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Definition: Central cystic lesion of bone, with a fluid content similar to serum, starting in the metaphysis during childhood and becoming inactive around or soon after the skeletal maturity. It is the only true cyst of bone that conforms to the pathologic definition of cyst. Simple bone cyst cavity will only contain blood if associated with a pathologic fracture.

Unicameral bone cysts are fluid-filled benign lesions that occur mostly in the long bones. Unicameral bone cysts in the pelvis are extremely rare. Continuous decompression using titanium or hydroxyapatite screws has been reported as a treatment. Screws made from a composite of unsintered hydroxyapatite particles and poly-l-lactide can be used for the treatment. An adolescent male patient presented with a unicameral bone cyst in the ilium extending to a region adjacent to the hip joint. As initial treatment, the cortex was fenestrated when the patient was 13 years old and β-tricalcium phosphate implanted. The cyst first reoccurred when the patient was 15 years old and again when he was 17 years old. During the most recent treatment, unsintered hydroxyapatite particles and poly-l-lactide composite screws were placed, and no recurrence was observed during 2 years of follow-up. The slow biodegradability and absorbability of the screws may allow continuous drainage of unicameral bone cysts.

Bei Fus- und Sprunggelenkstumoren kommt es haufiger zu Diagnosefehlern als bei Neubildungen in anderen Korperregionen, da echte Neoplasien oft nicht in Betracht gezogen und Pseudotumoren imitiert werden konnen. Bei unklarer, persistierender Schwellung oder Knochenlasion im Fusbereich sollten Sie daher immer auch Tumoren in Erwagung ziehen.

BACKGROUND Unicameral Bone Cyst (UBC) is described as a central metaphyseal cystic lesion of the bone with serum fluid content. Diagnosis is typically based on x-ray imaging features, age, localisation at proximal humerus and femur and the absence of symptoms until pathological fracture development. MATERIALS AND METHODS Eighteen patients with unicameral bone cysts were reviewed in Nalanda Medical College Hospital. Nine patients received serial steroid injections and the other nine patients were treated conservatively following fractures. In the steroid injection group, six cases were in the proximal femur and three in the proximal humerus. RESULTS The nine steroid injection patients showed radiological evidence of cyst healing within four months of treatment. Subsequently, all 9 patients showed a satisfactory radiological outcome after a year and complete resolution after 2 years. In the conservative group, all 9 cases were in the proximal humerus. Persistent cystic lesions were observed in all 9 patients and 2 was complicated by another fracture within 6 months. CONCLUSION Fractures through UBC in the upper extremity can be treated nonoperatively. However, steroid injection is an effective option to hasten healing and should be considered as a primary treatment of unicameral bone cyst.

Clinical Presentation A 23-year-old healthy, female with no known medical issues presents to the dental clinic at Indiana University School of Dentistry. Cone beam computed tomography (CBCT) volume was acquired as part of a dental implant evaluation for the sites of teeth #9 and #10. Upon review, an incidental finding of a well-defined, irregular, nonexpansile, radiolucent lesion along the anteroinferior border in the body of the C2 vertebrae was noted. Differential Diagnosis The working differential of the area included (1) unicameral bone cyst, (2) giant cell tumor, (3) brown tumor, and (4) fibrous dysplasia. These all appear radiolucent, and most do not manifest symptoms and are found incidentally. An evaluation with a physician to assess for neurologic deficits or other related symptoms would be needed. Possible further imaging with contrasted multidetector computed tomography (MDCT), magnetic resonance imaging (MRI), and/or blood tests may also be considered. Because of the invasive nature, the possibility of surgical intervention including biopsy, curettage, or bone grafting should be evaluated by an orthopedic surgeon. Diagnosis and Management The patient was notified by the provider to evaluate the lesion, and further dental treatment has been deferred until a diagnosis can be reached. Discussion Incidentally, the provider did not fully read the report. It was through inquiry by the radiologist that the patient’s status was brought to the provider’s attention. This emphasizes how comprehensive evaluation of CBCT can bring to light potentially urgent conditions.

Aim and scope of this lecture is: 1. to educate the General Orthopaedist and the paediatric orthopod to differentiate between infection v/s tumour and benign v/s malignant lesions which they will encounter in their day-to-day practice which can confuse even the experienced surgeon. 2. To stay safe while doing biopsy and the pitfalls associated ; tips on when to refer to an oncology surgeon who can plan on the biopsy and management if it requires expertise as in a benign aggressive neoplasm e.g. aneurysmal bone cyst, chondroblastoma. 3. Case based examples on management of common cystic lesions which are frequently encountered in one’s practice.

A 55-year-old man with a history of Benign Paroxysmal Positional Vertigo unalleviated by Epley manoeuvre presented to an otolaryngologist for dizziness, right ear fullness and headache. MRI of the brain showed numerous marrow-replacing lesions throughout the calvarium, skull base and upper cervical spine which were hypointense on T1-weighted images, hyperintense on T2-weighted images and avidly enhanced following contrast, concerning for a malignant process such as metastatic disease or multiple myeloma (figure 1). Systemic X-ray survey (spine, skull, chest, pelvis, all long bones) and nuclear medicine whole body bone scan were negative except for the lesions seen on MRI. β-2microglobin, immunoglobin and monoclonal protein electrophoresis were negative for myeloma or immunological process. Given the concern for metastatic disease, biopsy of a skull lesion was recommended. Pathological analysis of a calvarial lesion was consistent with unicameral bone cyst (figure 1). No ongoing therapy was offered; however, brain and spine surveillance imaging will continue.

A 20-month-old female spayed Staffordshire Terrier (22.3 kg) presented to the Orthopedic Surgery Service at North Carolina State University Veterinary Teaching Hospital for evaluation of a 6-week history of toe-touching to nonweight-bearing lameness in the right hind limb. Radiographs of the right stifle revealed a multiloculated lytic lesion of the distal femur, with a large open lytic zone centrally, numerous osseous septations peripherally, and focal areas of cortical thinning and loss. An aspirate of the right distal femoral lesion yielded mildly cloudy serosanguineous fluid. Cytologic examination of the fluid revealed a pleomorphic population of discrete cells that exhibited marked anisocytosis and anisokaryosis and a variable nuclear-to-cytoplasmic (N:C) ratio, which were interpreted as probable neoplastic cells, with few macrophages, and evidence of hemorrhage. Given the clinical signs of pain, lesion size, and concern for malignant neoplasia, amputation of the right hind limb was performed. Histologically, the lesion had undulating walls 1-3 mm thick with a continuous outer layer of dense fibrous tissue and an inner layer composed of reactive cancellous bone with no cortical compacta remaining. Remnants of thin fibrous or fibro-osseous septa projected from the bony wall into the cyst lumen. The final histologic diagnosis was a benign multiloculated solitary (unicameral) bone cyst of the distal right femur. Based on the histopathologic findings, it was speculated that the cells identified on cytology were a mixture of developing osteoclasts, osteoblasts, endothelial, and stromal cells. This is the first report describing the cytologic examination of a solitary bone cyst in veterinary medicine.

The mechanical features of and biologic response to using distraction osteogenesis with the circular external fixator are the unique aspects of Ilizarov's contribution that allows deformity correction and reconstruction of bone defects. We present a retrospective study of 20 patients who suffered from a variety of benign tumours for which external fixators (EF) were used to treat deformity, bone loss, and limb-length discrepancy. A total of 26 bony segments in twenty patients (10 males, 10 females; mean age 17 years; range 7-58 years) were treated with EF for residual problems from the tumour itself (primary treatment) in 8 patients and for complications related to the primary surgery (secondary treatment) in 12 patients. Histological diagnoses were Ollier's disease (n = 4), Fibrous Dysplasia (n = 5), Congenital multiple exostosis (n = 5), giant cell tumour (n = 2) and one case for chondromyxoid fibroma, desmoid fibroma, chondroma and unicameral bone cyst. Various types of external fixators used to treat these problems. These were Ilizarov, unilateral fixator, multiaxial correction frame (Biomet, Parsippany, NJ), Taylor spatial frame (Memphis, TN) and smart correction multiaxial frame. The mean follow-up time was 69.5 months (range 35-108 months). The mean external fixation time was 159.5 days (range 27-300 days). The mean external fixation index was 67.4 days/cm (12-610) in 26 limbs who underwent distraction osteogenesis. The mean length of distraction was 4.9 cm (range 0.2-14 cm). At final follow-up, all patients had returned to normal activities. Complications were in the form of knee arthrodesis in one patient, pin tract infection in six and residual shortening in eight patients. The use of EF and the principles of distraction osteogenesis, in the management of problems associated with benign bone tumours and related surgery yields successful results especially in young patients. With this approach, the risk for recurrence of shortening and deformity may be minimized with overcorrection or over-lengthening as dictated by preoperative planning.

Background: The quest for ideal bone graft substitutes still haunts orthopedic researchers. The impetus for this search of newer bone substitutes is provided by mismatch between the demand and supply of autogenous bone grafts. Bone banking facilities such as deep frozen and freeze-dried allografts are not so widely available in most of the developing countries. To overcome the problem, we have used partially decalcified, ethanol preserved, and domestic refrigerator stored allografts which are economical and needs simple technology for procurement, preparation, and preservation. The aim of the study was to assess the radiological and functional outcome of the partially decalcified allograft (by weak hydrochloric acid) in patients of benign lytic lesions of bone. Through this study, we have also tried to evolve, establish, and disseminate the concept of the bone bank. Materials and Methods: 42 cases of lytic lesions of bone who were treated by decalcified (by weak hydrochloric acid), ethanol preserved, allografts were included in this prospective study. The allograft was obtained from freshly amputated limbs or excised femoral heads during hip arthroplasties under strict aseptic conditions. The causes of lytic lesions were unicameral bone cyst ( n = 3), aneurysmal bone cyst ( n = 3), giant cell tumor ( n = 9), fibrous dysplasia ( n = 12), chondromyxoid fibroma, chondroma, nonossifying fibroma ( n = 1 each), tubercular osteomyelitis ( n = 7), and chronic pyogenic osteomyelitis ( n = 5). The cavity of the lesion was thoroughly curetted and compactly filled with matchstick sized allografts. Results: Quantitative assessment based on the criteria of Sethi et al. (1993) was done. There was complete assimilation in 27 cases, partial healing in 12 cases, and failure in 3 cases. Functional assessment was also done according to which there were 29 excellent results, 6 good, and 7 cases of failure (infection, recurrence, and nonunion of pathological fracture). We observed that after biological incorporation, the graft participates in bone physiology and morphology. We did not observe any adverse host graft antigenic reaction. Conclusions: We conclude that decalcified allograft is suitable alloimplant for use in benign lesions of bone, is easy to prepare and store, and is thus well suited for use in developing countries.

Bone cyst is a simple fluid filled lesion which can be diagnosed at any age and can occur in any bone of the body. These are non cancerous unicameral bone cysts (UBC). These are asymptomatic and usually do not cause any complications. Though common in the long bones but can rarely occur in flat bones. The iliac bone is a rare location for the occurrence and can be found as incidental finding while doing computerized tomography (CT) or magnetic resonance imaging (MRI) studies. There is no expansion of the bone with unicameral bone cysts but in our present case there was expansion making it atypical presentation. We present a 22-year male who underwent MRI for Lumbosacral spine for his vague low backache symptoms. There was incidental finding of bony lesion in left iliac bone which turned out to be simple bone cyst. The study of Lumbosacral spine was unremarkable.

Simple and aneurysmal bone cysts are benign lytic bone lesions, usually encountered in children and adolescents. Simple bone cyst is a cystic, fluid-filled lesion, which may be unicameral (UBC) or partially separated. UBC can involve all bones, but usually the long bone metaphysis and otherwise primarily the proximal humerus and proximal femur. The classic aneurysmal bone cyst (ABC) is an expansive and hemorrhagic tumor, usually showing characteristic translocation. About 30% of ABCs are secondary, without translocation; they occur in reaction to another, usually benign, bone lesion. ABCs are metaphyseal, excentric, bulging, fluid-filled and multicameral, and may develop in all bones of the skeleton. On MRI, the fluid level is evocative. It is mandatory to distinguish ABC from UBC, as prognosis and treatment are different. UBCs resolve spontaneously between adolescence and adulthood; the main concern is the risk of pathologic fracture. Treatment in non-threatening forms consists in intracystic injection of methylprednisolone. When there is a risk of fracture, especially of the femoral neck, surgery with curettage, filling with bone substitute or graft and osteosynthesis may be required. ABCs are potentially more aggressive, with a risk of bone destruction. Diagnosis must systematically be confirmed by biopsy, identifying soft-tissue parts, as telangiectatic sarcoma can mimic ABC. Intra-lesional sclerotherapy with alcohol is an effective treatment. In spinal ABC and in aggressive lesions with a risk of fracture, surgical treatment should be preferred, possibly after preoperative embolization. The risk of malignant transformation is very low, except in case of radiation therapy.

Background: Treatment of femoral fractures in age group of 6 – 12 years is controversial. Operative treatment is becoming better accepted. Various modalities of fixation include plate osteosynthesis, External fixation; Antegrade locked nailing, and flexible intramedullary nailing. Methods: 60 children aged 6-12 years (Average age – 8.2 years) with 66 femoral diaphyseal fractures (61 closed and 05 open) in 60 patients were managed with closed Ender’s nailing. Pathological fractures due to unicameral bone cyst were evident in 5 patients. Femoral shaft fractures at the level proximal to distal three fifth with canal diameter of ≥ 6mm were included in the study. Out of 66 traumatic fractures 42 fractures had stable pattern and 19 had unstable fracture pattern. The results were evaluated clinically and radiologically. Results: All the 42 stable femoral fractures showed bridging callus in a mean time of 3.83 weeks (2.5 to 6.5 weeks). Full weight bearing was possible in a mean time of 4.19 weeks. Radiological union was seen in a mean time of 9.4 weeks. 34 fractures were evaluated by scanogram one year after injury and they revealed lengthening of 0.3cms. All the children returned to their previous level of activities. All the 19 unstable femoral fractures showed bridging callus in a mean time of 5.53 weeks (4 – 8 weeks). Full weight bearing was possible in a mean time of 6.21weeks. Radiological union was seen in a mean time of 12 weeks. 8 patients were readmitted for adjunctive procedures like nail impaction, traction and cast immobilization. 20% patients with unstable group had shortening of 1.3cms and 20% had external rotation of lower limb. Conclusions: Ender’s nailing is simple, cost-effective and minimally invasive procedure in 6-12 years of age. It offers stable fixation with rapid healing. There is prompt return of child to normal activity.

Aneurysmal bone cysts (ABCs) were first described by Jaffe and Lichtenstein in 19421. Eighty percent of these lesions occur during the first two decades of life2; the most common location is the metaphysis of long bones. To the best of our knowledge, only four cases of individuals with multiple ABCs occurring over a period of time (metachronous ABCs) have been described to date3-6 (Table I). The cases all have been similar in presentation, imaging, and pathology to solitary ABCs; the only difference has been regarding the sex of the patient. While solitary ABCs have been shown to be predominant in females (62%)7, the reported cases of metachronous ABCs have all occurred in males. We report the case of an adolescent girl with multiple ABCs presenting separately in the proximal part of the femur and the distal part of the humerus over a five-month period. The patient and her parents were informed that data concerning the case would be submitted for publication, and they provided consent. View this table: TABLE I Reported Cases of Metachronous Aneurysmal Bone Cysts A healthy and active fourteen-year-old girl presented to the sports medicine clinic with unilateral hip pain. She had no history of trauma or an activity-related injury. Radiographs demonstrated a well-defined (5.4 × 2.8 cm) oval lucent geographic lesion in the proximal part of the femur, which initially was thought to be consistent with a unicameral bone cyst. At the short interval follow-up, the pain had worsened, and a new palpable mass was noted. Additional radiographs revealed substantial interval progression of the lesion with extension into the adjacent soft tissues with expansion of the bone (Fig. 1). Fig. 1 Anteroposterior radiograph demonstrates a lucent geographic lesion with a well-defined border (black arrow) in the right hip. However, there is focal extension …

Several therapeutic strategies have been used for managing unicameral bone cyst (UBC) of the proximal femur. However, there is insufficient evidence to support one treatment over another, and the optimal treatment is controversial. This study aims at describing our experience with surgical reconstruction of paediatric UBCs of the proximal femur using a proximal locking plate and fibular strut allograft. In total, 14 consecutive paediatric patients with Dormans types IB (four cases) and IIB (10 cases) UBC were assessed. Mean patient age was 8.6 ± 2.3 years, and mean follow-up period was 41.7 ± 29.8 months. Six patients (42.8%) were referred with a pathologic fracture. Clinical/radiological outcome and complication rates were evaluated at the final follow-up session. No cysts were Capanna’s class III (recurrence) or IV (no response). Complete healing (Capanna’s class I) was seen in ten cysts, while four other cysts healed with residual radiolucent areas (Capanna’s class II). Mean healing period was 14.1 ± 5.1 (9–24 months). One patient had superficial infection, one heterotopic ossification, and one mild coxa vara, and mean Musculoskeletal Tumor Society (MSTS) score was 99.5%. According to our results, locking plate and fibular strut graft in Dormans classification types IB and IIB results in a favorable outcome in managing UBC of the proximal femur in the paediatric population.

Bone cysts are benign bone lesions that are quite uncommon in the calcaneus. Calcaneal cysts generally remain asymptomatic in most patients and are discovered incidentally but in some, they may cause localized bone pain that is progressive in intensity. If not picked on the conventional radiographs, the diagnosis is delayed and the patient remains distressed and dispirited. We, here, report a military soldier with calcaneal cyst who remained misdiagnosed for six months and had been treated as a case of ankle sprain. After correct diagnosis, his problems were finally settled following surgical intervention. The physicians should keep a high degree of suspicion of an alternative diagnosis in all cases where usual management is not beneficial in commonly expected pathologies. Keywords: Ankle Pain; Bone Cement; Calcaneus; Case Report; Surgical Curettage; Unicameral Bone Cyst

Little data exist to guide the treatment of unicameral bone cysts in the proximal femur. Methods of treatment include corticosteroid injections, curettage and bone grafting, and internal fixation. The authors completed a multi-institutional, retrospective review to evaluate their experience with proximal femoral unicameral bone cysts. They posed the following questions: (1) Does internal fixation reduce the risk of further procedures for the treatment of a unicameral bone cyst? (2) Is radiographic healing faster with internal fixation? Following institutional review board approval, the authors conducted a retrospective review of 36 patients treated for a unicameral bone cyst of the proximal femur at their institutions between 1974 and 2014. Medical records and radiographs were reviewed to identify patient demographics and treatment outcomes. Tumor locations included femoral neck (n=13), intertrochanteric (n=16), and subtrochanteric (n=7). Initial treatment included steroid injection (n=2), curettage and bone grafting (n=9), and internal fixation with curettage and bone grafting (n=25). Mean time was 9 months to radiographic healing and 15 months to return to full activity. The number of patients requiring additional surgeries was increased among those who did not undergo internal fixation. There was no difference in time to radiographic healing. However, time to return to normal activities was reduced if patients had received internal fixation. A significant reduction in additional procedures was observed when patients had been treated with internal fixation. Although this did not influence time to radiographic healing, patients did return to normal activities sooner. Internal fixation should be considered in the treatment of proximal femoral unicameral bone cysts. [ Orthopedics. 2017; 40(5):e862–e867.]

Unicameral bone cysts (UBCs) are common benign bone tumors in skeletally immature individuals. UBCs are considered active when found in close proximity to the growing physis. An active UBC of the femoral neck raises unique management challenges. This is due to its location in an area known to be high risk for complications if fractured, such as avascular necrosis and varus malunion. Transfixing the femoral neck physis while aiming to stabilize the fracture poses a risk of growth arrest. This risk is minimized when employing smooth Kirschner wires. Here, we present the case of a 5-year-old male with a recurrent active UBC in the left femoral neck complicated with a pathological fracture in which stabilization was achieved utilizing the Wagner technique of multiple Kirschner wires. To our knowledge, this technique has not been described in the treatment of such pathology.

A 4-year-old Shih-Tzu, referred for an enlarged left carpus, was diagnosed with a unicameral bone cyst. A customized titanium device was inserted into cystic lesion and fixed by titanium screws. Sufficient strength of the affected bone with the device inserted to maintain limb function was established after resection of contents of cystic lesion. There was no deterioration of the lesion of bone cyst, and acceptable function of the affected limb with no clinical signs of lameness was maintained during 36 months follow-up. The results of this study demonstrated that bone cyst curettage and use of a customized titanium device could provide an effective alternative treatment of huge lesion of unicameral bone cysts with the intent of preventing pathologic fractures.

Introduction There is no consensus on when and how to treat unicameral bone cysts (UBCs), partly because of a lack of knowledge of the aetiology. Purpose To review the different treatment techniques for UBCs and to describe our results with a single injection of autogenous bone marrow (BM) mixed with demineralised bone matrix (DBM) in very young children. Patients and methods We reviewed five patients under the age of 8 years with UBCs treated by percutaneous aspiration and a single injection of BM associated with DBM. The cyst was located in the proximal humerus in four patients and in the proximal femur in one patient. Assessment of the need for surgery was based on the clinical and radiographic suspicion of new pathological fractures. The administration of a second injection, when necessary, was based on the surgeon's judgement regarding the risk of fracture. The mean follow-up after first injection was 41 months. Results There were no complications related to the procedure, except a non-displaced fracture, which healed without problems. All patients were pain free and progressively resumed their activities without restriction until a new fracture occurred in two cases. According to Capanna's classification, only one case healed completely (grade 1), one lesion was classified as grade 2, and there were three recurrences at 11, 12 and 27 months after initial treatment (grade 3). The final outcome was treatment failure for three out of the five patients. Two patients were treated with a second injection and one patient is waiting for surgery. Conclusion A single injection of aspirated autogenous BM mixed with DBM in very young children with active UBCs at risk of fracture is very simple, comfortable and safe. Nevertheless, the results seem to be unpredictable and are probably more dependent on the natural evolution of the cyst than on the treatment. Further comparative studies with larger sample numbers are needed.

Unicameral bone cysts are benign bone lesions that are often asymptomatic and commonly develop in the proximal humerus and femur of skeletally immature patients. The etiology of these lesions remains unknown. Most patients present with a pathologic fracture, but these cysts can be discovered incidentally, as well. Radiographically, a unicameral bone cyst appears as a radiolucent lesion with cortical thinning and is centrally located within the metaphysis. Although diagnosis is frequently straightforward, management remains controversial. Because the results of various management methods are heterogeneous, no single method has emerged as the standard of care. New minimally invasive techniques involve cyst decompression with bone grafting and instrumentation. These techniques have yielded promising results, with low rates of complications and recurrence reported; however, prospective clinical trials are needed to compare these techniques with current evidence-based treatments.

Traumatic bone cysts (TBC) in the jaws are asymptomatic, slow growing, usually non-expansile lesions commonly diagnosed during routine radiographic examination. Unusually large and relatively aggressive TBC of the jaws are uncommon. The aetiology and pathogenesis of this entity remain unclear. In the extremities, however, lesions similar to the TBC of jaws are noted but are much larger and exhibit significant growth potential. This series of cases highlights unusually large and aggressive nature of TBC of jaws that is generally considered to be innocuous and non-expansile with minimal clinical significance. TBC may be considered in the differential diagnosis of large mandibular radiolucent lesions.

Purpose Different treatment modalities have been utilized to treat unicameral bone cyst (UBC), but evidence has not been fully described to support one treatment over another and the optimal treatment is controversial. The aim of this quantitative systematic review was to assess the effectiveness of different UBC treatment modalities. Methods We utilized Pubmed to isolate retrospective studies on patients with UBC who received any kind of treatment. The included studies needed to have a minimum sample size of 15 patients, and have provided data on radiographic healing outcome. Results Sixty-two articles were selected for the meta-analysis from a total of 463 articles. The cumulative sample size was 3,211 patients with 3,217 UBC, and male to female ratio was 2.2:1. The summary or pool estimate of methylprednisolone acetate (MPA) injection resulted in a healing rate of (77.4 %) that was comparable to bone marrow injection (77.9 %). A higher healing rate was observed with MPA injection when inner wall disruption was performed. The pool estimate of bone marrow with demineralized bone matrix injection was high (98.7 %). UBC healing rate after surgical curettage was comparable whether autograft or allograft was utilized (90 %). UBC treatment with flexible intramedullary nails without curettage provided almost 100% healing rate, while continuous decompression with cannulated screws provided 89 % healing rate. Conservative treatment indicated a healing rate of 64.2, 95 % CI (26.7–101.8). Conclusions Active treatment for UBC provided variable healing rates and the outcomes were favorable relative to conservative treatment. Due to the heterogeneity of the studies and reporting bias, the interpretation of these findings should be handled with caution.

The simple bone cyst (SBC) also called unicameral bone cyst is a tumor-like lesion of unknown cause, attributed to a local disturbance of the bone growth. Although the pathogenesis is still unknown, the lesion appears to be reactive or developmental . Traumatic etiology of simple bone cysts remains an enigma up to now. We present a case of 44 year old woman who came with c/o pain in right shoulder due to fall from vehicle 5 months back with X-ray and MRI both suggestive of cystic lesion over greater tuberosity humeral head . Patient was treated with arthroscopic curettage and bone grafting. In the last decade, however, there has been an exponential growth in the use of minimally invasive surgical techniques. This is particularly seen in the shoulder, where multiple arthroscopic and procedures have been described in the treatment of intra- and extra-articular pathologies.

Simple bone cyst (SBC) also known as unicameral bone cyst is a benign, radiolucent bone lesion that is seen commonly in childhood. These lesions are usually found incidentally although pain and swelling can be seen. The most common complication is a pathological fracture, and this is often the cause of presentation. Here, we present a 22-year-old male with right lower quadrant pain due to SBC related pathological fracture of right iliac bone which is mimicking acute appendicitis. © 2018 Elsevier Inc.

An 18-month-old warmblood filly was 4/5 lame on the front right limb at referral and showed severe swelling of the right shoulder region and pain during manipulation of the shoulder region. Radiography revealed a roundish 5 × 7 cm radiolucent area with defined borders within the greater tubercle and the presence of a fracture of the lateral tubercle associated with the cyst. Cellular blood count was 27,500 WBC/μL and serum biochemical analyses revealed fibrinogen of 855 mg/dL. The fractured bone was removed surgically; the cyst debrided and filled with autologous cancellous bone graft. Three and five weeks after surgery the filly was reoperated on because of an osseous sequestrum and a periostal defect on the distal dorsolateral aspect of the pastern of the right hind limb and a septic synovitis of the DFTS of the left hind limb. Fifteen month after surgery the filly was not lame and was introduced to training. Unicameral bone cysts (UBC) are well described lesions, often associated to pathologic fracture in the proximal humerus of children but, until present, no scientific report exists of UBC in the foal. The prompt surgical management had a favorable outcome.

Recently, surgical treatment of a symptomatic unicameral cyst of the proximal femur has been achieved with less invasive procedures than traditional open curettage with an autologous bone graft. In this article we introduce endoscopic surgery for a symptomatic unicameral cyst of the proximal femur. The presented technique, which includes minimally invasive endoscopic curettage of the cyst and injection of a bone substitute, not only minimizes muscle damage around the femur but also enables sufficient curettage of the fibrous membrane in the cyst wall and the bony septum through direct detailed visualization by an endoscope. Furthermore, sufficient initial strength after curettage can be obtained by injecting calcium phosphate cement as a bone substitute.

Chondromyxoid fibroma occurs primarily in the long tubular bones of the lower extremity, with the foot representing the second most frequent location after the knee. This benign cartilaginous tumor of bone is currently the rarest reported neoplasm of cartilaginous origin. This mass can mimic other benign and malignant bone tumors owing to its variable histologic features. We report 2 cases of chondromyxoid fibroma of the calcaneus with varying presentations. Initially, advanced imaging studies pointed to a diagnosis of a unicameral bone cyst. Pathologic examination is difficult but can be used to differentiate this lesion from more serious conditions. A quick and accurate diagnosis of chondromyxoid fibroma can prevent unnecessary treatment that could be harmful to the patient.

A unicameral bone cyst is a relatively uncommon, benign bone tumor found in the metaphysis of long bones, such as the humerus and the femur, in skeletally immature persons. In the foot, these benign, fluid-filled cavities are most commonly found within the os calcis. We present a case report of a 10-year-old female with a unicameral bone cyst of the medial cuneiform.

PurposeTo review the outcome of 12 patients who underwent debridement and injection of bioceramic for unicameral bone cyst (UBC). The resorption rate of the bioceramic was estimated by both traditional and novel methods.MethodsRecords of 10 males and 2 females aged 6 to 34 years who underwent debridement and injection of bioceramic for UBC and were followed up for a mean of 41 (range, 26–57) months were reviewed. Functional outcome was assessed using the self-completed Musculoskeletal Tumor Society (MSTS) questionnaire. Radiological outcome was assessed using both original and modified Neer Outcome Rating System. The resorption rate of the bioceramic was estimated using both traditional and novel (ImageJ) methods.ResultsThe mean MSTS score was 29.7 (range, 28–30) indicating excellent functional outcome. Of the 12 patients, 9 achieved complete healing and 3 had a residual cyst of 1%, 11%, and 52%. The last was considered a local recurrence, and the patient underwent repeat percutaneous injection of the bioceramic 1.5 years later and remained disease-free 4 years later. The mean resorption rate was 29% faster when estimated using the traditional rather than the ImageJ method (0.47 vs. 0.33 cm3/day, p=0.02). In the patient with recurrence, the resorption rate was faster than the average (0.68 vs. 0.33 cm3/day).ConclusionA single percutaneous injection of the bioceramic for UBC achieved good functional and radiological outcome while avoiding donor-site morbidity.

Background Both unicameral bone cysts and intra-osseous lipoma of the calcaneus are rare entities which are mostly diagnosed due to unspecific heel pain, pathologic fracture or as an incidental finding. Minimally-invasive ossoscopy with endoscopic resection of the tumor followed by grafting can potentially minimize risks of open surgery and speed up convalescence. The objective of this study is to present a simple, safe and cost-effective surgical technique for endoscopic surgical treatment of benign osteolytic lesions of the calcaneus. Description of technique We present our modifications to previously described techniques of endoscopic curettage with a particular focus on intraosseous lipoma. The key point for grafting is the use of a funnel-shaped ear speculum facilitating the plombage with allogenic cancellous bone chips. Patients and methods Between June 2013 and January 2015 ten consecutive patients underwent ossoscopy of the calcaneus. There were 4 cases of intraosseous lipoma and 6 cases of unicameral bone cyst. In a retrospective study, radiological results were analyzed using the Glutting-Classification, functional outcome was recorded with the AOFAS Hindfoot score. Results Radiographic follow-up and functional outcome showed good to excellent results. All lesions radiologically classified as “healed”. AOFAS score (max. 100 pts) ranged from 74 to 100 (ø94.4 ± 9.3). Conclusions This technique is a simple and safe procedure for benign osteolytic bone lesions of the calcaneus. Compared to its alternatives, grafting with allogenic cancellous bone might prove favourable in this localization for several reasons: Osteointegration, handling, availability and costs. Our preliminary investigations show promising results although further clinical and radiographic results are needed.

The aim of this study was to determine the benefits of cystography in the management of a simple bone cyst, its implication in the final result of the treatment after corticoid intracystic injections, and the presence of secondary effects. We retrospectively reviewed 42 patients diagnosed with a simple bone cyst. Cystography was performed before the corticoid injection. The presence or absence of loculation intracyst and the existence and number of venous outflows were determined. According to the venous drainage, cysts were classified as type 0 when a venous outflow did not exist and as type 1 when there was a rapid venous outflow (

1. Moshe Shapira, MD* 2. Josephine Issakov, MD† 3. Mark Eidelman, MD‡ 1. *Maccabi Health Services, Nave-Sha’anan clinic, Haifa, Israel. 2. †Head of Bone and Soft Tissue Tumors Unit, Institute of Pathology, Tel-Aviv (Sourasky) Medical Center, Tel-Aviv University, Tel-Aviv, Israel. 3. ‡Head, The Pediatric Orthopedic Unit, Rambam Health Care Campus, Technion Rappaport, Faculty of Medicine and Research Institute, Haifa, Israel. An 11½-year-old girl presents to the clinic with a 6-week history of left leg pain. She is an active participant in gymnastics, and, although she has fallen a few times during practice, she denies any significant trauma. Recently, she has limited her participation in training because her leg pain has increased significantly. However, the pain does not restrict her walking. She denies other limb or joint pain, night sweats, joint swelling, fever, rash, anorexia, weight loss, or recent illness. Her past medical history is unremarkable. The patient is a well-appearing girl. Vital signs are normal. The only significant finding upon physical examination is point tenderness over the anterior aspect of the proximal left tibia. There is no swelling, warmth, or erythema of the left leg or knee. There is no active or passive restriction of range of motion of all joints. The remainder of the physical examination is normal. Laboratory examination reveals a normal complete blood cell count and erythrocyte sedimentation rate and normal levels of C-reactive protein, electrolytes, blood urea nitrogen, creatinine, and liver enzymes. Urinalysis yields unremarkable results. Radiography of the left leg reveals an abnormality that may be associated with her pain (Fig 1). Figure 1. Radiographs of the left knee demonstrate a radiolucent oval lesion with sharp borders within the proximal tibia. Radiography reveals a radiolucent oval lesion; it is most likely a unicameral bone cyst (UBC). There is no evidence of a fracture. The patient is referred to a pediatric orthopedist for further evaluation. Described by Virchow in 1876, a UBC (also known as a simple bone cyst, solitary bone cyst, or juvenile bone cyst) …

An intraosseous lipoma is a rare benign bone lesion that proliferates from mature lipocytes. It occurs most frequently in the lower limb, particularly in the calcaneus. The talus is an unusual location for this rare lesion. A review of the literature produced only two reports with talar intraosseous lipomas under the name of intraosseous lipomatosis, which described multiple lipomas in different areas. We describe a 38-year-old male patient who had an isolated intraosseous lipoma with an osteochondral defect in the talus and was treated with autologous osteochondral graft transplantation by medial malleolar osteotomy. He could walk with full weightbearing without any assistance at the end of 12 months. Intraosseous lipoma localized in the talus may be confused radiologically with other bone lesions, especially with unicameral bone cyst, if it is associated with an osteochondral defect. Autologous osteochondral graft transplantation is a successful treatment method for talar intraosseous lipoma. (J Am Podiatr Med Assoc 101(3): 269–274, 2011)

Background Interventions to treat unicameral bone cysts vary. Nonetheless, regardless of the intervention modality, the outcome is not certain. The purpose of this study was to determine if the distance between the growth plate and the cyst can be used to predict the outcome of the treatment. Methods and materials Retrospectively, we assessed the outcome of 39 interventions in nineteen children that were performed between 1994 and 2003. Seventeen different modalities of treatment were employed. There were three female and sixteen male patients. The average age was 8 years. Nine cysts were in the greater trochanter area, three were in the femoral capital area and seven were in the proximal humerus. According to the cyst's distance from the growth plate, at the intervention time, there were 18 cases within less than 2 cm and 21 cases of more than 2 cm. Results Complete healing was achieved in 10 children (employing seven different modalities). In nine of them, the cysts were more than 2 cm away from the growth plate. In one child, the cyst was within less than 2 cm of the growth plate, however, treatment here involved epiphyseodesis. Discussion This study confirmed that, regardless of intervention modality, complete healing was not achievable in those cysts that are within less than 2 cm of an active growth plate. Complete healing was possible in those cysts that are more than 2 cm away from the growth plate. Conclusion The 2-cm distance from the growth plate could be used as a predictor of treatment outcome of unicameral bone cysts.