Abstract
BackgroundThe different treatment strategies for bone cysts in children are often associated with persistence and high recurrence rates of the lesions. The safety and clinical outcomes of a combined mechanical and biological treatment with elastic intramedullary nailing, artificial bone substitute and autologous platelet rich plasma are evaluated.MethodsFrom 02/07 to 01/09 we offered all children with bone cysts the treatment combination of elastic intramedullary nailing (ESIN), artificial bone substitute (Orthoss®) and autologous platelet rich plasma, concentrated by the Gravitational Platelet Separation (GPS®) - System. All patients were reviewed radiologically for one year following the removal of the intramedullary nailing, which was possible because of cyst obliteration.ResultsA cohort of 12 children (4 girls, 8 boys) was recruited. The mean patient age was 11.4 years (range 7-15 years). The bone defects (ten humeral, two femoral) included eight juvenile and four aneurysmal bone cysts. Five patients suffered from persistent cysts following earlier unsuccessful treatment of humeral bone cyst after pathologic fracture; the other seven presented with acute pathologic fractures. No peri- or postoperative complications occurred. The radiographic findings showed a total resolution of the cysts in ten cases (Capanna Grade 1); in two cases a small residual cyst remained (Capanna Grade 2). The intramedullary nails were removed six to twelve months (mean 7.7) after the operation; in one case, a fourteen year old boy (Capanna Grade 2), required a further application of GPS® and Orthoss® to reach a total resolution of the cyst. At follow-up (20-41 months, mean 31.8 months) all patients showed very good functional results and had returned to sporting activity. No refracture occurred, no further procedure was necessary.ConclusionsThe combination of elastic intramedullary nailing, artificial bone substitute and autologous platelet rich plasma (GPS®) enhances the treatment of bone cysts in children, with no resulting complications.
Highlights
The different treatment strategies for bone cysts in children are often associated with persistence and high recurrence rates of the lesions
Driven by our own mediocre results during the treatment of juvenile bone cysts with prednisolone, cannulated “decompression” screws or elastic intramedullary nailing (ESIN) in isolation, we looked for an alternative additional treatment strategy to hasten healing and to minimize the need for repeat operations
This study evaluates the safety and clinical outcome of the treatment with elastic intramedullary nailing (ESIN), artificial bone substitute (Orthoss®) and autologous platelet rich plasma (GPS®) in bone cysts in children
Summary
The different treatment strategies for bone cysts in children are often associated with persistence and high recurrence rates of the lesions. Juvenile bone cysts were first described by Virchow in 1876, but their aetiology still remains unknown [1] They can occur in any bone, most often in the long bones and at any age, but mainly in the first two decades [2]. Despite their benign nature, simple bone cysts interfere with everyday activities. Experimental studies have shown that a gravitational platelet-separating system is able to boost the concentration of growth factors This has the potential to stimulate the prematurely terminated bone-healing processes, especially when combined with autologous bone or bone graft materials [20,21,22]. Initial published studies on the use of autologous concentrated platelets in poorly healing dermal wounds [23,24] and in artificial joint surgery [25] have demonstrated its efficiency
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
