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.     

Steroid injection of a unicameral bone cyst of the calcaneus: literature review and two case reports

Two interesting cases are presented, describing the diagnosis and treatment of unicameral bone cysts of the calcaneus. The first case report presents a patient who had a 5-month history of a painful right heel. The pain had been getting progressively worse and was aggravated by prolonged walking and physical activity. The second case report presents a patient whose unicameral bone cyst was discovered as a relatively incidental finding on radiographs; however, the patient later admitted that he had mild tenderness upon the plantar-lateral aspect of his right calcaneus with weightbearing. The authors reviewed the literature concerning the etiology and treatment of unicameral bone cysts. Attention is directed to the use of injectable steroid as an alternative means to open surgical intervention. Certain potential problems exist, in spite of the various surgical approaches utilized, including infection, postoperative fracture, recurrence, immobilization, and prolonged hospitalization.     

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.     

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.     

Outpatient surgery of a unicameral bone cyst of the calcaneus

The trend in medicine is toward increasing surgical procedures being performed on an outpatient basis. The authors present their clinical findings, differential diagnosis, and surgical treatment plan utilizing an allograft of freeze-dried cortical and cancellous bone for a unicameral bone cyst of the calcaneus treated on an outpatient basis.     

Treatment of active unicameral bone cysts with percutaneous injection of demineralized bone matrix and autogenous bone marrow

BACKGROUND: The treatment of unicameral bone cysts varies from open bone-grafting procedures to percutaneous injection of corticosteroids or bone marrow. The purpose of this study was to evaluate the feasibility and effectiveness of percutaneous injection of a mixture of demineralized bone matrix and autogenous bone marrow for the treatment of simple bone cysts. METHODS: Twenty-three patients with an active unicameral bone cyst were treated with trephination and injection of allogeneic demineralized bone matrix and autogenous bone marrow. The patients were followed for an average of fifty months (range, thirty to eighty-one months), at which time pain, function, and radiographic signs of resolution of the cyst were assessed. RESULTS: The average time until the patients had pain relief was five weeks, and the average time until the patients returned to full, unrestricted activities was six weeks. Bone-healing at the site of the injection was first seen radiographically at three to six months. No patient had a pathologic fracture during this early bone-healing stage. Cortical remodeling was seen radiographically by six to nine months, and after one year the response was usually complete, changing very little from then on. Five patients required a second injection because of recurrence of the cyst, and all five had a clinically and radiographically quiescent cyst after an average of thirty-six additional months of follow-up. Seven of the twenty-three patients had incomplete healing manifested by small, persistent radiolucent areas within the original cyst. None of these cysts increased in size or resulted in pain or fracture. CONCLUSIONS: Percutaneous injection of allogeneic demineralized bone matrix and autogenous bone marrow is an effective treatment for unicameral bone cysts.     

Treatment of unicameral calcaneal bone cysts in children: review of literature and results using a cannulated screw for continuous decompression of the cyst

Nine unicameral bone cysts of the calcaneus in children were managed surgically using the technique of continuous decompression with titanium cannulated cancellous screws. The average age of the patients at surgery was 12.8 years. At follow-up a minimum of 2 years after surgery, eight cysts showed complete healing; one patient showed healing with residuals. Irritation at the screw insertion site necessitated early removal of the screw in one patient; implant-related problems were not observed in the other patients. Patients were allowed to bear weight after surgery. Implant extraction was performed after full consolidation of the cyst and was uneventful in all patients. A review of the literature and the different treatment modalities used for managing calcaneal cysts is also presented.     

BMP复合牛骨胶原液经皮囊内注射治疗孤立性骨囊肿的初步报告

目的：观察经皮囊内注射BMP复合牛骨胶原液移植治疗孤立性骨囊肿的治疗结果。方法：在X线机电视屏引导下，用骨穿针刺入骨囊腔内，抽去囊液后，平均注入复合胶原液量34ml(20-40ml)。临床治疗8例孤立性骨囊肿，5例位于肱骨近端，2例位于股骨近端，1例位于髌骨。结果 7例骨囊腔平均愈合时间5－6个月（3－8个月），无并发症发生。结论 ：BMP复合牛骨胶原液囊内注射移植治疗孤立性骨囊肿是一种简单、有效、安全性高的方法。     

Chondromyxoid Fibroma of the Calcaneus: Two Case Reports and Literature Review

Chondromyxoid fibroma occurs primarily in the long tubular bones of the lower extremity, with the foot representing the second most frequent location after the knee. This benign cartilaginous tumor of bone is currently the rarest reported neoplasm of cartilaginous origin. This mass can mimic other benign and malignant bone tumors owing to its variable histologic features. We report 2 cases of chondromyxoid fibroma of the calcaneus with varying presentations. Initially, advanced imaging studies pointed to a diagnosis of a unicameral bone cyst. Pathologic examination is difficult but can be used to differentiate this lesion from more serious conditions. A quick and accurate diagnosis of chondromyxoid fibroma can prevent unnecessary treatment that could be harmful to the patient.     

Unicameral bone cyst in the scapula of an adolescent

Unicameral bone cysts of the scapula have been reported mainly in adult patients. The atypical location of the unicameral bone cyst in a 12-year-old girl presented a diagnostic dilemma. Curettage proved to be an effective method for both diagnosis and treatment of this benign lesion.     

Calcaneal cyst: a classical simple bone cyst?

INTRODUCTION: In the calcaneus differentiation between a solitary cyst and intraosseus lipoma is difficult. Radiologists frequently diagnose an intraosseus lipoma, whereas histology shows the classical signs of a solitary bone cyst. We present 12 cases of a solitary cyst of the calcaneus. MATERIAL AND METHODS: Between 1993 and 2001 we operated on 12 patients (8 men, 4 women, median age 28 +/- 14 years) with calcaneal cysts. 9 patients received a curretage and an autologous, one patient a homologous, one patient a mixed autologous-homologous bone-grafting and one patient only a curretage (due to the small diameter of the cyst) of their cysts. RESULTS: No case revealed the histological picture of a fatty formation, which appears to be typical for an intraosseus lipoma. All of the microscopic findings resembled the characteristics seen in cysts of the long bones. A pathological fracture has not been observed. CONCLUSION: The histologically confirmed calcaneal cysts showed the radiological signs that are supposed to be typical for an intraosseous lipoma. It cannot be decided whether the histologically diagnosed calcaneal lipomas described by others can be interpreted as fatty degeneration of a calcaneal cyst, or whether fatty areas of the bone marrow have given a wrong impression. Since the literature only describes single isolated cases of a pathological fracture of the calcaneal cyst or lipoma, asymptomatic patients should be treated non-operatively.     

Lipome intraosseux du calcanéus : à propos d’une observation

Intraosseous lipoma of the calcaneus is a rare, benign, primary bone lesion, frequently misdiagnosed as other tumours, especially unicameral bone cysts. We present the case of a 48-year-old member of the armed services who was diagnosed with intraosseous lipoma of the calcaneus and discuss the clinical presentation and treatment choice.     

Minimal invasive surgery for unicameral bone cyst using demineralized bone matrix: a case series

ABSTRACT: BACKGROUND: Various treatments for unicameral bone cyst have been proposed. Recent concern focuses on the effectiveness of closed methods. This study evaluated the effectiveness of demineralized bone matrix as a graft material after intramedullary decompression for the treatment of unicameral bone cysts. METHODS: Between October 2008 and June 2010, twenty-five patients with a unicameral bone cyst were treated with intramedullary decompression followed by grafting of demineralized bone matrix. There were 21 males and 4 female patients with mean age of 11.1 years (range, 3-19 years). The proximal metaphysis of the humerus was affected in 12 patients, the proximal femur in five, the calcaneum in three, the distal femur in two, the tibia in two, and the radius in one. There were 17 active cysts and 8 latent cysts. Radiologic change was evaluated according to a modified Neer classification. Time to healing was defined as the period required achieving cortical thickening on the anteroposterior and lateral plain radiographs, as well as consolidation of the cyst. The patients were followed up for mean period of 23.9 months (range, 15-36 months). RESULTS: Nineteen of 25 cysts had completely consolidated after a single procedure. The mean time to healing was 6.6 months (range, 3-12 months). Four had incomplete healing radiographically but had no clinical symptom with enough cortical thickness to prevent fracture. None of these four cysts needed a second intervention until the last follow-up. Two of 25 patients required a second intervention because of cyst.     

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.     

Tumors of the footbones- a report from the Hamburg Bone Tumor Registry

Aim of the present study was a systematic examination of the tumors of the foot registered in the Hamburg Bone Tumor Registry regarding age, sex, location, diagnosis and morphological characteristics. The registry files and histological specimens of 367 tumors and tumor-like lesions of the foot were reviewed. Males were more frequently affected (ratio 4 : 3). Some 20.4 % of all mass forming tumors were malignant. Cartilage tumors (146 cases), cystic (132 cases) and osteoblastic lesions (33 cases) were most common. Several tumors showed a strong predilection for certain parts of the foot. In the calcaneus a solitary bone cyst was the most common lesion. Lesions in the talus and metatarsals with a similar morphology mostly represented intraosseous ganglion cysts. Other tumors in the calcaneus were mainly cartilaginous. Besides chondroblastoma, chondrosarcoma was regularly diagnosed. Chondroma was extremely rare at this site. Contrary to that chondroma was regularly found at the metatarsal and phalangeal bones, it was 4 times more common than chondrosarcoma. An even distribution showed aneurysmal bone cysts and osteoidosteoma. Very rare lesions were fibrous dysplasia, eosinophilic granuloma and intraosseous lipoma. The knowledge of the distribution of tumors in the foot is important for an exact differential diagnosis and thereby for biopsy planning, diagnosis and therapy.     

Unicameral bone cyst with fracture

In this paper we have presented a 13-year-old boy whose unicameral bone cyst of the proximal humerus was, after sustaining a pathological fracture, obliterated with conservative management of the fracture. The literature is uncertain as to how many similar cases will go on to refracture union and cyst resolution. Therefore, we feel that invasive procedures should be delayed until the fracture heals. If healing of the cyst is not evident at six to eight weeks and if the cyst is small and monoloculated or adjacent to the growth plate, methylprednisolone acetate would be a recommended procedure. In cases of larger and/or multiloculated cysts or cysts that resist steroidal treatment, curettage and bone grafting is warranted.     

Continuous decompression of unicameral bone cyst with cannulated screws: a comparative study

We determined the role of mechanical decompression in the resolution of unicameral bone cyst. A total of 69 children with unicameral bone cysts were treated either by (i) open curettage and bone grafting, (ii) steroid injection or (iii) cannulated screw insertion. During a mean follow-up of 69 months (range, 12-58), the cysts were evaluated by radiological criteria. The healing rates in the three groups were 25, 12 and 29% after the first treatment, and a further 50, 19 and 65% after the second. The study has demonstrated the advantages of the decompression technique for unicameral bone cysts over other treatment modalities studied.     

Solitary calcaneal bone cyst in children]

The author presents results of treatment 10 children with calcaneal bone cyst. The mean age in the time of diagnosis was 13.5 years (10-18 years). The mean follow-up was 23.7 months (12-48 months). 4 children complained of heel pain; the rest were asymptomatic. In one child the cyst was large, filled nearly all bone. The rest were typically localized in the antero-middle part of the calcaneus. Steroid injection in one patient failed. All the patient were treated with curettage and bone grafting. The results were good--all the cysts healed. Curretage and bone grafting is indicated in the cases when cyst is large (more than half of the bone), when is localized in the posterior weight-bearing part of the calcaneus, when is painful or the radiograph is not typical.     

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。