Operative Treatment Versus Steroid Injection in the Management of Unicameral Bone Cysts

Oppenheim, William L.; Galleno, Humberto

doi:10.1097/01241398-198401000-00001

Cited by 147 publications

(110 citation statements)

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“…Although others have reported using doses as much as 240 mg [34], we are not aware of any doseresponse curve that suggests higher doses are more effective. Our finding that curettage was associated with a 64% failure rate after one treatment is higher than the 47% reported by one large study [13], and others have reported lower failure rates of 38% [29], 36% [38], 25% [39], and even 22% [28]. One possible explanation for the differences in failure rates in our study versus published rates is the longer followup in our study, which may have resulted in detection of more late failures.…”

Section: Discussioncontrasting

confidence: 84%

“…Our finding that steroids were associated with an 84% failure rate after one treatment is comparable to the 76% failure rate after one procedure in a series of 163 patients [34]; other smaller series have reported failure rates of 41% [10], 47% [13], 50% [29], and 78% [42] after one injection. Although others have reported using doses as much as 240 mg [34], we are not aware of any doseresponse curve that suggests higher doses are more effective.…”

Section: Discussionsupporting

confidence: 76%

“…Curettage and other invasive procedures have long been associated with high complication rates [29], although we could not find any studies that reported on pain or discomfort. The relationship between younger age and higher failure rates has been noted in other studies [14,27,29,38,39]. Although most consider age 10 as the cutoff between patients who do well and those who fare poorly, we believe there is a more linear relationship between younger age and higher failure rates.…”

Section: Discussionmentioning

confidence: 70%

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Unicameral Bone Cyst: A Retrospective Study of Three Surgical Treatments

Sung

Anderson

Zurakowski

et al. 2008

Clinical Orthopaedics &Amp; Related Research

100

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Between 1979 and 2004, 167 patients younger than 20 years were treated surgically for humeral or femoral unicameral bone cysts with either injection of corticosteroids (steroids), curettage plus bone grafting (curettage), or a combination injection of steroids, demineralized bone matrix, and bone marrow aspirate (SDB) at Children's Hospital of Boston and Massachusetts General Hospital (mean followup, 7.3 years; range, 1 month-27 years). Outcomes included treatment failure (defined clinically as subsequent pathologic fracture or need for retreatment to prevent pathologic fracture) and complications. Information was obtained from medical records and by telephone questionnaire. After one treatment, 84% of cysts treated with steroids experienced failed treatment versus 64% with curettage and 50% with SDB. For unicameral bone cysts requiring retreatment (regardless of first treatment), 76% retreated with steroids had failed treatment versus 63% with curettage and 71% with SDB. Curettage was associated with the lowest rate of posttreatment pathologic fractures and highest rate of pain and other complications. Multivariate logistic regression indicated treatment with steroids alone and younger age were independent predictors of failure. We believe SDB is a reasonable first treatment for unicameral bone cysts in the humerus and femur in patients younger than 20 years, being less invasive yet comparable to curettage in preventing recurrence.

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Section: Discussioncontrasting

confidence: 84%

Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 70%

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Unicameral Bone Cyst: A Retrospective Study of Three Surgical Treatments

Sung

Anderson

Zurakowski

et al. 2008

Clinical Orthopaedics &Amp; Related Research

100

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“…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. 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].…”

Section: Introductionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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

Min

Shin

Kim

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Studies have focused on intramedullary nailing of femoral simple bone cysts but have not clarified the recurrence frequency or management of recurrent cysts. In particular, the affect of pathologic fractures on cyst healing, recurrence, and complications of treatment have not been reported. Questions/purposes We performed a retrospective comparative study to examine whether there were differences between simple bone cysts in the proximal femur nailed after pathologic fracture and those without pathologic fracture in terms of (1) healing time, (2) frequency and timing of recurrence, and (3) complications.Methods From 1995 to 2005, 54 patients diagnosed with femoral simple bone cysts were treated and followed for a minimum of 8 years. Flexible nails were inserted in a retrograde fashion in 25 patients with fractures and 29 patients without fractures. The healing period, degree of radiographic consolidation based on the criteria of Capanna et al., recurrence frequency, and final bony abnormalities were analyzed. The mean followups were 107 months (range, 96-124 months) and 103 months (range, 96-140 months) in the groups with and without fractures, respectively. With the numbers available, a post hoc calculation showed that this study had 80% power to detect a difference of 7 months of healing time as significant with a probability less than 0.05.

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