Flexible Intramedullary Nailing for the Treatment of Unicameral Bone Cysts in Long Bones*

Roposch, Andreas; Saraph, Vinay; Linhart, Wolfgang E.

doi:10.2106/00004623-200010000-00011

Cited by 153 publications

(106 citation statements)

References 20 publications

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“…Humerus presented more tendencies to restitution ad integrum and a major percentage of healing than femur. In our experience, only 8% of our patients required a second intervention to change the nailing, a rate noticeably less than the 28% reported by Roposch [21].…”

Section: Discussioncontrasting

confidence: 63%

Continuous decompression with intramedullary nailing for the treatment of unicameral bone cysts

Masquijo

Baroni

Miscione

2008

Journal of Children's Orthopaedics

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Purpose To evaluate the efficacy of decompression of unicameral bone cysts (UBCs) of the long bones with intramedullary nailing and to compare responses to treatment according to location. Materials and methods We evaluated 48 consecutive patients treated between January 1988 and June 2000. Mean age was 10.3 years. Mean follow-up was 9.8 years. Evaluation was performed according to the radiographic criteria of Capanna. Results UBCs were located in the proximal humerus (n = 24), humeral shaft (n = 2), proximal femur (n = 19), distal tibia (n = 2) and fibula (n = 1). A total of 62.5% presented a pathological fracture. Successful results were observed in 89.5% (26 total healing, 17 healing with residual radiolucent areas), and there were four recurrences and, in one case, no response to treatment. There was more healing in the humerus than in the femur (92.3% versus 84.2%), and more tendency to restitution ad integrum, although the difference was not statistically significant (P = 0.1499). Conclusions Intramedullary nailing is a minimally invasive method, which permits early stability and decompresses the cyst allowing healing. Significant differences were not observed among results from different locations.

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Section: Discussioncontrasting

confidence: 63%

Continuous decompression with intramedullary nailing for the treatment of unicameral bone cysts

Masquijo

Baroni

Miscione

2008

Journal of Children's Orthopaedics

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“…Trephination and drilling with or without Kirschner wire placement have resulted in failure rates after one treatment of 27% [22], 30% [6], and 52% [36]. Even greater successes have been reported with intramedullary nailing, with failure rates after one treatment of 0% [11,33] and 6% [31]. However, intramedullary nailing remains controversial because local relapse of UBC is usually tolerable and rarely limb-threatening, and one has to balance the invasiveness and complications of a procedure with disease control.…”

Section: Discussionmentioning

confidence: 99%

“…However, intramedullary nailing remains controversial because local relapse of UBC is usually tolerable and rarely limb-threatening, and one has to balance the invasiveness and complications of a procedure with disease control. Furthermore, one study noted 28% of patients needed another operation because the nail became too short for the growing bone [31]. For other injection techniques, an 18% failure rate has been reported after one DBM injection [21], and failure rates of 11% [19] and 22% [32] have been reported after one injection of DBM plus bone marrow.…”

Section: Discussionmentioning

confidence: 99%

“…However, uncertainty exists regarding the effectiveness of various treatments: even for curettage and steroids, two of the more traditional and well-studied methods, wide ranges of failure rates after initial treatment are reported: 22% [28] to 47% [13] after curettage and 41% [10] to 78% [42] after steroids. Numerous other treatments have been suggested, ranging from subtotal resection [12,25], to flexible intramedullary nailing [9,11,31,33], to placement of Kirschner wires [6,7]. In addition to steroids [4,34], percutaneous injection has been attempted with demineralized bone matrix (DBM) [21], bone marrow [23,42], or a combination of DBM and bone marrow [19,32].…”

Section: Introductionmentioning

confidence: 99%

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Unicameral Bone Cyst: A Retrospective Study of Three Surgical Treatments

Sung

Anderson

Zurakowski

et al. 2008

Clinical Orthopaedics &Amp; Related Research

100

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Between 1979 and 2004, 167 patients younger than 20 years were treated surgically for humeral or femoral unicameral bone cysts with either injection of corticosteroids (steroids), curettage plus bone grafting (curettage), or a combination injection of steroids, demineralized bone matrix, and bone marrow aspirate (SDB) at Children's Hospital of Boston and Massachusetts General Hospital (mean followup, 7.3 years; range, 1 month-27 years). Outcomes included treatment failure (defined clinically as subsequent pathologic fracture or need for retreatment to prevent pathologic fracture) and complications. Information was obtained from medical records and by telephone questionnaire. After one treatment, 84% of cysts treated with steroids experienced failed treatment versus 64% with curettage and 50% with SDB. For unicameral bone cysts requiring retreatment (regardless of first treatment), 76% retreated with steroids had failed treatment versus 63% with curettage and 71% with SDB. Curettage was associated with the lowest rate of posttreatment pathologic fractures and highest rate of pain and other complications. Multivariate logistic regression indicated treatment with steroids alone and younger age were independent predictors of failure. We believe SDB is a reasonable first treatment for unicameral bone cysts in the humerus and femur in patients younger than 20 years, being less invasive yet comparable to curettage in preventing recurrence.

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“…While there are a handful of adult case series reporting excellent healing with Enders nails [13,14], there are no dedicated reports in the pediatric literature describing the results of this technique and its complications [10][11][12]. Several small case series have shown the efficacy of this implant in treating pathologic humeral shaft fractures in children and, in particular,in promoting healing in unicameral bone cysts [15][16][17]. The aim of this report is to describe the technique and results of operative stabilization of pediatric humeral shaft fractures with titanium elastic nails.…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment of traumatic pediatric humeral diaphyseal fractures with titanium elastic nails

Garg

Dobbs

Schoenecker

et al. 2009

Journal of Children's Orthopaedics

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Background Nearly all pediatric humeral shaft fractures can be successfully treated with closed methods. Some patients, however, require internal fixation either because of an inability to maintain an adequate reduction, significant soft tissue injury, or concomitant fractures. Methods This is a retrospective review of all traumatic humeral shaft fractures treated at our hospitals between 1999 and 2006. Thirteen pediatric patients ranging in age from 4.8 to 16.7 years (mean age 12.0 years) were treated surgically with titanium elastic nails (TENs). Relative surgical indications included open fractures, inability to maintain an acceptable reduction, the presence of ipsilateral forearm fractures (floating elbow), concomitant lower extremity fractures, and closed head injury. Two patients had associated radial nerve injury at presentation. Results The patients were followed for a mean of 29 months. All fractures healed in good alignment. There were no intraoperative complications, including neurologic or vascular injury, and no patient developed an infection postoperatively. Two patients had nail migration, one of whom developed nail protrusion through the skin. One patient with preoperative radial nerve injury ultimately underwent tendon transfer to restore wrist extension. Of the 13 patients, 12 reported a full return to sports and other activities with no limitations or discomfort. Conclusions When surgical stabilization of pediatric humeral shaft fractures is indicated, TEN fixation is effective and has a high rate of union and a low rate of complications. This technique is familiar to most orthopaedic surgeons treating pediatric fractures. Level of evidence Level of evidence: IV (case series)

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Flexible Intramedullary Nailing for the Treatment of Unicameral Bone Cysts in Long Bones*

Cited by 153 publications

References 20 publications

Continuous decompression with intramedullary nailing for the treatment of unicameral bone cysts

Continuous decompression with intramedullary nailing for the treatment of unicameral bone cysts

Unicameral Bone Cyst: A Retrospective Study of Three Surgical Treatments

Surgical treatment of traumatic pediatric humeral diaphyseal fractures with titanium elastic nails

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