title: Treatment of pathological fractures due to simple bone cysts by extended curettage grafting and intramedullary decompression.
abstract: OBJECTIVE
  Effectiveness and morbidity of curettage grafting and intramedullary decompression in the treatment of pathological fractures due to simple bone cysts (SBCs) were evaluated.
  
  
  METHODS
  Between 2005 and 2012, 34 children with SBCs were treated with extended curettage grafting and intramedullary decompression. Average age of the patients (23 male, 11 female) at surgery was 11.7 years (range: 6-21 years). The lesions were localized in the humerus (19), femur (12), tibia (2), and ulna (1). Pathological micro- or displaced fractures occurred in 31 patients. Surgical procedure included extended curettage by using cauterization and high-speed burring, bone grafting, and intramedullary decompression with elastic nails. Six patients had been treated conservatively or surgically in other institutions previously. Radiographic and functional results were evaluated by Capanna criteria and MSTS scores respectively. Early and late complications and additional surgical procedures were recorded.
  
  
  RESULTS
  The average follow-up was 37 months (range: 18-89 months). The average time to heal for pathological fractures was 8 weeks (range: 6-12 weeks). Radiographic evaluation revealed Grade 1 healing in 28 patients (82%) and Grade 2 healing in 6 patients (18%). The average MSTS score based on final follow-up was 28.5 (range: 17-30); excellent (32 patients; 94%) and good (2 patients; 6%) functional results were obtained. There was no early or late infection, refracture or implant failure. Malunion developed following treatment of 2 humeral and 2 femoral lesions. With the exception of 2 implant removals, no patients required additional surgical intervention.
  
  
  CONCLUSIONS
  Complete cyst healing and satisfactory functional results can be obtained by curettage grafting and intramedullary decompression. This technique restores bone integrity by allowing early motion and prevents refracture and subsequent deformity in the majority of patients.
authors.affiliation: Marmara University Pendik Training and Research Hospital, Department of Orthopedics and Traumatology, İstanbul, Turkey.
authors.forename: Bülent
authors.initials: B
authors.lastname: Erol
authors.affiliation: Marmara University Pendik Training and Research Hospital, Department of Orthopedics and Traumatology, İstanbul, Turkey.
authors.forename: Tolga
authors.initials: T
authors.lastname: Onay
authors.affiliation: Marmara University Pendik Training and Research Hospital, Department of Orthopedics and Traumatology, İstanbul, Turkey.
authors.forename: Emrah
authors.initials: E
authors.lastname: Çalışkan
authors.affiliation: Marmara University Pendik Training and Research Hospital, Department of Orthopedics and Traumatology, İstanbul, Turkey.
authors.forename: Ahmet Nadir
authors.initials: AN
authors.lastname: Aydemir
authors.affiliation: Marmara University Pendik Training and Research Hospital, Department of Orthopedics and Traumatology, İstanbul, Turkey.
authors.forename: Osman Mert
authors.initials: OM
authors.lastname: Topkar
mesh_terms: D000293:Adolescent; D001845:Bone Cysts / Q000601:surgery*; D016025:Bone Transplantation / Q000009:adverse effects*; D002648:Child; D003475:Curettage; D019299:Decompression, Surgical; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging; D005598:Fractures, Spontaneous / Q000209:etiology / Q000601:surgery*; D006801:Humans; D006811:Humerus / Q000000981:diagnostic imaging; D008297:Male; D011859:Radiography; D055815:Young Adult