Calcium Sulfate/Calcium Phosphate Bone Void Filler in the Treatment of Bilateral Adolescent Unicameral Calcaneal Bone Cysts: 36-Month Follow-Up.

A 36-month follow-up of the management of bilateral adolescent unicameral bone cysts in a high school gymnast treated with a calcium sulfate/calcium phosphate (CSCP) bone void filler (BVF) is presented. The more developed left calcaneal cyst was managed with a traditional, open approach consisting of allogenic bone graft, CSCP BVF mixed with platelet-rich plasma. The less developed right calcaneal cyst was managed with a less used approach, a percutaneous bone cortex incision with only the CSCP BVF. The rationale for the selection between the open and percutaneous approaches, long-term BVF incorporation, and positive patient outcome allowing a quick return to athletics are presented.

The Use of Triphasic Bone Graft for the Treatment of Pediatric Bone Cysts: Experience at 2 Institutions.

Unicameral/aneurysmal bone cysts can lead to pain, fracture, and limb deformity. In this study, the authors evaluated the outcome of triphasic bone graft to treat unicameral/aneurysmal bone cysts. They retrospectively evaluated 41 immature patients from a prospectively enrolled cohort from 2 institutions treated from May 9, 2007, to November 1, 2014. Medical record review and evaluation of radiographs and computed tomography scans were performed. The authors characterized replacement of the material by normal bone or recurrent cyst at final follow-up. They recorded rates of fractures and complications after treatment. Twenty-nine patients were treated in Wisconsin, and 12 patients were treated in Florida. Average follow-up was 2.8 years. At follow-up, 13 of 41 patients had cyst recurrence. Three patients had fracture after initial treatment; 2 were treated surgically. Two of 9 patients with extraosseous bone graft had soft tissue swelling, and 1 required debridement. Complications did not differ by cyst type, location, sex, age, or use of internal fixation. For 27 patients with at least 2-year follow-up, percent fill of triphasic bone graft at initial surgery correlated with rate of recurrence at final follow-up: 15 of 27 patients with no cyst recurrence at final follow-up had a mean of 100% initial fill, and 12 of 27 with cyst recurrence at final follow-up had a mean of 90% initial fill (P=.048). Using triphasic bone graft for the treatment of unicameral/aneurysmal bone cysts, the authors observed a 7% rate of clinical recurrence (3 of 41 had fracture). Because this material has the potential to be locally inflammatory, efforts are needed to keep it within the bone. [Orthopedics. 2018; 41(5):e705-e712.].

Natural Course of Local Bone Mineralization After Treatment of Benign or Borderline Bone Tumors and Cysts With a Composite Ceramic Bone Graft Substitute.

After surgical bone tumor removal, filling of the bone defect is frequently performed using a bone graft or bone graft substitute. During follow-up, precise quantification of changes in bone mineral density, within the treated bone defect, is very difficult using conventional X-ray examinations. The objectives of this study were to characterize the pattern of resorption/biodegradation of a composite calcium sulfate/hydroxyapatite bone graft substitute and to quantify the bone defect healing with repeated dual-energy X-ray absorptiometry (DXA) measurements. Seventeen patients treated for 18 benign bone lesions, with subsequent defect filling using 2 variants of a composite ceramic bone graft substitute (CERAMENT™|BONE VOID FILLER or CERMAMENT™|G, BONESUPPORT AB, Lund, Sweden), were scanned postoperatively and after 2, 6, 12, 26, and 52 wk using DXA. After an initial increase in bone mineral density after implantation of the bone graft substitute, bone mineral density decreased in the bone defect region throughout the 52 wk: rapidly in the first 12 wk and slower in the remaining weeks. Despite this continuous decrease, bone mineral density remained, on average, 25% higher in the operated extremity, compared with the nonoperated extremity, after 52 wk. The observed pattern of reduction in bone mineral density is consistent with the anticipated resorption of calcium sulfate within the bone graft substitute during the first 12 wk after surgery. We believe the DXA technique provides a precise method for quantification of bone graft resorption, but for evaluation of new bone formation, 3-dimensional imaging is needed.

Outcomes of Bone Grafting of Bone Cysts After Total Ankle Arthroplasty.

BACKGROUND: The operative treatment of bone cysts after total ankle replacements (TAR) is not well described. Bone cysts may cause component migration, implant failure, and pain. Surgery is performed on cysts with the goals of reducing pain and preventing component failure. METHODS: We retrospectively evaluated a consecutive series of 726 primary TARs performed between January 1998 and May 2013 and identified those who had a subsequent bone cyst grafting procedure. We identified cyst location and method of treatment. Clinical outcomes including secondary procedures, infection rate, complications, and failure rate were recorded. Thirty-one patients were treated with a total of 33 operative procedures for bone cysts after TAR. Of these patients, 22 (71.0%) were males with an average age of 62.2 and median follow-up 65.9 months. RESULTS: Intraoperatively, 22 tibial cysts (71.0%), 20 talar cysts (64.5%), 5 fibular cysts (16.1%), and 13 multiple cysts (41.9%) were treated. Allograft was used in 25 procedures (75.8%), calcium phosphate in 4 (12.1%), cement in 3 (9.1%), and autograft in 1 (3.0%). These procedures were supplemented by calcaneus autograft, allograft mixed with mesenchymal stem cells, platelet-rich plasma, recombinant human bone morphogenic protein-2, and demineralized bone matrix. There were no infections or wound complications. Of the 27 subjects with a successful second surgery, the success rate for bone grafting of cysts was 90.9% (95% CI: 50.8, 98.7%) at 24 months and 60.6% (95% CI: 25.1%, 83.4%) at 48 months. One patient needed a repeat bone grafting. The 4 failures observed postprocedure resulted in 3 tibial and talar component revisions, and 1 tibiotalocalcaneal (TTC) fusion. CONCLUSIONS: Grafting bone cysts without revision of TAR was in general an effective and safe means for treating patients with peri-prosthetic bone cysts. Treatment with grafting and supplemental materials may improve implant survivorship and might improve the structural support surrounding the implant. Further exploration of the etiology of bone cysts may aid in the prevention and treatment of cystic formation in the TAR. LEVEL OF EVIDENCE: Level IV, case series.

Percutaneous treatment of calcaneus fractures associated with underlying bone cysts.

BACKGROUND: Calcaneal bone cysts with pathological fractures are rare. There is no clear consensus on their management with a few reports of open curettage, bone grafting and internal fixation in the treatment of pathological calcaneal fractures. No minimally invasive management has been reported before. METHODS: We reviewed our experience in treating five patients with pathologic calcaneus fractures associated with pre-existing bone cysts who underwent percutaneous cyst curettage, fracture reduction, screw fixation and calcium sulfate cement injection between 2004 and 2009. RESULTS: All of the pathologic fractures healed with satisfactory radiological results. There were no soft tissue complications or cyst recurrences. Partial weightbearing with plaster cast immobilization was allowed at 4 weeks postoperatively and full weightbearing was allowed at 6 weeks postoperatively. CONCLUSION: This percutaneous technique provided a minimally invasive option for treatment of a calcaneal bone cyst with pathologic fracture.

Treatment of unicameral bone cyst: surgical technique.

BACKGROUND: There is a variety of treatment modalities for unicameral bone cysts, with variable outcomes reported in the literature. Although good initial outcomes have been reported, the success rate has often changed with longer-term follow-up. We introduce a novel, minimally invasive treatment method and compare its clinical outcomes with those of other methods of treatment of this lesion. METHODS: From February 1994 to April 2008, forty patients with a unicameral bone cyst were treated with one of four techniques: serial percutaneous steroid and autogenous bone-marrow injection (Group 1, nine patients); open curettage and grafting with a calcium sulfate bone substitute either without instrumentation (Group 2, twelve patients) or with internal instrumentation (Group 3, seven patients); or minimally invasive curettage, ethanol cauterization, disruption of the cystic boundary, insertion of a synthetic calcium sulfate bone-graft substitute, and placement of a cannulated screw to provide drainage (Group 4, twelve patients). Success was defined as radiographic evidence of a healed cyst or of a healed cyst with some defect according to the modified Neer classification, and failure was defined as a persistent or recurrent cyst that needed additional treatment. Patients who sustained a fracture during treatment were also considered to have had a failure. The outcome parameters included the radiographically determined healing rate, the time to solid union, and the total number of procedures needed. RESULTS: The follow-up time ranged from eighteen to eighty-four months. Group-4 patients had the highest radiographically determined healing rate. Healing was seen in eleven of the twelve patients in that group compared with three of the nine in Group 1, eight of the twelve in Group 2, and six of the seven in Group 3. Group-4 patients also had the shortest mean time to union: 3.7 ± 2.3 months compared with 23.4 ± 14.9, 12.2 ± 8.5, and 6.6 ± 4.3 months in Groups 1, 2, and 3, respectively. CONCLUSIONS: This new minimally invasive method achieved a favorable outcome, with a higher radiographically determined healing rate and a shorter time to union. Thus, it can be considered an option for initial treatment of unicameral bone cysts.

Acute intraoperative reactions during the injection of calcium sulfate bone cement for the treatment of unicameral bone cysts: a review of four cases.

Unicameral bone cysts can predispose patients to pathologic fracture and deformities of growth. Treatment options vary from continuous decompression with transcortical placement of a cannulated screw to percutaneous aspiration and injection of medical-grade calcium sulfate. From 2005 to 2007, we treated 22 patients with unicameral bone cysts using aspiration and injection of calcium sulfate. Three patients experienced acute laryngospasm and one patient developed tachyarrhythmia, temporarily, associated with injection of calcium sulfate. All reactions occurred in patients under age 18 without predisposing risk factors and resolved spontaneously with supportive care. Although the mechanism is unclear, we hypothesize that these reactions are either due to the nociceptive stimulus of the calcium sulfate injection or a systemic calcium bolus. Clinicians using this product for this indication should be aware that such reactions may occur. We suggest endotracheal intubation and communication to the anesthesiologist about the time of the injection in preparation for these idiopathic responses. Further research is necessary to determine exactly how this reaction occurs and how it can be avoided.

Treatment of unicameral bone cysts by curettage and packing with plaster-of-Paris pellets. 1978.

Long-term follow-up of twenty-six patients with unicameral bone cysts treated by curettage and packing with plaster-of-Paris pellets showed a recurrence in only two cases and no serious complications.

Anodoncia parcial relacionada con quiste dentígero y quiste traumático: revisión de la literatura y presentación de un caso / Partial anodontia related with dentigerous cyst and traumatic cyst: a review of the literature and report of a case

La anodoncia parcial es una anomalía de número caracterizada por la ausencia congénita de dientes, principalmente permanentes. Se ha designado con otros tgérminos, como agenesia dental, oligodoncia e hipodoncia. Se presenta el caso de una niña afectada por esta enfermedad, teniendo en cuenta que es un caso aislado sin otros rasgos de patología genética sindromática y que a la vez estaba relacionado con dos patologías: quiste traumático y quiste dentígero. Se planificó tratamiento combinado: quirúrgico y toma de muestra para estudio histopatológico, ortodoncia y prótesis. Se planearon evaluaciones periódicas.

Aneurysmal bone cyst of the hand.

This article discusses a case of an aneurysmal bone cyst in the finger of a male patient. Such tumors are rarely located in the hand. Although rare, an aneurysmal bone cyst is the only benign bone tumor which can extend across a growth plate into the epiphysis. Diagnostic and therapeutic features of the cyst are discussed in this article.

Unicameral bone cysts. A comparison of treatment options.

Thirty-two unicameral bone cyst cases from various hospital centers in the San Francisco Bay Area were reviewed in order to compare the results of different treatment methods. Thirteen of the 32 cysts were latent and 19 were active, judged by their proximity to the growth plate. The average age at presentation was 8.9 years, and average follow-up was 5.6 years. Fifteen patients were treated surgically, 12 were given steroid injections, and five were treated nonoperatively. Comparative analysis of these methods supports previous studies which show that steroid injections are as effective as surgical intervention while having lower morbidity.

[A case of aneurysmal cyst of the spine. Pathogenic and therapeutic problems]. / A propos d'un cas de kyste anévrysmal du rachis. Problèmes pathogéniques et thérapeutiques.

The diagnosis of aneurysmal bone cyst is facilitated by modern methods and progress in surgical technique allows their excision. A cyst of the spine was found in a 23 year old woman. It was the size of a grapefruit at the level of the 12th thoracic vertebra. It was asymptomatic and discovered after routine radiological examination. It was removed by a thoraco-abdominal approach to avoid neurological impairment. The spine was fixed by internal fixation and grafted. The condition of the patient was satisfactory after 9 months. A review of the literature reveals the frequency of neurological complications and of recurrence. This justified the planned removal of the tumour despite the possibility of a spontaneous healing. Radiotherapy should be considered only in cases where total excision and fixation is not possible.

[Clinical experiences with a fibrin-nebacetin-spongy bone seal in the treatment of chronic bone infections and as local prophylaxis of infection in uninfected bones]. / Klinische Erfahrungen mit einer Fibrin-Nebacetin-Spongiosaplombe zur Behandlung der chronischen Knocheninfektionen und als lokale Infektionsprophylaxe bei nicht infiziertem Knochenherd.

Clinical experiences with Fibrin-Nebacetin-bone marrow combination for the treatment of chronic bone infection and as local prophylaxis by operation of non-infected bone diseases. Since 1979 we have carried out 33 autologous bone graftings in children and used the Fibrin-Nebacetin-bone marrow combination. Nebacetin provides a most effective local antibiotic therapy as supplementary and consecutive treatment are surgical procedures executed in bone infection. The chronic bone infection of 15 children subsided completely. In 18 children with bone transplants no infections was observed and all the patients showed primary healing. The use of fibrin did not disturb the bone reconstruction. After 12 weeks the reconstruction of the bone was almost complete. In two cases only we had to make a reoperation, caused by a recurrent cyst. We could not observe any hepatitis in our patients. The operative technique and advantages of treatment were discussed.

Treatment of unicameral bone cysts by curettage and packing with plaster-of-Paris pellets.

Long-term follow-up of twenty-six patients with unicameral bone cysts treated by curettage and packing with plaster-of-Paris pellets showed a recurrence in only two cases and no serious complications.