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Flexible Intramedullary Nailing for the Treatment of Unicameral Bone Cysts in Long Bones*
Andreas Roposch, M.D.†; VinAy Saraph, M.S., D.N.B.‡; Wolfgang E. Linhart, M.D.‡
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Investigation performed at the Department of Pediatric Orthopaedic Surgery, Karl-Franzens-University of Graz, Graz, Austria
*No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.
†Spittelauerlaende 9/21, 1090 Vienna, Austria. E-mail address for A. Roposch: andreas.roposch@univie.ac.at. Please address requests for reprints to A. Roposch.
‡Department of Pediatric Orthopaedic Surgery, Karl-Franzens-University of Graz, Auenbruggerplatz 34, 8036 Graz, Austria. E-mail address for W. E. Linhart: wolfgang.linhart@kfunigraz.ac.at.

J Bone Joint Surg Am, 2000 Oct 01;82(10):1447-1447
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Background: Unicameral bone cyst is characterized by its tenacity and risk of recurrence. Pathological fracture is common and is often the presenting symptom. The objective of the present study was to evaluate the results of flexible intramedullary nailing for the treatment of a unicameral bone cyst with or without a pathological fracture.

Methods: Flexible intramedullary nailing for the treatment of a unicameral bone cyst was performed in thirty-two patients. Thirty of these patients presented with a pathological fracture; twenty-four were managed immediately with intramedullary nailing, and the other six had been managed conservatively at other clinics before they were referred to our department. The remaining two cysts were detected incidentally. The cyst was located in the humerus in twenty-one patients, in the femur in nine, and in the radius in two. The mean age of the patients at the time of surgery was 9.8 years, and the mean duration of follow-up was 53.7 months. Radiographic evaluation was performed according to the criteria of Capanna et al., and the cyst was classified as completely healed, healed with residual radiolucency (osteolysis), recurred, or having no response.

Results: The healing period ranged from three to 105 months. Fourteen cysts healed completely, and sixteen healed with residual radiolucent areas visible on radiographs. There was recurrence of two cysts that had healed with residual radiolucency. All of the cysts in the present study responded to treatment. A change of nails was necessary in nine patients, as the nails had become too short after bone growth. No major complications were observed.

Conclusions: Flexible intramedullary nailing provides early stability, which allows early mobilization and thus obviates the need for a plaster cast and decreases the prevalence of the most common complication: a pathological fracture. This method of treatment also allows for an early return to normal activity.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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