Percutaneous Method of Management of Simple Bone Cyst

Abstract

Introduction. Simple bone cyst or unicameral bone cysts are benign osteolytic lesions seen in metadiaphysis of long bones in growing children. Various treatment modalities with variable outcomes have been described in the literature. The case report illustrates the surgical technique of minimally invasive method of treatment. Case Study. A 14-year-old boy was diagnosed as active simple bone cyst proximal humerus with pathological fracture. The patient was treated by minimally invasive percutaneous curettage with titanium elastic nail (TENS) and allogenic bone grafting mixed with bone marrow under image intensifier guidance. Results. Pathological fracture was healed and allograft filled in the cavity was well taken up. The patient achieved full range of motion with successful outcome. Conclusion. Minimally invasive percutaneous method using elastic intramedullary nail gives benefit of curettage cyst decompression and stabilization of fracture. Allogenic bone graft fills the cavity and healing of lesion by osteointegration. This method may be considered with advantage of minimally invasive technique in treatment of benign cystic lesions of bone, and the level of evidence was therapeutic level V.

Comparison of titanium elastic intramedullary nailing versus injection of bone marrow in treatment of simple bone cysts in children: a retrospective study

“…At our institution, a percutaneous technique is used instead of open operations such as curettage and grafting. The percutaneous technique is safe and effective; ABM, methylprednisolone acetate, cortisone, demineralized bone matrix, calcium-phosphate bone cement, and intramedullary nails can be applied to bone cysts with various results [ 1 , 6 , 18 , 19 ]. In this study, we retrospectively reviewed patients treated with ABM injection or TEN to evaluate clinical outcomes and radiographic findings.…”

“…Percutaneous drilling of multiple sites with Kirschner wires and prolonged decompression of bone cysts with cannulated screws or intramedullary nails left in place have been advocated for the treatment of bone cysts. Drilling leads to decompression and decreases the pressure within the bone cyst [ 27 , 28 ]. TEN decompresses bone cysts and breaks down the capsule wall to allow the capsule fluid to flow into the medullary cavity.…”

“…We repeatedly rotated the nail in the bone cyst to break down the structure of the capsule wall, which reduces the production of capsule fluid by the cyst and decompresses the bone cyst. Some authors have recommended performing multiple perforations of the cyst wall, breaking the intralesional septa, and/or curetting the cyst membrane [ 19 , 25 ]. Glanzmann et al [ 25 ] reported that it was unclear whether insertion of nails and consecutive decompression of bone cysts can lead to migration of pathological tissue, provoking recurrence.…”