Management of unicameral bone cysts by intramedullary flexible nails: a series of 18 children

Abstract

Abstract Introduction The intracystic injection of methylprednisolone acetate, curettage with bone grafting, osteoinductive treatments employing demineralized bone matrix, and intramedullary fixation with flexible nails are being used to treat unicameral bone cysts (UBC) in children. The purpose of this study was to assess the functional results of elastic stable intramedullary nails for symptomatic UBC with or without a fracture. Methods From March 2012 to March 2022, 18 patients with UBC were treated with intramedullary flexible nails. Pathological fractures were present at the cyst site in 6 individuals. 12 patients had discomfort and swelling in the afflicted extremity. Cysts were found in the humerus in 13 (72%) patients and the femur in 5 (28%) cases. The average age of the patient at the time of surgery was 7.8 (6–12 years), and the average follow-up period was 16 months. The Capanna et al. criteria were used to do the radiographic evaluation. Results According to radiological evaluation by Capanna et al., 5 cysts healed completely (Stage I), 5 cysts healed with residual radiolucent areas visible on radiographs that were less than 3 cm in size (Stage II), and 7 cysts healed with residual radiolucent areas that were visible on radiographs that were larger than 3 cm in size (Stage III). An infection at the surgery site affected one patient. A 12 (60%) patients had their implants removed. Conclusion Elastic stable intramedullary nailing promotes early stabilization, enables early mobilization, eliminates the need for a plaster cast, and reduces the occurrence of a pathological fracture with early return to functional activity.