UNIVERSITATEA “TITU MAIORESCU”

FACULTATEA DE MEDICINA

The Modern Treatment of

Child’s Simple Bone Cyst
Iustina Veselu, George Ghiga,
Dr. Alexandru Ulici, Dr. Doina Veselu
 Retrospective research
1990 - 2001

 94 patients
 42 patients had benefited by surgical treatment
 52 patients had benefited by conservative
treatment
 Case distribution according to the
anatomico-clinical form

32

Intact bone cyst

Fractured bone cyst

62

Most
Mostcases,
cases,the
thetraumatism
traumatismwhich
whichcauses
causesaafracture
fracturetotothe
theesential
esentialbone
bonecyst
cystisisminor
minorand
andthe
the
fragments’
fragments’movement
movementisisminimal.
minimal.
 Case distribution according to
their disposal
50
50
45
40
humerus
35
radius
30
metacarpus 5
25
femur
20 25
fibula
15 tibia
10 calcaneus
5 5 1 8 4
1
0
superior member inferior member

Most
Mostfrequent
frequentdisposals
disposalswere
werefound
foundatatthe
thelevels
levelsofofthe
thehumerus
humerusand
andthe
thefemur.
femur.
Case distribution according to the
evolutive form

75
active
latent
19
 Case distribution according to the
active forms’ disposal
40
35
37
30
25
20 25
15 No. of cases
10
5 7 2 4
0
superior femural fibula tibia radius
humeral neck
metaphysis
Active
Activeforms
formsare
arelocalized
localizedaround
aroundthe
thegrowth
growthcartilage;
cartilage;the
thelatent
latentforms
formsare
arediaphysic.
diaphysic.
 Case distribution according to the
cystic index
40
35 40

30
25 IK > 4
IK < 4
20
22 IK > 3.5
20
15 IK 2 - 3.5
10 IK < 2
11
5 7
0
superior member inferior member
Tachdjian,
Tachdjian,Pouliquen,
Pouliquen,Padovani,
Padovani,Carlioz,
Carlioz,Journeau:
Journeau:
The
Thefracture
fracturehazard
hazardononaapathologic
pathologicbone
boneisisimportant
importantfor
foran
ancystic
cysticindex
indexabove
above44for
foraasuperior
superiormember
member
and above 3.5 for an inferior member.
and above 3.5 for an inferior member.
 The cystic index’ calculation formula

Cyst’s projected surface

Cystic index =
2
Diaphysis’ diameter
Cystic index’ measurement
radiographic model

S1 2
IK = S1+S2/d
S2

d
Case distribution according to the
applied treatment

Surgical treatment
42
52 Conservative
tratement
 Surgical treated case distribution
according to their disposal
30

25
28
20

15
No. of cases
10
10
5
2 1 1
0
humerus radius femur tibia calcaneus
 Case distribution according to the
applied surgical treatment

25 24

20

15

10
11
5 8
5
4
0
elastic arming diaphysectomia+bone graft curretage+bone graft curettement+substitute curretage+bone
graft+osteosynthesis
No. of cases
 Femural disposal bone cyst
elastic arming

initial 3 months 6 months

 Case distribution according to post-
surgical treatment recurrences

12

10 12

6 No. of cases
4

2
2
0
humerus femur
42%
42%ofofthe
thesurgeries
surgeriesatatthe
thehumerus’
humerus’level
levelhad
hadrecurrences
recurrences(the
(thegrephon’s
grephon’scomplete
completelysis
lysisororcystic
cystic
formation’s
formation’s reappearance at the inferior pole of the primary lesion). The recurrences appearedafter
reappearance at the inferior pole of the primary lesion). The recurrences appeared afterusing
using
bone grephon and bone substitutes.
bone grephon and bone substitutes.
 Humerus bone cyst
curettage and grafting with bone grephon
 Humerus bone cyst
curettage + grafting + osteosynthesis

One month 15 months

post-surgical post-surgical

Cystic cavity
recovery
 Case distribution according to the time
passed until recovery after the surgical
treatment
16
14 16
12 14
10
8
6 No. of cases
4 6
2 4
2
0
6 12 18 24 more
months months months months than 2
years
The
Thelatent
latentcysts
cystsrecovered
recoveredininless
lessthan
thanan
anyear
yearafter
afterthe
thesurgical
surgicaltreatment.
treatment.
The
Theslow-recovery
slow-recoverycysts
cystsrequired
requiredone
oneor
ormore
moresurgeries
surgeriesafter
afterthe
thefirst
firstsurgery.
surgery.
 Case distribution according to the
traditional treatment
35
30 35
25
20
15 No. of cases
10
15
12
5
0
simple immobilization methylprednisolone hemathogene autolog
injection marrow injection

The
Thesimple
simpleimmobilization
immobilizationwith
withcast
castapplied
appliedtotothe
thefractured
fracturedbone
bonecyst
cystcases,
cases,with
withno
no
movement, localized at the superior member’s level.
movement, localized at the superior member’s level.
The
Theinjections
injectionswere
weremade
madetotointact
intactand
andunfractured
unfracturedcysts.
cysts.
 Methylprednisolone injection case
repartition according to the required
injections number
14
12 14

10
10
8
6 No. of cases
4 5
2
2
0 0
1 injection 2 injections 3 injections 4 injections didn't
respond

The
Thepatients
patientswho
whodid
didnot
notrespond
respondtotothe
themethylprednisolone
methylprednisoloneinjection
injectionbenefited
benefitedofofsurgical
surgical
treatment.
treatment.
 Hemathogene autolog marrow injection
case distribution according to the required
number of injections
9
8 9
7
6
5
4 No. of cases
3
2 3
1
0
0
1 injection 2 injections did not respond

The
Theinjected
injectedcysts
cystswere
wereactive
activeand
andlatent.
latent.
 Radius bone cyst
autolog marrow injection

Diagnosis’ time 3 months after the injection

Cystic cavity
 Femural bone cyst
casual discovery
Injection’s time
3 months after injection

Cystic cavity
 Femural bone cyst
autolog marrow injection

Injection’s time 6 months after injection

 Case distribution according to the time
passed until recovery after applying the
traditional treatment
18
16 18
14 simple
immobilization
12
10 methylprednisolon
10 e injection
8 9
6 hemathogene
autolog marrow
4 injection
4 4
2 3 3
2 2 2
0 0 0 0 0 0
3 months 6 months 12 months 24 months 48 months

The
Therecovery
recoverycriteria
criteriaare
arelike
likethe
themechanical
mechanicalrecovery’s:
recovery’s:cystic
cysticindex
indexless
lessthan
than33and
and
corticals’ width more than 2
corticals’ width more than 2 mm.mm.
 Conclusions
 The surgical treatment by curettage and grafting is
frequently accompanied by recurrence, the grephon’s type
does not matter;
 The diaphysectomia and the bone grafting lead to 100%
recovery; it is also a very laborious operation when it is
addressing to a mature cyst which tends to spontaneous
recovery;
 The logical treatment for the fractured essential bone cysts is
the one used for common fractures; other gestures are rather
futile than healthy;
 The retard methylprednisolone (Depomedrole)’s injection
may fail; in exceptional cases may appear certain healing
signs before the third injection;
 Conclusions

 Hemathogene autolog marrow’s injection is a simple

and unexpensive method, effective to the active and
to the latent cysts also. It is accompanied by certain
healing signs right after the first treatment.
 Therapeutic Protocol
by A. Kaelin
Superior member Active phase Latent phase

IK > 4 Repose. Repose.

Cyst’s injection. Cyst’s injection,
eventually.
IK < 4 Radiologic surveillance. No treatment.
Cyst’s injection,
eventually.
Inferior member

IK > 3.5 Stabilizing by elastic Repose.

embrocation. Cyst’s injection.
Cyst’s injection.
IK < 3.5 Radiologic surveillance. No treatment.
Cyst’s injection whether
IK > 2