Treatment of a Simple Bone Cyst Using a Cannulated Hydroxyapatite Pin

Abstract

Simple bone cysts (SBCs) are benign bone tumors. However, the treatment of SBCs remains controversial because of their healing rate and the invasiveness of surgery. The purpose of the present study was to evaluate the treatment of SBCs using a cannulated hydroxyapatite (HA) pin.A total of 43 patients (35 males, 8 females; mean age 12.1 years; age range, 5–22 years) with SBCs were treated with continuous decompression by inserting ceramic HA pins between 1989 and 2014. The SBCs were located in the calcaneus in 23, the humerus in 15, the femur in 3, and the pelvis in 2 cases. In all patients, minimal fenestration of the cyst wall and curettage and multiple drilling in the cyst wall were performed, followed by insertion of the HA pin. The mean follow-up period was 26.6 months. Operating time, healing period, risk factors for recurrence, and the cure rate were evaluated.Healing was achieved without intervention in 38 patients after a mean of 6.4 months. Two patients had persistent small residual cysts, which had no changes after 1 year at the latest follow-up. There were 5 patients with recurrences (humerus 4, femur 1), who were cured by curettage and artificial bone grafting. The final healing rate by cannulation only using an HA pin was 88.2%. On Fisher exact test, age, site of SBCs, and distance from the physis were found to be significantly associated with SBC recurrence (P < 0.05).In the present study, cannulation using an HA pin for SBCs was found to be a useful technique, particularly for calcaneal cysts, because it is a minimally invasive procedure with a high cure rate. In patients <10 years, involvement of the humerus and contact with the growth plate were significant risk factors for SBC recurrence.

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

“…Those aggressive operations are extensive and complex, often with high complications [12]. In recent decades, new treatments have been developed, such as intralesional injections of steroids [13,14], intralesional injections of bone marrow [15], bone grafting with homologous cancellous bone chips [16], bone grafting with freeze-dried crushed cortical bone [17], and decompression with screws or pins with holes [18]. Even though these new surgical treatments present promising short-term outcomes, most of them are likely to end up with partial recoveries [19], and the recrudesce and tenacity are still the biggest challenges [3].…”

Simple Bone Cyst Treated with Percutaneous Steroid Injection

“…In the present study, a significantly higher recurrence rate was found for patients with a lesion contacting the physis [16]. However, the other studies demonstrated that the results of PSI might be worse in as many as half of the patients had the lesion relapses [26]. In addition, despite its anti-inflammatory properties, extra care should be taken when administering steroid injection, due to its possible adverse effect [27][28][29][30].…”

Proximal Femoral Unicameral Cyst Resolved by Single Injection of a Calcium Phosphate Bone Void Filler without Instrumentation

“…Alternative treatment options were reviewed with the family. These included cyst injection with or without supplemental fixation [3,7,8]. The risks and benefits were discussed with the family, including the potential need to cross the proximal femoral growth plate with fixation which may lead to growth arrest [7].…”