title: Determining the best treatment for simple bone cyst: a decision analysis.
abstract: BACKGROUND
  The treatment of simple bone cysts (SBC) in children varies significantly among physicians. This study examined which procedure is better for the treatment of SBC, using a decision analysis based on current published evidence.
  
  
  METHODS
  A decision tree focused on five treatment modalities of SBC (observation, steroid injection, autologous bone marrow injection, decompression, and curettage with bone graft) were created. Each treatment modality was further branched, according to the presence and severity of complications. The probabilities of all cases were obtained by literature review. A roll back tool was utilized to determine the most preferred treatment modality. One-way sensitivity analysis was performed to determine the threshold value of the treatment modalities. Two-way sensitivity analysis was utilized to examine the joint impact of changes in probabilities of two parameters.
  
  
  RESULTS
  The decision model favored autologous bone marrow injection. The expected value of autologous bone marrow injection was 0.9445, while those of observation, steroid injection, decompression, and curettage and bone graft were 0.9318, 0.9400, 0.9395, and 0.9342, respectively. One-way sensitivity analysis showed that autologous bone marrow injection was better than that of decompression for the expected value when the rate of pathologic fracture, or positive symptoms of SBC after autologous bone marrow injection, was lower than 20.4%.
  
  
  CONCLUSIONS
  In our study, autologous bone marrow injection was found to be the best choice of treatment of SBC. However, the results were sensitive to the rate of pathologic fracture after treatment of SBC. Physicians should consider the possibility of pathologic fracture when they determine a treatment method for SBC.
authors.affiliation: Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
authors.forename: Seung Yeol
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
authors.forename: Chin Youb
authors.initials: CY
authors.lastname: Chung
authors.affiliation: Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
authors.forename: Kyoung Min
authors.initials: KM
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea.
authors.forename: Ki Hyuk
authors.initials: KH
authors.lastname: Sung
authors.affiliation: Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
authors.forename: Sung Hun
authors.initials: SH
authors.lastname: Won
authors.affiliation: Department of Orthopedic Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: In Ho
authors.initials: IH
authors.lastname: Choi
authors.affiliation: Department of Orthopedic Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Tae-Joon
authors.initials: TJ
authors.lastname: Cho
authors.affiliation: Department of Orthopedic Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Won Joon
authors.initials: WJ
authors.lastname: Yoo
authors.affiliation: Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
authors.forename: Ji Hyun
authors.initials: JH
authors.lastname: Yeo
authors.affiliation: Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
authors.forename: Moon Seok
authors.initials: MS
authors.lastname: Park
mesh_terms: D000704:Analysis of Variance; D001845:Bone Cysts / Q000601:surgery*; D016026:Bone Marrow Transplantation / Q000379:methods*; D003663:Decision Trees; D006801:Humans; D017410:Practice Guidelines as Topic; D014182:Transplantation, Autologous
keywords: Autologous bone marrow injection; Decision analysis; Simple bone cyst; Unicameral bone cyst