Management of Unicameral Bone Cyst with Pathological Fracture of Proximal Humerus with Curettage, Fibular Grafting and Plate Osteosynthesis: A Retrospective Study

Abstract

Introduction: Unicameral Bone Cysts (UBC) are benign fluid filled lesions at metaphyseal regions of long bones of immature skeleton. Several treatment options exist but none have proven to be the best. Curettage helps to remove the cyst membrane responsible for lysis of bone and fibular grafting with plate osteosynthesis which gives adequate stability to the fracture and promotes healing of the UBC of proximal humerus with pathological fracture. Aim: To assess functional outcome, pain relief, healing of the cyst and recurrence of lesion with curettage and fibular bone grafting with proximal humerus plating in UBC of proximal humerus with pathological fracture. Materials and Methods: This was a retrospective study done using the medical records of 10 patients with UBC of proximal humerus with pathological fracture treated with curettage and fibular grafting and plate osteosynthesis at Nizams Institute of Medical Sciences, Hyderabad, Telangana, India, between January 2018 to December 2021. Patients were studied for functional outcome by Musculoskeletal Tumour Society (MSTS) score before surgery and one year after surgery. Healing of the cysts was evaluated by using a modified classification system by Chang et al., and pain relief was evaluated with pre and postoperative Visual Analogue Scale (VAS). Paired t-tests were used to compare the MSTS scores and VAS scores. Results: MSTS score increased significantly after surgery from 11.6±2.06 to 27.3±1.6, p<0.0001. Cysts have healed completely in seven cases, partially in three cases and recurrence was seen in three cases at the end of one year. Mean VAS scores decreased significantly from 7.60±0.97 to 1.40±0.97 after the surgery. Among three cases with recurrence of UBC, two cases were diagnosed at eight months and one case at 12 months after surgery. Conclusion: Treatment of UBC of proximal humerus with pathological fracture by curettage, fibular grafting and plate osteosynthesis gives good functional outcome and cyst healing rate. It is a safe and effective procedure without any complications.

Treatment and Outcomes of 4,973 Unicameral Bone Cysts

“…Curettage as a whole was also highly effective, with a success rate of nearly 80%, which likely underscore the wide adoption of this technique (37% of all included UBCs). Its popularity can be attributed to its frequent utilization in cases involving displaced pathologic fractures caused by UBCs 19 . In recent years, continuous decompression of the cyst cavity using elastic intramedullary nails has garnered increased attention because of its favorable outcomes in UBC healing and its associated low complication rates 45,77,90 .…”

“…Among these, 39 studies with a total 1,631 patients with UBCs described whether decompression of the cyst wall was performed in addition to treatment with injection 1,3-6,10,16,21,27,29,30,32,43,45,46,50,54,56,60,61,69,70,73,74,78,81,83,87,88,91,92,94,95,97,99,101-103,106,108 . Outcomes of patients treated with curettage were described in 61 studies 1,3,4,7,8,17-20,23,24,26,28,31,34,35,37,39,41-44,47,48,51,52,55-59,61-63,66-68,73,74,79,81,82,85,86,89,93,95,97-101,103,104,106,109-112,114,115 . Packing of the bone defect after curettage was performed with autograft in 294 patients 3,7,8,17,19,61,82,98,…”

“…A total of 4,973 patients with UBCs from 109 studies were included in our systematic review 1,3-10,15-40,41-70,71-110,111-115 . The number of cysts taken from each study ranged from 10 19,38,57,100,105 to 319 104 (Supplementary Table 2). Most studies were performed in the United States, and all articles, except for 1 randomized clinical trial, 16 were retrospective cohorts.…”

“…A total of 4,973 patients with UBCs from 109 studies were included in our systematic review 1,3-10,15-40,41-70,71-110,111-115 . The number of cysts taken from each study ranged from 10 19,38,57,100,105 to 319 104 (Supplementary Table 2).…”

“…Most studies were performed in the United States, and all articles, except for 1 randomized clinical trial, 16 were retrospective cohorts. Date of publication of included studies ranged from 1948 115 to 2022, 19-21 and the mean or median age of patients included in most articles was the first and second decades of life. Two studies reported a mean age of 37.9 17 and 27.4, 18 respectively.…”