Efficiency of treatment methods for bone cysts of the humerus in pediatric patients

Abstract

Introduction Aneurysmal and unicameral bone cysts (ABC and UBC) are non-cancerous bone tumors. 75 % occurs in first two decades of life. Mostly discovered after pathological fracture. ABC: UBC = 1:1 (~0.3/100,000). Treatment is controversial. Life quality after surgery mostly is decreased. Non- vascularized fibula allograft can be used for restoration of the humerus after wide cyst resection, healed 4-6 months. Aims and Objectives To compare: efficiency of the different treatment methods for bone cysts of the humerus in pediatric patients; bone structure of the humerus of the same patients’ healthy and surgically treated hand by clinical, X-ray and MRI findings. Materials and methods Single center retrospective study. 34 patients with ABC or UBC, yr 2000-2014. Mean age -10.24 (±0.54) yrs. Mean follow-up - 7.56 yrs (SD 4.75). 13 patients’ clinical exam., X-rays, MRI were performed. 13 patients’ quality of life was evaluated using RFGK questionnaires. MRI scanning was performed on 10 patients who received surgical treatment to compare bone structure of healthy and operated humerus. Results Mean age 10.24±0.54 years. In 31 (91.2 %) patients cyst was diagnosed after the pathological fracture (p < 0.001). Total reoperation rate was 18.52 % (n = 27). 5 (45.45 %) of the patients who suffered from two or more fractures needed second surgery (p = 0.002). 16 (47.06 %) ABC’s and 18 UBC’s (52.94 %) were diagnosed. 14 (35 %) radical and 18 (45 %) non-radical surgeries were performed. Average length of radical and non-radical surgeries (2h 53 min vs 1h 41 min) and postoperative stay (12 vs 8 days) was significantly different (p < 0.05). In all 7 patients who received fibular graft transplantation bone structure in MRI is the same as in analogical section of healthy humerus or with some minor defects. Although no significant difference was found depending on surgery type (p > 0.005). Conclusions In 5 out of 7 patients MRIs after reconstruction of humerus using non vascularized fibular allograft showed no difference comparing to healthy humerus. After both types of surgeries patients were satisfied with the function of their arm and health.