Unicameral bone cysts of the proximal femur in skeletally immature patients: Do radiological parameters, pathological fracture, treatment method and recurrence affect the outcomes?

Objective & Hypothesis:Unicameral bone cysts (UBC) are reported to be the underlying lesion in 40% of pathological femoral neck fractures in skeletally immature patients.

📊

Key Findings & Data:Medical records were retrospectively reviewed of patients with pediatric proximal femoral UBC’s who underwent surgery between 2004 and 2018.

💡

Conclusion & Impact:The recurrence rate was significantly high in UBC’s who were operated on at

🔬Design:Review & Systematic Survey

📍Scope:2004 Verileri

⚙️Variables:Domain Parameters

Abstract

Unicameral bone cysts (UBC) are reported to be the underlying lesion in 40% of pathological femoral neck fractures in skeletally immature patients. They are typically asymptomatic and incidentally found on imaging. However, when symptomatic, it commonly may present with pathologic fracture that causes pain, swelling, or deformity. The purpose of this study was to assess the natural history of the pediatric proximal femoral unicameral bone cyst, risk factors for pathological fracture and recurrence. Medical records were retrospectively reviewed of patients with pediatric proximal femoral UBC’s who underwent surgery between 2004 and 2018. We included 51 consecutive patients with pediatric proximal femoral UBC (36 impending fractures/15 pathological fractures). The patients were evaluated regarding the localization of the UBC and the activity of the cyst. The cyst parameters were measured, and the patients were further assessed regarding the presence of pathological fracture and applied treatment. The pathological fracture group was compared to the impending fracture group using radiological cyst parameters, management options, healing, recurrences, and other related complications. The most commonly affected localizations were combined involvement of femoral neck and intertrochanteric (n=21) The number of latent lesions was 27 and active lesions were 24. The mean cyst index in our series was 3.8±1.2 (1.2-7.2). The cyst index in our series was correlated with pathological fractures. (p=0.048) There were significantly higher cyst index values in recurrent cases. (p=0.016) The cyst extension below the trochanter minor level was found as a risk factor for pathological fractures. (p=0.021) The most common treatment in our series was curettage, graft packing, and plate fixation with 27 patients. The treatment method showed no correlation with consolidation or recurrence rate. According to the healing criteria for UBC’s at final follow-up, 36 cysts were completely consolidated, 13 were evaluated as incomplete healing and two were persistent. The recurrence rate was significantly high in UBC’s who were operated on at

🔖

Cite This Article

Koksal, A., Aycan, O. E., Mert, M., Arslan, M. C., Kaya, O. (2022). Unicameral bone cysts of the proximal femur in skeletally immature patients: Do radiological parameters, pathological fracture, treatment method and recurrence affect the outcomes?. Medicine Science, Cilt: 10 - Sayı: 3, 670–678. https://ajindex.com/articles/579699

📄 Full Text PDF Viewer

Open in New Tab ↗

↗New Tab

📄

PDF görüntüleyici hazırlanıyor...

References (16)

Sevımlı, R. Distribution and evaluation of primary bone and soft tissue tumors admitted from Malatya province and surrounding provinces. Med Sci,2017;3:546-50.
Campanacci M, Capanna R, Picci P. Unicameral and aneurysmal bone cysts. Clin Orthop Relat Res. 1986;:25-36.
Roposch A, Saraph V, Linhart WE. Treatment of femoral neck and trochanteric simple bone cysts. Arch Orthop Trauma Surg. 2004;124:437-42.
Norman-Taylor FH, Hashemi-Nejad A, Gillingham BL et al. Risk of refracture through unicameral bone cysts of the proximal femur. J Pediatr Orthop. 2002;22:249-54.
Azouz EM, Karamitsos C, Reed MH et al. Types and complications of femoral neck fractures in children. Pediatr Radiol. 1993;23:415-20.
Kaelin AJ, MacEwen GD. Unicameral bone cysts. Natural history and the risk of fracture. Int Orthop. 1989;13:275-82.
Vasconcellos DA, Yandow SM, Grace AM et al. Cyst index: A nonpredictor of simple bone cyst fracture. J Pediatr Orthop. 2007;27:307-10.
Ahn JI, Park JS. Pathological fractures secondary to unicameral bone cysts. Int Orthop. 1994;18:20-2.
Zamzam MM, Abak AA, Bakarman KA et al. Efficacy of aspiration and autogenous bone marrow injection in the treatment of simple bone cysts. Int Orthop. 2009;33:1353-8.
Tey IK, Mahadev A, Lim KB et al. Active unicameral bone cysts in the upper limb are at greater risk of fracture. J Orthop Surg (Hong Kong). 2009;17:157-60.
Kim MC, Joo SD, Jung ST. The role of fractures on pathologic bone in healing of proximal humerus unicameral bone cysts. J Orthop Surg (Hong Kong). 2018;26:2309499018778366. Jamshidi K, Mirkazemi M, Izanloo A et al. Locking plate and fibular strut-graft augmentation in the reconstruction of unicameral bone cyst of proximal femur in the paediatric population. Int Orthop. 2018;42:169-174.
Fahey JJ, O'Brien ET. Subtotal resection and grafting in selected cases of solitary unicameral bone cyst. J Bone Joint Surg Am. 1973;55:59-68.
McKay DW, Nason SS. Treatment of unicameral bone cysts by subtotal resection without grafts. J Bone Joint Surg Am. 1977;59:515-9.
Shinozaki T, Arita S, Watanabe H, et al. Simple bone cysts treated by multiple drill-holes. 23 cysts followed 2-10 years. Acta Orthop Scand. 1996;67:288-90.
Capanna R, Albisinni U, Caroli GC, et al. Contrast examination as a prognostic factor in the treatment of solitary bone cyst by cortisone injection. Skeletal Radiol. 1984;12:97-102.
Cha SM, Shin HD, Kim KC et al. Does fracture affect the healing time or frequency of recurrence in a simple bone cyst of th