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The modern treatment of the simple bone cysts.

Ulici A, Balanescu R, Topor L, Barbu M - J Med Life (2012)

Bottom Line: The first group included the patients who have benefited from surgical treatment (42 cases) and the second one included patients who benefited from conservative treatment.Cyst index of more than five and cortical index of less than 1 mm were significantly prone to pathological fractures and had significant poor results after treatment.Our results suggested that an autogenous bone marrow injection is a safe and effective treatment method for simple bone cysts, when compared with the surgical management, but sometimes-repeated injections are necessary.

View Article: PubMed Central - PubMed

Affiliation: Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. alexandruulici@me.com

ABSTRACT
This study was performed between 2007-2012 and encompasses 94 patients. The patients were divided in two groups. The first group included the patients who have benefited from surgical treatment (42 cases) and the second one included patients who benefited from conservative treatment. Out of the total number of cases, 63 cases showed an intact simple bone cyst that was most of the time an accidental discovery. 31 patients presented with fracture sustained on a simple bone cyst. There were 63 boys and 31 girls. Their mean age was 9.9 +/- 2.34 years. Single injection was performed for 49 patients; the rest had double or triple injections. The mean follow-up was 34.5 +/- 6.6 months. The procedure succeeded in obtaining healing in 77 cysts (82%). Cyst index of more than five and cortical index of less than 1 mm were significantly prone to pathological fractures and had significant poor results after treatment. Our results suggested that an autogenous bone marrow injection is a safe and effective treatment method for simple bone cysts, when compared with the surgical management, but sometimes-repeated injections are necessary. Cyst index and cortical width are good indicators for treatment outcome.

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Femoral bone cyst – injection’s time
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F9a: Femoral bone cyst – injection’s time

Mentions: After a brief period of time that mimed healing, we encountered the reappearance of the cyst, most of the time in the inferior pole of the old cyst. In the upper limb most of the recidivated cyst appeared in the humerus. The only surgical management that did not lead to a recidivated cyst was elastic reinforcement and osseous reconstruction with diaphysectomy. The only impediment related to simple elastic reinforcement was the period of time needed for the healing of the lesion, which proved to be very long. In the case of osseous reconstruction with diaphysectomy, this procedure is prone to a far greater morbidity rate. We recommend this kind of treatments only in the cases of conservative management failure and in cases of displaced pathological fracture. The conservative treatment consisted in simple cast immobilization of the pathological fracture localized in the upper limb and without fragment displacement, ABMI or steroid injections. The last two methods of treatment were employed only in those cases that sustained a cyst without a pathological fracture or after the healing of a previous pathological fracture, which did not lead to cyst healing. Those cases that sustained a pathological fracture localized at the level of the upper limb were successfully treated by conservative means, the result being the healing of the fracture and subsequently of the cyst. In the case of the steroid injection, we encountered 5 cases that had no response, in comparison with ABMI, in which case we encountered a 100% rate of lesion healing, even from the first injection (Fig. 9a, Fig. 9b).


The modern treatment of the simple bone cysts.

Ulici A, Balanescu R, Topor L, Barbu M - J Med Life (2012)

Femoral bone cyst – injection’s time
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3539840&req=5

F9a: Femoral bone cyst – injection’s time
Mentions: After a brief period of time that mimed healing, we encountered the reappearance of the cyst, most of the time in the inferior pole of the old cyst. In the upper limb most of the recidivated cyst appeared in the humerus. The only surgical management that did not lead to a recidivated cyst was elastic reinforcement and osseous reconstruction with diaphysectomy. The only impediment related to simple elastic reinforcement was the period of time needed for the healing of the lesion, which proved to be very long. In the case of osseous reconstruction with diaphysectomy, this procedure is prone to a far greater morbidity rate. We recommend this kind of treatments only in the cases of conservative management failure and in cases of displaced pathological fracture. The conservative treatment consisted in simple cast immobilization of the pathological fracture localized in the upper limb and without fragment displacement, ABMI or steroid injections. The last two methods of treatment were employed only in those cases that sustained a cyst without a pathological fracture or after the healing of a previous pathological fracture, which did not lead to cyst healing. Those cases that sustained a pathological fracture localized at the level of the upper limb were successfully treated by conservative means, the result being the healing of the fracture and subsequently of the cyst. In the case of the steroid injection, we encountered 5 cases that had no response, in comparison with ABMI, in which case we encountered a 100% rate of lesion healing, even from the first injection (Fig. 9a, Fig. 9b).

Bottom Line: The first group included the patients who have benefited from surgical treatment (42 cases) and the second one included patients who benefited from conservative treatment.Cyst index of more than five and cortical index of less than 1 mm were significantly prone to pathological fractures and had significant poor results after treatment.Our results suggested that an autogenous bone marrow injection is a safe and effective treatment method for simple bone cysts, when compared with the surgical management, but sometimes-repeated injections are necessary.

View Article: PubMed Central - PubMed

Affiliation: Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. alexandruulici@me.com

ABSTRACT
This study was performed between 2007-2012 and encompasses 94 patients. The patients were divided in two groups. The first group included the patients who have benefited from surgical treatment (42 cases) and the second one included patients who benefited from conservative treatment. Out of the total number of cases, 63 cases showed an intact simple bone cyst that was most of the time an accidental discovery. 31 patients presented with fracture sustained on a simple bone cyst. There were 63 boys and 31 girls. Their mean age was 9.9 +/- 2.34 years. Single injection was performed for 49 patients; the rest had double or triple injections. The mean follow-up was 34.5 +/- 6.6 months. The procedure succeeded in obtaining healing in 77 cysts (82%). Cyst index of more than five and cortical index of less than 1 mm were significantly prone to pathological fractures and had significant poor results after treatment. Our results suggested that an autogenous bone marrow injection is a safe and effective treatment method for simple bone cysts, when compared with the surgical management, but sometimes-repeated injections are necessary. Cyst index and cortical width are good indicators for treatment outcome.

Show MeSH
Related in: MedlinePlus