title: Comparison of titanium elastic intramedullary nailing versus injection of bone marrow in treatment of simple bone cysts in children: a retrospective study.
abstract: Simple bone cysts are common benign lytic bone lesions in children. The main goals of treatment for bone cysts are to prevent pathological fractures, support the healing process, and prevent recurrence. This retrospective study compared fixation with titanium elastic intramedullary nailing (TEN) versus aspiration and injection of autogenous bone marrow (ABM) for the treatment of simple bone cysts in children.
  
  
  
  Forty-six patients (mean follow-up, 62 months; range, 34-71 months) who presented with bone cysts (30 in the humerus, 16 in the femur) from January 2006 to December 2012 were retrospectively evaluated. Patients were treated with either TEN or ABM injection. Radiographs were evaluated according to previously established criteria. Clinical evaluations of pain, infection, additional fractures, and range of motion were performed.
  
  
  
  After treatment, all patients were pain-free and had normal range of motion in adjacent joints. In the ABM group, 14 (60.9 %) bone cysts completely healed, six (26.1 %) healed with small residuals after two injections, and three (13.0 %) recurred. In the TEN group, 16 (69.6 %) bone cysts completely healed, four (17.4 %) healed with small residuals, and three (13.0 %) recurred. There were no significant differences in radiographic outcomes between groups at the final follow-up (P > 0.05). Three patients developed skin irritation as a result of the nail ends. Additional fractures occurred in four patients who underwent ABM injection and in two patients who underwent TEN. No significant associations were found between pathological fractures and cyst activity, location, or treatment outcomes in the patients studied.
  
  
  
  Both TEN and ABM injection are safe and effective treatment for bone cysts. ABM injection promotes osteogenic differentiation of bone marrow stromal cells; multiple injections can reduce the likelihood of recurrence. TEN stabilizes the affected bone and thus allows early limb mobilization. It also reduces pressure in the capsule wall by continuous decompression to promote cyst healing. ABM injections can be used to treat cyst recurrence after previous TEN, with favorable results.
authors.affiliation: Department of Pediatric Orthopaedic Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China.
authors.forename: Wenchao
authors.initials: W
authors.lastname: Li
authors.affiliation: Department of Pediatric Orthopaedic Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China. xuruiiang301@163.com.
authors.forename: Ruijiang
authors.initials: R
authors.lastname: Xu
authors.affiliation: Department of Pediatric Orthopaedic Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China.
authors.forename: Minghua
authors.initials: M
authors.lastname: Du
authors.affiliation: Department of Pediatric Orthopaedic Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Chen
mesh_terms: D001845:Bone Cysts / Q000000981:diagnostic imaging / Q000601:surgery*; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D001858:Bone Nails; D002648:Child; D005260:Female; D005264:Femoral Fractures / Q000517:prevention & control*; D005269:Femur / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000295:instrumentation*; D017102:Fracture Healing; D005598:Fractures, Spontaneous / Q000517:prevention & control*; D006801:Humans; D006811:Humerus / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D007267:Injections; D008297:Male; D009364:Neoplasm Recurrence, Local; D010012:Osteogenesis; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D014025:Titanium; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D014025:Titanium
keywords: Bone marrow; Children; Elastic intramedullary nailing; Long bones; Simple bone cyst