Conservative Management in Simple Bone Cyst

Ji Youn Kim; Yong Jin Cho; Kyoo-Ho Shin

doi:10.5292/jkbjts.2011.2.17.51

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Kim, Cho, and Shin: Conservative Management in Simple Bone Cyst

Original Article

J Korean Bone Joint Tumor Soc 2011;17(2):51-57.

Published online: 10 January 2011

DOI: https://doi.org/10.5292/jkbjts.2011.2.17.51

Conservative Management in Simple Bone Cyst

Ji Youn Kim, M.D., Yong Jin Cho, M.D., Kyoo-Ho Shin, M.D.

Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea

Correspondence to: Kyoo-Ho Shin, M.D. Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea TEL: +82-2-2228-2180 FAX: +82-2-363-1139 E-mail: qshin@yuhs.ac

Received 28 October 2011 Revised 23 November 2011 Accepted 2 December 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study evaluated the results of conservative treatment for simple bone cyst.

Materials and Methods

We studied 126 cases of simple bone cyst, which were treated by observation or steroid injection from February 1990 to May 2010. Their mean age at diagnosis was 14 years (±9 years, 2–60 years) and the mean follow-up duration for this study were 41 months (±37 months, 12–159 months). Observation and steroid injection was applied for conservative management of simple bone cyst and results was scored by modified Neer classification.

Results

31 cases (24.6%) were treated by observation and 95 cases (75.4%) were treated by steroid injection. The 95 patients were treated by a mean of 1.1 (±0.9, 0–4) steroid injections and a single steroid injection was given in 65 cases (51.6%). The 102 cases (80.9%) were resulted in modified Neer classification I and II which could be considered as healing of simple bone cyst.

Conclusion

Conservative management can be considered as an initial treatment for simple bone cyst with good result.

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Keywords: simple bone cyst, conservative management, observation, steroid injection

References

1. Di Bella C, Dozza B, Frisoni T, Cevolani L, Donati D. Injection of demineralized bone matrix with bone marrow concentrate improves healing in unicameral bone cyst. Clin Orthop Relat Res. 2010; 468:3047–55.

2. Cohen J. Etiology of simple bone cyst. J Bone Joint Surg Am. 1970; 52:1493–7.

3. Cohen J. Unicameral bone cysts. a current synthesis of reported cases. Orthop Clin North Am. 1977; 8:715–36.

4. Fahey JJ, O'Brien ET. Subtotal resection and grafting in selected cases of solitary unicameral bone cyst. J Bone Joint Surg Am. 1973; 55:59–68.

5. Spence KF Jr, Bright RW, Fitzgerald SP, Sell KW. Solitary unicameral bone cyst: treatment with freeze-dried crushed cortical-bone allograft. A review of one hundred and forty-four cases. J Bone Joint Surg Am. 1976; 58:636–41.

6. Neer CS 2nd, Francis KC, Marcove RC, Terz J, Carbonara PN. Treatment of unicameral bone cyst. A follow-up study of one hundred seventy-five cases. J Bone Joint Surg Am. 1966; 48:731–45.

7. Capanna R, Dal Monte A, Gitelis S, Campanacci M. The natural history of unicameral bone cyst after steroid injection. Clin Orthop Relat Res. 1982; 166:204–11.

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Figure 1.

Simple bone cyst of the proximal humerus in a 7-year-old boy treated by observation only. (A) Plain radiograph shows a simple bone cyst at first visit. (B, C) Bone consolidation and remodeling are visible at serial follow-up. (D) At the age of 11 years, Modified Neer classification was Grade I.

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Figure 2.

Simple bone cyst of the proximal femur in a 11-year-old boy treated by steroid injection. (A) Fluoroscopic image showing placement of the spinal needle into the cyst. (B) Multilocular simple bone cyst was visible after injection of contrast agent.

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Table 1.

Site of the Lesion

Site and location	No. of cases	%
Humerus: proximal metaphysis	36	28.6
Humerus: diaphysis	24	19.0
Femur: proximal metaphysis	34	27.0
Femur: diaphysis	2	1.6
Femur: distal metaphysis	2	1.6
Calcaneous	26	20.6
Others (Patella, Pelvis)	2	1.6
Total	126	100

Table 2.

Modified Neer Classification of Radiologic Results

Score	Classification	Description	Treatment
I	Healed	Cyst filled with new bone, with or without small radiolucent area(s) <1 cm in size	Not necessary
II	Healed with defects	Radiolucent area(s) <50% of the diameter of the bone with enough corical thickness to prevent fracture	Not necessary
III	Persistent cyst	Radiolucent area(s) >50% of the diameter of the bone with a thin cortical rim; no increase of the size of the cyst	Continued restriction of activity, possible repeated treatment required
IV	Recurrent or nonresponsive cyst	Cyst reappeared in a previously obliterated area or a radiolucent area has increased in size	Need for repeated treatment

Table 3.

Clinical Results of Solitary Bone Cyst Following Conservative Management

	No. of cases	%
Activity of growth plate at 1^st visit
Open	48	38.1
Closed	58	46.0
NA	16	12.7
Transverse occupation at 1^st visit
>90%	54	42.9
50–90%	31	24.6
<50%	11	8.7
Treatment
Only F/U	31	24.6
Injection # 1	65	51.6
Injection # 2	20	15.9
Injection # 3	8	6.3
Injection # 4	2	1.6
Mod. neer classification at last visit
I	89	70.6
II	13	10.3
III	22	17.5
IV	2	1.6

NA, not assessed.

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