Does Fracture Affect the Healing Time or Frequency of Recurrence in a Simple Bone Cyst of the Proximal Femur?

Abstract

Background Studies have focused on intramedullary nailing of femoral simple bone cysts but have not clarified the recurrence frequency or management of recurrent cysts. In particular, the affect of pathologic fractures on cyst healing, recurrence, and complications of treatment have not been reported. Questions/purposes We performed a retrospective comparative study to examine whether there were differences between simple bone cysts in the proximal femur nailed after pathologic fracture and those without pathologic fracture in terms of (1) healing time, (2) frequency and timing of recurrence, and (3) complications.Methods From 1995 to 2005, 54 patients diagnosed with femoral simple bone cysts were treated and followed for a minimum of 8 years. Flexible nails were inserted in a retrograde fashion in 25 patients with fractures and 29 patients without fractures. The healing period, degree of radiographic consolidation based on the criteria of Capanna et al., recurrence frequency, and final bony abnormalities were analyzed. The mean followups were 107 months (range, 96-124 months) and 103 months (range, 96-140 months) in the groups with and without fractures, respectively. With the numbers available, a post hoc calculation showed that this study had 80% power to detect a difference of 7 months of healing time as significant with a probability less than 0.05.

Treatment of simple bone cysts of the humerus by intramedullary nailing and steroid injection

“…When the elastic intramedullary nails were inserted between the medullary canal and the cyst cavity, continuous drainage and intracystic pressure decompression were carried out. Furthermore, elastic intramedullary nails could play a stable and supporting role, enabling early postoperative motion, preventing adjacent joint stiffness and promoting healing, particularly in the treatment of pathological fractures [22,23]. However, it was reported that residual lesions were found in the patients with SBCs after treated of only by elastic stable intramedullary nailing (ESIN) [24,25].…”

Intramedullary Nailing Combined with Bone Grafting for Benign Lesions of the Proximal Femur

“…Moreover, complications may occur in these patients, with high risk of slipped epiphysis, external rotational deformity, and arthroclisis of the knee. In summary, the main problems with the conventional treatment are coxa vara, exposure to infection, lack of stability to the bone, and restriction of normal activity; the recurrence rate has also been noted as a major drawback. Thus, the importance of internal fixation in the treatment of tumors of the proximal femur has been emphasized in the past decade due to the benefits of reducing hospitalization time and postoperative complications.…”

“…performed a retrospective comparative study of 54 patients diagnosed with femoral simple bone cysts. In these patients, the intramedullary nailing of the proximal with simple bone cysts resulted in reliable healing. Steensma and Healey conducted an online survey, and show a trend among Musculoskeletal Tumor Society (MSTS) members for selecting intramedullary nail fixation and arthroplasty‐related techniques to treat pathologic fractures of the proximal femur.…”

“…prove that multiple osteotomies and intramedullary nailing with neck cross‐pinning can be used to correct developed or progressing shepherd's crook deformity in polyostotic fibrous dysplasia, and the failure of elastic endomedullary nailing. In light of the drawbacks of the other approaches to this problem, we consider intramedullary nailing to be an attractive and simple approach, which offers stability around the lesions.…”

Treatment of simple bone cysts of humerus by intramedullary decompression and drainage with elastic stable intramedullary nailing combined with intralesional injections of steroids

“…When the elastic intramedullary nails were inserted between the medullary canal and the cyst cavity, continuous drainage and intracystic pressure decompression were carried out. Furthermore, elastic intramedullary nails could play a stable and supporting role, enabling early postoperative motion, preventing adjacent joint stiffness and promoting healing, particularly in the treatment of pathological fractures [21,22]. However, it was reported that residual lesions were found in the patients with SBCs after treated of only by elastic stable intramedullary nailing (ESIN) [23,24].…”