The Choice of Treatment for Simple Bone Cysts of the Upper Third of the Femur in Children

Abstract

A retrospective study of a series is presented of 19 simple cysts of the upper third of the femur in children of a mean age of 7 years. The patients included 4 adolescents and 15 children under the age of 10. Mean recurrence was 6 years. Different treatment methods were utilized: - surgical treatment: curettage-bone grafting with or without osteosynthesis, - intra-cystic corticoid injection, - orthopedic treatment. Cysts may be small with a low lytic potential, in this case intra-cystic corticoid injections are very effective; or bigger in size with a risk of fracture or have already caused a fracture, the treatment is then surgical but should always be combined with osteosynthesis.

Treatment for unicameral bone cysts in long bones: an evidence based review

“…Gennari et al 27 retrospectively compared steroid injection (n=3), curettage and bone grafting and osteosynthesis (n=10), rupture of cyst without osteosynthesis (n=5), and observation (or “orthopedic treatment”) (n=2) in cysts in the upper third of the femur with a follow-up of six years. There was no difference in rates of healing between treatment groups (P=0.08).…”

“…Fracture(s) in this area may result in physeal damage, coxa vara, extremity shortening or avascular necrosis. 27,36 As cysts rarely heal following fracture, 36,37 risk of refracture leads to restriction of physical activities. As failure to achieve radiographic healing within the first year following presentation increases the risk of refracture, 38 the goal of treatment is to stabilize the fracture and treat the cyst simultaneously.…”

“…32 A less intrusive technique, intralesional steroid injections, 13 became a common treatment modality for many years with rates of healing ranging from 41–90%. 8,13,27,32,33,46 In 1996, Lokiec et al 14 published a preliminary study on bone marrow injections reporting that all ten cysts demonstrated radiographic healing. Subsequent reported rates of healing using bone marrow injections ranged from 42–100%.…”

Mid-term results of treatment with curettage and grafting in tumor-like cysts of long bones

“…In addition to the curettage and bone grafting, they also used argon beam coagulation as an adjuvant, and reported that they did not found any recurrence (34). Therefore, recurrence was very common after the intra-lesional curettage and bone grafting interventions (35). No recurrence was observed in our patients with FD who were operated in our clinic.…”

“…Later on, these two techniques were compared in many studies, and it could not be shown that which method is superior (21)(22)(23). In 1995, Gennari et al (35) compared the osteosynthesis technique with the abovementioned two techniques; however, they did not see any differences in the results. Then, Bensahel et al (24) claimed that the resection and myoplasty techniques were superior to the steroid injection.…”