Fractures in benign bone cysts

Etiology, clinical manifestations, roentgenographic appearance and histological variations of solitary and aneurysmatic bone cyst are reported. The classification of solitary bone cyst into active and inactive cysts is important therefore prognosis and treatment are different. The critical control of our patients with fractured solitary and aneurysmatic bone cysts since 1973 resulted in a very contenting management of treatment. Active solitary bone cysts, recurrent cysts, fractured cysts and large cysts close to joints are treated by segmental resection, interposing of ribs, homologous or autogenous cancellous bone graft and plate osteosynthesis. We never found recidives under this treatment. The only curettage of active solitary bone cyst frequently is accompanied by recidive and unsatisfying functional results. Reports of local corticoid injections in treatment of bone cysts should be furthermore controlled critical.     

Diagnosing aneurysmal and unicameral bone cysts with magnetic resonance imaging

The differential between aneurysmal bone cysts and unicameral bone cysts usually is clear clinically and radiographically. Occasionally there are cases in which the diagnosis is not clear. Because natural history and treatment are different, the ability to distinguish between these two entities before surgery is important. The authors reviewed, in a blinded fashion, the preoperative magnetic resonance images to investigate criteria that could be used to differentiate between the two lesions. All patients had operative or pathologic confirmation of an aneurysmal bone cyst or unicameral bone cyst. The authors analyzed the preoperative magnetic resonance images of 14 patients with diagnostically difficult bone cysts (eight children with unicameral bone cysts and six children with aneurysmal bone cysts) and correlated these findings with diagnosis after biopsy or cyst aspiration and contrast injection. The presence of a double density fluid level within the lesion strongly indicated that the lesion was an aneurysmal bone cyst, rather than a unicameral bone cyst. Other criteria that suggested the lesion was an aneurysmal bone cyst were the presence of septations within the lesion and signal characteristics of low intensity on T1 images and high intensity on T2 images. The authors identified a way of helping to differentiate between aneurysmal bone cysts and unicameral bone cysts on magnetic resonance images. Double density fluid level, septation, and low signal on T1 images and high signal on T2 images strongly suggest the bone cyst in question is an aneurysmal bone cyst, rather than a unicameral bone cyst. This may be helpful before surgery for the child who has a cystic lesion for which radiographic features do not allow a clear differentiation of unicameral bone cyst from aneurysmal bone cyst.     

Aneurysmal Bone Cyst of the Talus

Aneurysmal bone cysts localized in the talus are extremely rare. Such a case is described and the histological findings are analysed in relation to those in aneurysmal bone cysts in general. The pathomechanism of the lesion is discussed.     

Simple bone cysts of the calcaneus: a report of five cases and a review of the literature

BACKGROUND: Simple bone cysts of the calcaneus are relatively uncommon. There is no clear consensus on either their etiology or management. Pathological fractures of such cysts are exceptionally rare. MATERIALS AND METHODS: Five simple bone cysts of the calcaneus were present in three males and two females with an average age of 44 years. One patient presented with pain, three cysts were incidental findings on ankle radiographs, and one patient presented with a fracture after a significant fall. RESULTS: All five were managed nonoperatively and had satisfactory outcomes. CONCLUSIONS: A review the literature on the etiology and management of simple bone cysts of the calcaneus and the outcomes of these patients indicate that complications of these cysts are rare and nonoperative management is appropriate.     

The distribution of bone islands and juxta-articular bone cysts in the growing hand

Bone islands and juxta-articular bone cysts are relatively common incidental findings when X-rays are taken for other purposes. We have identified that the incidence of bone islands in the hands of asymptomatic children between the ages of 5 and 13 years is 3.8% and the incidence of cysts in the same population is 2.8%. Bone islands were most common in the scaphoid, whilst juxta-articular bone cysts were most common in the capitate. The age at which they appear has not been reported previously. This study first identifies their presence in the hands of children of age 10 years and 2 months (bone islands) and 10 years 0 months (juxta-articular bone cysts). Most of the lesions were already present on the first radiograph taken. New bone islands appeared in five cases between the ages of 13 years and 1 month and 15 years and 3 months. New juxta-articular bone cysts were observed to appear in five cases between the ages of 10 years 10 months and 15 years 0 months. No island or cyst changed in size during the review period.     

Spontanheilung einer juvenilen Knochenzyste der Tibia nach pathologischer Fraktur

Up to the present only few cases of spontaneous healing of juvenile bone cysts after pathological fractures were published. Most authors will not accept the possibility of a "healing fracture" in bone cysts because of missing documentation. In our clinic we could observe spontaneous healing of a juvenile bone cyst of the tibia after a pathological fracture in a ten-year old boy. Therefore healing of bone cysts after fracture is proven. On the other hand healing of bone cysts following conservative treatment after a fracture is not sure. Conservative treatment depends on the localization and type of the fracture. We recommend nonoperative treatment of first pathological fractures in small-sized bone cysts. This kind of treatment can be especially advised for young patients up to the tenth year because there are only few complications in fracture healing and a relatively high recurrence rate following operative treatment. In case of a refracture there are better conditions for fracture healing after surgery.     

A new treatment of aneurysmal bone cyst by endoscopic curettage without bone grafting

Curettage and bone grafting are the accepted methods of treatment of aneurysmal bone cysts. Unfortunately, recurrence is common. We treated 4 patients with atypical aneurysmal bone cysts that lacked aneurysmal dilatation by endoscopic curettage without bone grafting. New bone formation and remodeling were observed in all patients. In the patients in whom the follow-up was longer than 30 months, there was no evidence of recurrence. Endoscopic curettage without bone grafting is a simple and effective treatment for aneurysmal bone cysts.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 7 (September), 2001: E28     

Surgical management of calcaneal unicameral bone cysts

Unicameral bone cysts are not seen commonly in the calcaneus. Little is known about the etiology and natural history of these lesions. Calcaneal cysts often are symptomatic, although some of these lesions are detected as incidental findings. Treatment has been advocated based on the fear of pathologic fracture and collapse. Several published series have been divided in their favor for either open treatment or injection management. These series are small, and the optimal treatment is still in question. The current study compared the efficacy of methylprednisolone acetate injection treatment with curettage and bone grafting in the treatment of unicameral bone cysts of the calcaneus. All patients treated for unicameral bone cysts of the calcaneus during the past 7 years at two institutions were reviewed. Eleven patients met inclusion criteria. All diagnoses were confirmed radiographically or histologically. Demographic information, presenting complaints, diagnostic imaging, treatment modalities, and outcome were analyzed. Long term radiographic and subjective followup was obtained. Eighteen surgical procedures were performed on 11 patients with 12 cysts. Nine injections performed on six patients failed to show healing of the cyst. Nine cysts treated with curettage and bone grafting showed cyst healing. At mean followup of 28 months (range, 12-77 months), all 11 patients had no symptoms; there were no recurrences of the cyst in the nine patients who underwent bone grafting and persistence of the cyst in the two patients who underwent injection therapy. This review reports one of the largest series of cysts in this location. The results indicate that steroid injection treatment, although useful in other locations, may not be the best option for the management of unicameral bone cysts in the calcaneus. Curettage and bone grafting yielded uniformly good results.     

A study of 23 unicameral bone cysts of the calcaneus: open chip allogeneic bone graft versus percutaneous injection of bone powder with autogenous bone marrow

BACKGROUND: The treatment of unicameral bone cyst varies from percutaneous needle biopsy, aspiration and local injection of steroid, autologous bone marrow, or demineralized bone matrix to curettage and open bone-grafting. The purpose of this study was to compare the results of open chip allogeneic bone graft versus percutaneous injection of demineralized bone powder with autogenous bone marrow in management of calcaneal cysts. MATERIALS AND METHODS: Twenty-three calcaneal unicameral cysts in 20 patients were treated. Lyophilized irradiated chip allogeneic bone (CAB) and autogenous bone marrow were used for treatment of 13 cysts in 11 patients, and 10 cysts in 9 patients were treated with percutaneous injection of irradiated allogeneic demineralized bone powder (DBP) and autogenous bone marrow. There were 11 males and 9 female patients with mean age of 17 years. RESULTS: The patients were followed for an average of 49.4 months. Complete healing was achieved in 9 cysts treated with chip allogeneic bone and in 5 cysts treated with powdered bone. Four cysts treated with CAB and 3 cysts treated with DBP healed with a defect. Two cysts treated with powdered bone and autogenous bone marrow were classified as persistent. No infections or pathological fractures were observed during the followup period. CONCLUSION: Percutaneous injection of a mixture of allogeneic bone powder with autogenous bone marrow is a minimal invasive method and could be an effective alternative in the treatment of unicameral calcaneal bone cysts. The postoperative morbidity was low, the hospital stay was brief, and patient's comfort for unrestricted activity was enhanced.     

Solitary bone cyst of the os calcis. 2 Case reports and review of the literature

The calcaneus is a uncommon site for a unicameral solitary bone cyst. However, because of the concentration of forces through the heel, such solitary bone cysts are usually symptomatic, depending on the proximity to the joint and the size of the cyst and therefore require in most cases surgical treatment. This is a report about two patients with a solitary bone cyst of the os calcis in 1996 and 1997. The diagnosis was confirmed radiologically and histologically. The standard therapie in both cases was the curretage of the cyst by packing the defect with bone graft from the pelvis. The author reviewed the literature concerning ethiology, diagnosis and treatment of unicameral solitary bone cysts of the calcaneus. The diagnosis cannot be based solely on radiological findings because of the variation of solitary bone cysts and the special forms, such as calcifying solitary bone cysts. Therefore exact histological diagnosis is of particular importance.     

Solitary bone cyst of the os calcis. 2 Case reports and review of the literature Falldarstellung und Literaturübersicht

The calcaneus is a uncomon site for a unicameral solitary bone cyst. However, because of the concentration of forces through the heel, such solitary bone cysts are usually symptomatic, depending on the proximity to the joint and the size of the cyst and therefore require in most cases surgical treatment. This is a report about two patients with a solitary bone cyst of the os calcis in 1996 and 1997. The diagnosis was confirmed radiologically and histologically. The standard therapie in both cases was the curretage of the cyst by packing the defect with bone graft from the pelvis. The author reviewed the literature concerning ethiology, diagnosis and treatment of unicameral solitary bone cysts of the calcaneus. The diagnosis cannot be based solely on radiological findings because of the variation of solitary bone cysts and the special forms, such as calcifying solitary bone cysts. Therefore exact histological diagnosis is of particular importance.     

Aneurysmal bone cyst of the rib.

Aneurysmal bone cysts are uncommon lesions, especially in the ribs. Four patients with aneurysmal bone cysts of the rib are presented and previously reported cases reviewed. A brief discussion of the clinical manifestations, pathology, aetiology, and current treatment of aneurysmal bone cyst is also included.     

Aneurysmal Bone Cysts Recur at Juxtaphyseal Locations in Skeletally Immature Patients

Aneurysmal bone cysts are associated with a high rate of recurrence. Many aneurysmal bone cysts arise near open physes or articular cartilage in skeletally immature patients. Fear of damaging these structures could cause surgeons to curette the tumors less aggressively. We hypothesized location of an aneurysmal bone cyst in a periarticular or juxtaphyseal location would increase the risk of recurrence. We retrospectively studied 53 patients with aneurysmal bone cysts treated between 1989 and 2004. All patients had primary disease, and all patients underwent curettage of the lesion. Ten patients (18.9%) had local recurrence. Gender, race, and size did not predict recurrence; however 12 years of age or younger was associated with recurrence. Of the 19 juxtaphyseal cysts directly adjacent to an open physis, eight developed recurrence. Of the five periarticular cysts, two developed recurrence. The data suggest the risk of recurrence is highest in pediatric patients with juxtaphyseal or periarticular aneurysmal bone cysts. Meticulous treatment of these cysts is necessary, but we believe an overly aggressive approach that destroys the physis or articular cartilage is not warranted. Preservation of these structures remains a high priority of treatment.     

Bilateral symmetrical cysts in the upper tibiae in a skeletally mature patient: might they be simple bone cysts?

A 55-year-old Japanese woman presented with right knee pain of 1-month duration. Radiological studies revealed bilateral mild osteoarthritic changes in the medial knee joint compartment and symmetrical cysts in the upper tibial metaphyses, extending to the epiphyses. Intraosseous ganglion was considered the most probable diagnosis. However, intraoperatively, serous fluid-filled cavities were recognized; these were curetted and filled with hydroxyapatite granules. Histopathological examination of the cyst wall revealed thin fibrous tissue formed of collagen fibers without a lining cell layer, with scattered lymphocytes, histiocytes, irregular masses of fibrin-like material, and periosteal osteocartilagenous callus formation; a picture compatible with simple bone cysts. Bilateral symmetrical cysts of the upper tibial metaphyses extending to the epiphyses are extremely rare. A literature review revealed that the age incidence, and bony locations of multiple and epiphyseal simple bone cysts are atypical in relation to the classic metaphyseal simple bone cysts. Also, multiple and epiphyseal simple bone cysts have a better prognosis than the classic metaphyseal ones. Four clinicoanatomic varieties of simple bone cysts are recognized; classic metaphyseal, nontubular, epiphyseal, and multiple.     

Bilateral unicameral bone cysts in the hamate bones

This is a case report of bilateral unicameral bone cysts located in the hamate bones of a 22-year-old man. Unicameral bone cysts are rarely seen in the bones of the hand or bilaterally. In this case the diagnosis was made clinically using both radiographic and magnetic resonance imaging studies, and verified by microscopy of the biopsied specimen. Treatment consisted of curettage, autogenous bone grafting, and immobilization. To our knowledge there has not been any record in the literature of symmetrical unicameral bone cysts in the carpal bones.     

Treatment of aneurysmal bone cysts in childhood

Twenty-five aneurysmal bone cysts were treated by curettage, saucerization, or resection. Healing occurred in all cysts of the long bones that were treated by saucerization and bone grafting or by resection and bone grafting. However, healing occurred in only half of the cysts of the long bones that were treated by curettage and bone grafting. In contrast, removal of the soft tissue contents from cysts of the pelvis, without curettage of bone or bone grafting, was sufficient to initiate healing. Although there was an apparent difference in the behavior of cysts of the long bones and pelvis, it is likely that the essential component of treatment at both sites is to remove the vascular soft tissue from the cyst.     

Minimally Invasive Bone Grafting of Cysts of the Femoral Head and Acetabulum in Femoroacetabular Impingement: Arthroscopic Technique and Case Presentation

Femoroacetabular impingement (FAI) has been recently established as a risk factor in the development of osteoarthritis of the hip. Intraosseous cysts are commonly seen on imaging of FAI. In most cases these cysts are incidental and do not require specific treatment at the time of surgical treatment of hip impingement. However, in some cases the cysts may mechanically compromise the acetabular rim or femoral neck. We present a technique for treating such cysts with an all-arthroscopic technique using a commercially available bone graft substitute composed of cancellous bone and demineralized bone matrix placed within an arthroscopic cannula for direct delivery into the cysts. This technique may be of benefit to surgeons treating FAI with an all-arthroscopic technique.     

Benigne zystische Knochenläsionen

Background

Bone cysts are benign tumor-like lesions which often present as a fluid-containing cavity in the bone. They can occur in the skeletal bone as solitary or sometimes multiple bone lesions.

Objectives

This review discusses the diagnostics, radiological appearance and therapeutic strategies of the most important benign cystic bone lesions, such as simple bone cysts, aneurysmal bone cysts, intraosseous ganglia, epidermoid cysts and subchondral cysts. The differential diagnoses with respect to cystoid formations and tumors with cystic components are discussed.

Method

A selective literature search was performed taking own experiences into consideration.

Results

These tumor-like lesions can have the radiological appearance of bone tumors but show no autonomic, stimulus-independent growth and can resolve spontaneously. In the majority of cases open biopsy is necessary to confirm the diagnosis. In some cases no surgical intervention is necessary (e.g. do not touch and leave me alone lesions), whereas in other cases the focus of treatment is on the prevention and therapy of pathological fractures as well as prevention of recurrence.

Conclusion

Cystic bone formations are among the most commonly occurring non-traumatic bone lesions. To eliminate differential diagnostic unclarity, histological investigation of biopsy material is essential. In terms of surgical intervention there exists a trend towards multimodal therapy mostly based on a meticulous curretage.     

经皮囊内注射移植自体骨髓治疗单房性骨囊肿的初步报告

目的报道经皮囊内注射移植自体骨髓治疗８例单房性骨囊肿的疗效。方法保守治疗８例单房性骨囊肿,男５例,女３例,平均年龄１０岁５个月（７～１８岁）。５例位于肱骨近端,２例位于股骨颈,１例位于股骨干。抽去囊液后注入从髂骨吸取的骨髓。结果平均用骨髓３５ｍｌ（３０～６５ｍｌ）。５ｍｌ组每个穿刺点骨髓有核细胞为（５８５±２９９）×１０９／Ｌ。计算机测量平均囊腔面积为１０９００４ｍｍ２。未见手术并发症发生。下肢治疗６周后去石膏逐渐负重。治疗后６个月内Ｘ线片示所有囊腔骨化,随访６～１７个月,平均１１个月,骨愈合满意,未见并发症发生。结论经皮囊腔内注射移植自体骨髓治疗单房性骨囊肿有效。     

Clinical relevance of calcaneal bone cysts: a study of 50 cysts in 47 patients

The clinical relevance and nature of calcaneal cysts is controversial. The risk of pathologic fracture is undefined and diagnostic criteria to differentiate between cysts in patients who can be treated nonoperatively and patients who require surgical intervention are not available. To address these questions, 50 calcaneal bone cysts in 47 patients were evaluated. The majority of cysts (40 of 50) were asymptomatic and were treated nonoperatively. Cysts reaching a critical size, defined as 100% intracalcaneal cross section in the coronary plane and at least 30% in the sagittal plane, are at risk for becoming symptomatic and at risk for fracture. Fracture is a significant complication and occurred in four of 47 patients, three of whom were treated by open reduction internal fixation and bone grafting. In addition, six patients with symptomatic critical size cysts without apparent fracture were treated by curettage and subsequent autogenous bone grafting or calcium-phosphate cement filling, and there were no recurrences. We report one of the largest series of cysts in the calcaneus. The results suggest that calcaneal cysts are clinically relevant because of the potential risk of fracture and that size is a significant factor in terms of the treatment of the cyst.