Treatment for unicameral bone cysts in long bones: an evidence based review

Abstract

The purpose of this paper is to perform an evidence based review for treatment of unicameral bone cysts. A search of MEDLINE (1966 to 2009) was conducted and the studies were classified according to levels of evidence. This review includes only comparative Level I-III studies. The systematic review identified 16 studies. There is one level I study, one level II study and the remaining 14 studies are level III. Seven of the sixteen studies had statistically different results: three studies indicated that steroid injection was superior to bone marrow injection or curettage and bone grafting; one study indicated that cannulated screws were superior to steroid injections; one study indicated resection and myoplasty was superior to steroid injection; one study indicated a combination of steroid, demineralized bone matrix and bone marrow aspirate, and curettage and bone grafting were superior to steroid injection; and one study indicated that curettage and bone grafting was superior to non-operative immobilization. Based on one Level I study, including a limited number of individuals, steroid injection seems to be superior to bone marrow injection. As steroid injections have already demonstrated superiority over bone marrow injections in a randomized clinical trial, the next step would be a prospective trial comparing steroid injections with other treatments.

Mid-term results of treatment with curettage and grafting in tumor-like cysts of long bones

“…Myelle et al (9) aimed to improve the success by adding steroid to the curettage and bone grafting treatment; however, these treatment modalities were not found to be superior to steroid injection. Donaldson et al (30) wrote an evidence-based article on the treatment of UBC after they examined Level I-III studies between 1966 and 2010. Most of the cases were treated with the methods of curettage and bone grafting, and also steroid injection.…”

Benign cystic bone lesions

“…Im Inneren findet sich typischerweise klare gelbliche oder nach Frakturen blutig imbibierte Flüssigkeit [1]. Prädilektionsstellen sind die proximale Humerusmetaphyse (50-70% [1]) und die proximale Femurmetaphyse (25% [1,2]). Bei älteren Patienten (>20 Jahre) können auch die Patella, die Skapula und das Becken (zumeist Os ilium) betroffen sein.…”

“…Metaanalyse [2] wurden in den letzten 5 Jahren veröffentlicht. Grundsätzlich ist bei radiologisch eindeutiger Diagnose die konservative Therapie möglich.…”

“…Die Verwendung kanülierter Schrauben führte laut einer Metaanalyse [2] in 46-100% zur Heilung. Es kam jedoch zu inkompletten Heilungen, Obstruktionen der Perforationen, Frakturen an der Insertionsstelle, Refrakturen und Reoperationen [9,10].…”

“…Bei alleiniger ESIN-Osteosynthese sind jedoch Refrakturen, Reoperationen, Wechsel der Nägel und inkomplette Heilungen dokumentiert; zusätzlich können Nagelwechsel technisch schwierig sein [11]. Die alleinige Instillation von autogenem Knochenmark zeigte in verschiedenen Studien Heilungsraten von 23-92% [2]; als potenziell nachteilig zu erwähnen sind hier die Entnahmemorbidität, die partielle Heilung sowie die teilweise erforderliche mehrfache Durchführung [7]. Die Instillation von Kortison ist meist mit nur geringen Erfolgsraten nach der ersten Behandlung assoziiert.…”