Comparing indirect decompression using elastic nails versus curettage, bone graft substitute, and intramedullary stabilization for the management of unicameral bone cysts in skeletally immature patients: a retrospective case series study

Abstract

Background: Unicameral bone cysts account for 20% of benign bone lesions. A variety of treatment modalities exist with variable outcomes. This was a retrospective study that aimed to compare the clinical and radiographic outcomes of two treatment methods for unicameral bone cysts in children: cyst decompression utilizing intramedullary nailing alone versus marginal resection through curettage, intramedullary nailing, and synthetic bone grafting. Methods: Seventy-one patients with unicameral bone cysts were treated with one of two techniques: decompression using elastic intramedullary nails (Group 1, 37 patients) or open curettage and grafting with a calcium sulfate bone substitute with fixation by elastic intramedullary nails (Group 2, 34 patients). Outcome parameters included the radiographic healing rate, time to solid union, recurrence rate, functional outcome, and complication rates. Results: The mean follow-up period was 30.9 mo for group 1 and 35.9 mo for group 2. The mean Musculoskeletal Tumor Society scoring was 91 for group 1 and 93 for group 2. Radiographic healing showed Capanna grade 1 in 78% of the patients in group 1 and 85% in group 2 with a similar mean time to healing of 8 wk. Recurrence occurred in two patients in group 1 and in one patient in group 2. Conclusions: No statistically significant difference exists regarding the outcomes of both treatment techniques. Therefore, we recommend the use of elastic nails for intramedullary nailing alone as a first line of management of primary unicameral bone cyst because it is a less invasive technique with reliable results. Level of Evidence: Level IV.