Simple bone cyst of the proximal femur: Curettage and plating with Synthes 45 mm DCP plate
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Unicameral bone cysts (UBC) or simple bone cysts were reported by Virchow in 1876 and despite therefore the considerable length of experience with this tumour many factors related to it, including pathogenesis and treatment, continue to be under debate. They represent about 3% of all bone tumors and there is a prevalence of males / female of 2:1. Malignant transformation has not been documented in these tumours.
Around 75% of all UBCs occur in children and adolescents and usually these cysts are reported in the metaphyseal areas of long bones with open physes. Most of the time they are solitary lesions and there are not associated with syndromes. The proximal humerus and femur account for almost 90% of these cases. UBCs in the proximal humerus develop more frequently during childhood and tend to disappear after puberty. On the other hand proximal femoral UBCs tend to present in adolescent patients.
The etiology of this tumor remains unclear. Many hypotheses, including disturbance in bone growth, inflammatory and dysplastic processes, traumatic events or blockage in the venous drainage, are described.
UBC diagnosis is based characteristic plane X-ray images in the main and most of time does not require biopsy. However one should include as differential diagnoses aneurysmal bone cyst, fibrous dysplasia, enchondroma and eosinophlic granuloma. If I am not sure that I am dealing with an UBC I will confirm the diagnosis through histology.
The main therapeutic options for simple bone cysts are immobilisation and observation, percutaneous decompression, percutaneous aspiration plus injection of corticosteroids or intralesional surgery.
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Author: Nacho Albergo MD.
Institution: The Italian Hospital, Buenos Aires, Argentina.
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