely displaced humerus shaft fractures are preferably treated surgically (63%) by intramedullary stabilization (60%). Conclusions: There is great variation among EPOS and POSNA members with regards to the diagnosis and treatment of UBCs in the humerus. Although some consensus on general treatment principles is seen, specific surgical treatment indications vary. Prospective randomized-controlled studies are needed to evaluate the outcomes of the different surgical approaches compared with nonoperative strategies. Level of Evidence: Level V—expert opinion.

Current trends in the treatment of supracondylar fractures of the humerus in children: Results of a survey of the members of European Paediatric Orthopaedic Society

“…Despite such limitations, the survey had an excellent response rate of 46.3% higher than most other surveys. [13][14][15][16][17] In conclusion, surgeon experience, type of fracture, treatment modality, and pins configuration were indicated as the main factors influencing the outcome of SHFs. EPOS members agreed on the treatment modality of Gartland's type II and III SHFs, patient positioning, and timing of hardware removal.…”

“…The 2020 EPOS SHFs questionnaire received the highest response rate (46.3%) among EPOS surveys; in fact, most of the previous questionnaires received a variable response rate, between 23% and 43%. 13 – 17 Concerning the previously published SHFs surveys from other scientific societies, they reported limited evidence, focused on specific fracture patterns only, did not detail the post-operative protocol, and in some cases were limited to a restricted cohort of a nation cohort. 2 , 7 , 18 , 19 The 2020 EPOS SHFs survey provided data on the management and follow-up of SHFs from more than 20 countries.…”

“…Despite such limitations, the survey had an excellent response rate of 46.3% higher than most other surveys. 13 – 17 …”

Impact of the COVID-19 pandemic on patients suffering from musculoskeletal tumours

“…Benign bone tumours and bone cysts are the most common lesion in the immature skeleton and mostly appear in the proximal femur and humerus [14]. Although these lesions tend to fracture, which would require surgery to avoid malalignment of the bone and to reduce the morbidity of pain and fracture [15], only 51.1% of our participants stated that these patients were being treated at their department.…”

Minimally Invasive Treatment for Unicameral Bone Cysts with Chemical Sclerosis and Bone Graft Substitute: A Preliminary Report

“…Treatment options for UBCs include observation, curettage, steroid injection, bone grafting, screw cannulation or a combination of these techniques, although no consensus treatment option exists [5,6]. Recurrence rates vary by intervention and have been reported as high as 50% and may require multiple interventions [7][8][9][10].…”