Total subperiosteal resection treatment of solitary bone cysts of the humerus

Abstract

The solitary bone cyst is most frequently located in the upper arm and the average age of the affected patients is between 7 and 9 years, thus perceptibly lower than in cases where solitary bone cyst occurs elsewhere, where the average age is 15. The tendency towards recurrence before 10 years of age is twice as great as the tendency after that age. Investigation of the results obtained from the treatment of 26 patients suffering from solitary bone cyst of the humerus showed a recurrence rate of 55% after curettage and filling-in of the defect with cancellous bone grafts, whereas after total subperiosteal resection and bridging the defect with an autologous tibia graft the corresponding recurrence frequency was 7%. The average duration of the plaster cast fixing period after resection treatment was 18 days longer than after curettage, but the low rate of recurrence in the first-mentioned case makes up for this disadvantage. It is absolutely essential to retain the periosteum in cases of cyst resections. The defect is bridged over by an autologous tibia graft, but fibula grafts are also suitable for bridging the defect. Osteosyntheses are not necessary with latent cysts. In the case of active cysts screws, wire loops, Kirschner wires, and thin Küntscher nails can be used as temporary stabilisation means. Plate osteosyntheses constitute an exception. Complete removal of the cyst by resection is the most certain prophylactic method against recurrence, and hence the most reliable form of treatment of the solitary bone cyst of the humerus.

Subperiosteal resection of aneurysmal bone cysts of the distal fibula

“…3,6,22,25,26 Resection of the lesion has the lowest association with recurrence while excision through the margin has consistently decreased the rate of local recurrence. 10,[27][28][29] Despite the rate of recurrence in various methods of treatments, more aggressive operative intervention does not appear to be indicated and recurrence can be successfully treated by repeated extended curettage and bone graft. 19,30 It is important to preserve the growth plate, especially in young children, even if the lesions are likely to recur.…”

“…33 No previous study has highlighted the effectiveness of the periosteum alone in forming new bone after resection of lesions of the distal fibula. 27,32 We assume that the inner layer of the periosteum has an osteoblastic capability which allows invasion of the haematoma in the tightly sutured periosteal tube by osteoprogenitor cells. Healing of the remaining defect occurred in a progressive manner which suggests that osteogenesis occurred initially at the margins of the cavity and moved toward its centre over the following weeks.…”

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

“…However, healing time and frequency of recurrence after treatment of these cysts have not been specified as clearly or sufficiently as for cysts of the proximal humerus. Numerous studies have been performed on humeral cysts [4,7,11,19,24,25], whereas only a few have focused on femoral cysts [3,13,16,20]. Several aspects, including weightbearing, the presence of a final deformity at the end of growth, limb length, and normal gait, should be considered for femoral cysts.…”

“…These treatment options have a complication rate of 15%, leading to sequelae such as infection, coxa vara, epiphyseal arrest, and limb shortening [5,9,14,17,18]. Furthermore, the recurrence rate is as much as 40% [13,14,17,18,24]. Oppenheim and Galleno [17] concluded that curettage and bone grafting should not be considered the preferred treatments for simple bone cysts.…”

“…Oppenheim and Galleno [17] concluded that curettage and bone grafting should not be considered the preferred treatments for simple bone cysts. The major drawbacks of other surgical techniques, such as subtotal resection and total subperiosteal resection, include physeal damage, intraoperative blood loss, intraoperative fracture, and a long period of postoperative immobilization [14,24]. Catier et al [3] reported successful results after flexible intramedullary nailing for treatment of simple bone cysts in the proximal aspect of the femur.…”