The Efficacy of Nonsurgical and Surgical Interventions in the Treatment of Pediatric Wrist Ganglion Cysts

Shanks, Carolyn; Schaeffer, Tyler; Falk, David; Nunziato, Carl; Hogarth, Danielle A.; Bauer, Andrea S.; Shah, Apurva S.; Gottschalk, Hilton P.; Abzug, Joshua M.; Ho, Christine A.

doi:10.1016/j.jhsa.2021.12.005

Cited by 7 publications

(12 citation statements)

References 16 publications

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“…27 Additionally, a recent multi-center study reported a recurrence rate of 27% with surgical excision compared to 82% with aspiration, although aspiration methodology was not reported. 34 Reported recurrence rates after surgical excision are similar to our analysis, yet the rate of recurrence after aspiration is significantly lower in our study. 34 The authors attribute the success of USGT to improved visualization and complete aspiration of ganglia by a trained musculoskeletal radiologist, in addition to protocolized fenestration, compression, and brace wear.…”

Section: Discussionsupporting

confidence: 88%

“…34 Reported recurrence rates after surgical excision are similar to our analysis, yet the rate of recurrence after aspiration is significantly lower in our study. 34 The authors attribute the success of USGT to improved visualization and complete aspiration of ganglia by a trained musculoskeletal radiologist, in addition to protocolized fenestration, compression, and brace wear. 12,35 Although surgical excision had a lower rate of recurrence than USGT, percutaneous treatment affords multiple benefits.…”

Section: Discussionsupporting

confidence: 88%

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Surgical Excision versus Ultrasound-Guided Treatment of Symptomatic Wrist Ganglia in Pediatric Patients

Bratsman¹,

Cano²,

Phillips³

et al. 2023

Journal of the Pediatric Orthopaedic Society of North America

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Background: Multiple invasive treatments exist for pediatric patients presenting for evaluation of symptomatic wrist ganglia, most commonly surgical excision or percutaneous treatment. Treatment modality is often dictated by patient preference and recurrence rate. Compared with adult literature, treatment outcomes of wrist ganglia in children are less examined. This study examines recurrence rates of wrist ganglia after surgical excision and ultrasound-guided treatment (USGT) in a pediatric population.Methods: A retrospective study of patients referred for wrist ganglia treatment from January 2015 to February 2020 at a single-center children's hospital was performed. Patients aged 0-18 years with a minimum of 1-year follow-up from either USGT or surgical excision were included.Results: Sixty-nine patients underwent surgical excision with 15 (22%) experiencing recurrence. Seventy-seven patients underwent USGT with 26 (34%) experiencing recurrence. There was no statistical difference between recurrence rates between the two groups (p = 0.140). Thirty of 146 (20.5%) patients underwent a subsequent excision procedure where 18 (60%) experienced no recurrence, 4 (13%) experienced recurrence, and 8 (26%) had insufficient follow-up of less than one year. All 7 patients treated in clinic with aspiration without ultrasound guidance required subsequent intervention. Conclusion:USGT of wrist ganglia is a reasonable treatment choice for pediatric patients and has a similar recurrence rate to surgical excision. For patients that require subsequent treatment, recurrence rates are also similar between USGT and surgical excision. Parents of children with wrist ganglia should be educated about treatment options and recurrence rates, and patients should have age-appropriate involvement in management decisions regarding treatment of wrist ganglia.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 88%

Surgical Excision versus Ultrasound-Guided Treatment of Symptomatic Wrist Ganglia in Pediatric Patients

Bratsman¹,

Cano²,

Phillips³

et al. 2023

Journal of the Pediatric Orthopaedic Society of North America

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“…With a minimum 2-year follow-up, there was a 44% rate of resolution with conservative treatment compared with an 18% resolution rate with aspiration. The recurrence rate was nearly 30% after surgical excision 80 .…”

Section: Upper Extremitymentioning

confidence: 99%

What’s New in Pediatric Orthopaedics

Andras

Sanders²,

Goldstein

et al. 2022

Journal of Bone and Joint Surgery

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This pediatric orthopaedic update represents a review of articles predominantly from October 2021 to October 2022. Spine Adolescent Idiopathic ScoliosisAs we strive toward optimal adolescent idiopathic scoliosis treatment that will serve patients well into adulthood, longterm follow-up studies are of particular importance. Lander et al. reported on a series of 134 patients treated with Harrington instrumentation with a minimum 40-year follow-up. Patients with a lowest instrumented vertebra (LIV) at L3 or proximal had a lower likelihood of undergoing additional surgical procedures at 13% compared with patients with an LIV at L4 or distal at 36%, but, aside from this, the groups were similar with regard to health-related quality of life and their scores were not different from normal age-based means 11 . Also encouraging was the report on 115 patients with a 25year follow-up that showed that the serum levels of cobalt and chromium ions were similar in the patients treated with Harrington instrumentation compared with a control group of patients treated with bracing 12 . However, questions with regard to the long-term effect of retained implants continue to generate concern as titanium levels were found to be persistently elevated to 5 times the preoperative level at the 2-year follow-up in a series with more contemporary implants 13 . The impact of this remains unknown but warrants continued study.There remains continued interest in leveraging technology to achieve optimal pedicle screw placement safely and consistently. In a systematic review and meta-analysis by Baldwin et al., screws placed with intraoperative computed tomographic (CT) navigation were determined to be one-third Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/H355).

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“…Children ≤10 years of age had a higher rate of spontaneous resolution than those >10 years of age. Based on the findings, the authors suggested that the expense of a wrist orthosis or cyst aspiration is not warranted over simple observation and that a surgical procedure should be judiciously offered to patients with persistent pain or functional limitations 62 .…”

Section: Pediatricsmentioning

confidence: 99%

What’s New in Hand and Wrist Surgery

Bohn

2023

Journal of Bone and Joint Surgery

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The Efficacy of Nonsurgical and Surgical Interventions in the Treatment of Pediatric Wrist Ganglion Cysts

Cited by 7 publications

References 16 publications

Surgical Excision versus Ultrasound-Guided Treatment of Symptomatic Wrist Ganglia in Pediatric Patients

Surgical Excision versus Ultrasound-Guided Treatment of Symptomatic Wrist Ganglia in Pediatric Patients

What’s New in Pediatric Orthopaedics

What’s New in Hand and Wrist Surgery

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