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Elastic intramedullary nailing and DBM-bone marrow injection for the treatment of simple bone cysts.

Kanellopoulos AD, Mavrogenis AF, Papagelopoulos PJ, Soucacos PN - World J Surg Oncol (2007)

Bottom Line: The mean follow-up was 77 months (range, 5 to 8 years).All patients were pain free and had full range of motion of the adjacent joints at 6 weeks postoperatively.Until the latest examination there was no evidence of fracture or re-fracture.

View Article: PubMed Central - HTML - PubMed

Affiliation: First Department of Orthopaedics, Athens University Medical School, Athens Greece. adkanell@yahoo.com

ABSTRACT

Background: Simple or unicameral bone cysts are common benign fluid-filled lesions usually located at the long bones of children before skeletal maturity.

Methods: We performed demineralized bone matrix and iliac crest bone marrow injection combined with elastic intramedullary nailing for the treatment of simple bone cysts in long bones of 9 children with a mean age of 12.6 years (range, 4 to 15 years).

Results: Two of the 9 patients presented with a pathological fracture. Three patients had been referred after the failure of previous treatments. Four patients had large lesions with impending pathological fractures that interfered with daily living activities. We employed a ratio to ascertain the severity of the lesion. The extent of the lesion on the longitudinal axis was divided with the normal expected diameter of the long bone at the site of the lesion. The mean follow-up was 77 months (range, 5 to 8 years). All patients were pain free and had full range of motion of the adjacent joints at 6 weeks postoperatively. Review radiographs showed that all 7 cysts had consolidated completely (Neer stage I) and 2 cysts had consolidated partially (Neer stage II). Until the latest examination there was no evidence of fracture or re-fracture.

Conclusion: Elastic intramedullary nailing has the twofold benefits of continuous cyst decompression, and early immediate stability to the involved bone segment, which permits early mobilization and return to the normal activities of the pre-teen patients.

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A bony plug (arrow) may cause venous obstruction and increased pressure of the interstitial fluid that may lead to the formation of a unicameral or simple bone cyst.
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Figure 5: A bony plug (arrow) may cause venous obstruction and increased pressure of the interstitial fluid that may lead to the formation of a unicameral or simple bone cyst.

Mentions: Several authors have advocated percutaneous multiple drilling with Kirschner wires [26,41-43], or prolonged decompression of the cyst using cannulated screws left in place without corticosteroid injection [25]. The mechanism of action of percutaneous drilling and decompression of the cysts is based on the concept that the lesions are caused by the interstitial fluid that is unable to escape from the bone because of a bony plug and venous obstruction (Figure 5). Drilling leads to a continuous decompression and decrease of the internal pressure within the cyst because of drainage of fluid through the cyst wall [25,26,41,42,44,45].


Elastic intramedullary nailing and DBM-bone marrow injection for the treatment of simple bone cysts.

Kanellopoulos AD, Mavrogenis AF, Papagelopoulos PJ, Soucacos PN - World J Surg Oncol (2007)

A bony plug (arrow) may cause venous obstruction and increased pressure of the interstitial fluid that may lead to the formation of a unicameral or simple bone cyst.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2117015&req=5

Figure 5: A bony plug (arrow) may cause venous obstruction and increased pressure of the interstitial fluid that may lead to the formation of a unicameral or simple bone cyst.
Mentions: Several authors have advocated percutaneous multiple drilling with Kirschner wires [26,41-43], or prolonged decompression of the cyst using cannulated screws left in place without corticosteroid injection [25]. The mechanism of action of percutaneous drilling and decompression of the cysts is based on the concept that the lesions are caused by the interstitial fluid that is unable to escape from the bone because of a bony plug and venous obstruction (Figure 5). Drilling leads to a continuous decompression and decrease of the internal pressure within the cyst because of drainage of fluid through the cyst wall [25,26,41,42,44,45].

Bottom Line: The mean follow-up was 77 months (range, 5 to 8 years).All patients were pain free and had full range of motion of the adjacent joints at 6 weeks postoperatively.Until the latest examination there was no evidence of fracture or re-fracture.

View Article: PubMed Central - HTML - PubMed

Affiliation: First Department of Orthopaedics, Athens University Medical School, Athens Greece. adkanell@yahoo.com

ABSTRACT

Background: Simple or unicameral bone cysts are common benign fluid-filled lesions usually located at the long bones of children before skeletal maturity.

Methods: We performed demineralized bone matrix and iliac crest bone marrow injection combined with elastic intramedullary nailing for the treatment of simple bone cysts in long bones of 9 children with a mean age of 12.6 years (range, 4 to 15 years).

Results: Two of the 9 patients presented with a pathological fracture. Three patients had been referred after the failure of previous treatments. Four patients had large lesions with impending pathological fractures that interfered with daily living activities. We employed a ratio to ascertain the severity of the lesion. The extent of the lesion on the longitudinal axis was divided with the normal expected diameter of the long bone at the site of the lesion. The mean follow-up was 77 months (range, 5 to 8 years). All patients were pain free and had full range of motion of the adjacent joints at 6 weeks postoperatively. Review radiographs showed that all 7 cysts had consolidated completely (Neer stage I) and 2 cysts had consolidated partially (Neer stage II). Until the latest examination there was no evidence of fracture or re-fracture.

Conclusion: Elastic intramedullary nailing has the twofold benefits of continuous cyst decompression, and early immediate stability to the involved bone segment, which permits early mobilization and return to the normal activities of the pre-teen patients.

Show MeSH
Related in: MedlinePlus