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      Predictive characteristic of simple bone cyst treated with curettage and bone grafting

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          Abstract

          Background

          The efficiency of treating simple bone cyst (SBC) is low. Depending on the choice of treatment, a positive response occurs in 20 to 80 % of cases. These rates are unacceptable, particularly considering they concern the treatment of benign lesions affecting children. Although cyst curettage is one of the first known ways of treating SBC, no precise qualification criteria exists for this procedure. The aim of our study is to identify which type of cyst may be most effectively treated using curettage with grafting.

          Methods

          A retrospective analysis was performed on 24 patients referred to our clinic for SBC treatment. To identify predictive factors, the group of patients who positively responded to treatment (Neer stages I and II, n = 14) were compared with the group in which recurrences occurred (Neer stages III and IV, n = 10).

          Results

          Significantly fewer patients with lesions located in the humerus (chi 2 = 9.351; p <0.05) and without pathological facture at the time of diagnosis ( p = 0.017) were found in the group with no recurrence. The following radiological parameters were found to vary significantly between groups: cyst area (z = 3.121; p < 0.01), cyst index (z = 2.213; p <0.05) and cyst diameter ratio (z = 2.202; p <0.05). In the group with no recurrences, the mean values of these parameters were found to be lower than in group with poor response to treatment. No statistically significant differences regarding age, sex or type of bone graft ( p > 0.05) were found. Recurrences were experienced by 10 patients (41.7 %) during the 3-year period after surgery

          Conclusion

          In the group treated with curettage, associations were identified between worse treatment results and the location in the humerus, pathological fractures at the time of diagnosis, large cyst area, large cyst index and large cyst diameter.

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          Most cited references27

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          A system of staging musculoskeletal neoplasms.

          A system for staging benign and malignant musculoskeletal lesions is presented. This system, first devised at the University of Florida in 1977, was based on data assembled from 1968 through 1976. It was field tested by the Musculoskeletal Tumor Society and published in Clinical Orthopaedics and Related Research in 1980. In the ensuing five years, the system has undergone refinement. It has recently been adapted by the American Joint Committee Task Force on Bone Tumors and proposed by them to the International Union Against Cancer (IUCC) for international usage. Based upon histologic grade (G), anatomic site (T), and presence or absence of metastases (M), it describes the progressive stages, irrespective of histogenesis, that assess the progressive degrees of risk to which the patient is subject. This system articulates well with current radiologic techniques of staging and serves as a useful guide in the selection of an appropriate definitive surgical procedure. Its usage permits comparative end result studies on the effect of surgical and nonsurgical methods of management.
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            Unicameral and aneurysmal bone cysts.

            One hundred and seventy-eight cases of unicameral bone cysts (UBC) treated with curettage and bone grafting were compared to 141 cases treated with cortisone injections. The end results were comparable in the two groups. Local recurrence risk factors in the surgical group were active cyst and previous operations. In the other group they were multilocation of the cyst, active cyst, and size of cyst. A new radiographic classification of aneurysmal bone cyst (ABC) is proposed in a report of 198 cases of ABC. The treatment of choice in ABC is surgical and the type (curettage, curettage plus phenole or cryosurgery, resection or hemiresection) is selected on the basis of the radiographic aspect and the rate of growth of the cyst. Radiotherapy is only indicated in inoperable ABC cases.
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              Unicameral bone cysts treated by injection of bone marrow or methylprednisolone.

              In 79 consecutive patients with unicameral bone cysts we compared the results of aspiration and injection of bone marrow with those of aspiration and injection of steroid. All were treated by the same protocol. The only difference was the substance injected into the cysts. The mean radiological follow-up to detect activity in the cyst was 44 months (12 to 108). Of the 79 patients, 14 received a total of 27 injections of bone marrow and 65 a total of 99 injections of steroid. Repeated injections were required in 57% of patients after bone marrow had been used and in 49% after steroid. No complications were noted in either group. In this series no advantage could be shown for the use of autogenous injection of bone marrow compared with injection of steroid in the management of unicameral bone cysts.
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                Author and article information

                Contributors
                0048 505 078 105 , flont2002@yahoo.com
                krzynormal@wp.pl
                niewolaanna@gmail.com
                zbyszek@lipczyk.com
                ortopedia-czmp@tlen.pl
                Journal
                BMC Musculoskelet Disord
                BMC Musculoskelet Disord
                BMC Musculoskeletal Disorders
                BioMed Central (London )
                1471-2474
                14 November 2015
                14 November 2015
                2015
                : 16
                : 350
                Affiliations
                Clinic of Orthopaedic and Traumatology, Polish Mother’s Memorial Hospital Research Institute, Rzgowska 281/289, 93-338 Lodz, Poland
                Article
                797
                10.1186/s12891-015-0797-6
                4647485
                61d7331e-de7c-4b72-97c5-d885c2773924
                © Flont et al. 2015

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 21 July 2015
                : 31 October 2015
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2015

                Orthopedics
                simple bone cyst,children,curettage,recurrences
                Orthopedics
                simple bone cyst, children, curettage, recurrences

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