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
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.