Injection of demineralized bone matrix with bone marrow concentrate improves healing in unicameral bone cyst.
BACKGROUND
Unicameral bone cysts are benign lesions that usually spontaneously regress with skeletal maturity; however, the high risk of pathologic fractures often justifies treatment that could reinforce a weakened bone cortex. Various treatments have been proposed but there is no consensus regarding the best procedure.


OBJECTIVE
We compared the healing rates and failures of two methods of cure based on multiple injections of corticosteroid or a single injection of demineralized bone matrix (DBM) in association with bone marrow concentrate (BMC).


METHODS
We retrospectively reviewed 184 patients who had one of the two treatments for unicameral bone cysts with cortical erosion. Clinical records were reviewed for treatment failures and radiographs for healing in all patients. The minimum followup was 12 months for the Steroids Group (mean, 48 months; range, 12-120 months) and 12 months for the DBM + BMC Group (mean, 20 months; range, 12-28 months).


RESULTS
After one treatment we observed a lower healing rate of cysts treated with multiple injections of steroids compared with the healing after the first injection of DBM + BMC (21% versus 58%, respectively). At last followup, 38% healed with steroids and 71% with DBM + BMC. The rate of failure after one steroid injection was higher than after a single injection of BDM + BMC (63% versus 24%, respectively). We observed no difference in fracture rates after treatment between the two groups.


CONCLUSIONS
A single injection of DBM added with autologous bone marrow concentrate appears to provide a higher healing rate with a lower number of failures compared with a single injection of steroids.
Di Bella
Claudia
C
Department of Oncology Orthopaedic, Rizzoli Orthopaedic Institute, Bologna, Italy.
Dozza
Barbara
B
Frisoni
Tommaso
T
Cevolani
Luca
L
Donati
Davide
D
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D001845:Bone Cysts / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D016026:Bone Marrow Transplantation; D001857:Bone Matrix / Q000637:transplantation*; D002648:Child; D002675:Child, Preschool; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D015552:Injections, Intralesional; D007558:Italy; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011859:Radiography; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014182:Transplantation, Autologous; D017211:Treatment Failure; D014945:Wound Healing / Q000187:drug effects*; D055815:Young Adult
D000305:Adrenal Cortex Hormones; D008775:Methylprednisolone