Unicameral Bone Cyst Treatment & Management
- Author: Charles T Mehlman, DO, MPH; Chief Editor: Harris Gellman, MD more...
Nonoperative treatment of a unicameral bone cyst (UBC) usually amounts to closed fracture care following pathologic fracture through the lesion. It has been suggested that in as many as 25% of cases, spontaneous healing of the cyst may occur after such pathologic fractures. However, not all authors have reported such a high frequency of spontaneous healing. Thus, watchful waiting and routine fracture care only are not a universally accepted treatment option.[7, 8, 20, 39, 40, 41, 42, 43, 44, 45, 46]
Surgical therapy for a UBC may be divided into open and percutaneous procedures. The success rates of such procedures have varied considerably, and the very definition of success has also varied from author to author.[7, 8, 39, 40, 41, 42, 45, 46, 47]
In a study of 144 UBCs treated by curettage and packing with freeze-dried, crushed, cortical-bone allograft, Spence et al demonstrated higher recurrence rates in patients younger than 10 years, female patients, those with active cysts, and those with incompletely packed cysts. Of the completely packed cysts, 88% healed. The authors suggested that freeze-dried allogeneic crushed cortical bone yielded results superior to those of similarly processed cancellous bone but comparable to those of fresh autogenous cancellous bone.
Other studies have also demonstrated multiloculated cysts and fracture immobilization as a primary treatment as associated with cyst recurrence and/or persistence.
Neer et al stressed that reported recurrence rates in UBC surgery could be quite misleading if complete cyst obliteration was the criterion for success. They believed that true recurrences were characterized by the cyst cavity reappearing and enlarging, causing expansion and thinning of the cortex and the threat of fracture.
The key aspects of the Neer rating system for the purposes of evaluating treatment response are as follows :
Excellent – Complete obliteration of the cyst
Residual defect – One or more static cystlike areas with good reestablishment of bone strength
Reoperation – Subsequent operation required due to recurrence
Open techniques that have been reported include subtotal resection with and without bone grafting. Different bone-grafting materials that have been used include autograft, allograft, demineralized bone matrix, high-porosity hydroxyapatite bone grafting material, and plaster-of-paris pellets.
Subtotal resection with and without grafting
In 1962, Fahey and O'Brien introduced a technique for UBC treatment that they referred to as subtotal resection and grafting. The described technique involved subperiosteal exposure of the cyst and a portion of the adjacent normal bone, followed by removal of two thirds to four fifths of the cyst. Cortical struts of bone graft harvested from the patient's iliac crest or tibia were then used to fill the defect. Freeze-dried allograft was also used at times.
At an average of almost 4 years' follow-up, Fahey and O'Brien reported a 95% (19/20) success rate with their technique (using absence of cyst as their criterion). They considered the operation to be the procedure of choice for individuals with latent primary cysts and for persons with cysts that have recurred following conventional operation. One patient required repeat grafting to achieve healing, and no other specific complications were reported with the technique.
Fifteen years later, McKay and Nason reported on a similar subtotal resection approach to UBCs but without bone grafting. Their technique yielded a 90% (19/21) success rate (also defined as complete cyst obliteration). No infectious or neurocirculatory complications were reported, but the authors did identify three patients who suffered humeral growth disturbances and seven patients whose bones fractured during the procedure (though this did not substantively affect their later outcome).
Subtotal resection and bone grafting thus remains an option for UBC treatment. The procedure certainly carries with it a higher level of surgical morbidity than other procedures do, and the surgeon's enthusiasm for the procedure may be directly proportional to the cyst's distance from the growth plate.
Curettage and bone grafting procedures have been used extensively in the treatment of a UBC.
In 1974, Scaglietti introduced a procedure by which steroids were percutaneously instilled within UBCs (as well as other types of bone lesions). A minimum of 40 mg of methylprednisolone acetate was used for smaller cysts in young patients, and as much as 200 mg was used for larger cysts in older patients. The described technique included, on average, three or four injections in a period of 12-20 months, but as many as nine injections over 4 years were used.
Scaglietti et al reported complete healing of the bone cysts in 55% of his cases and 45% with some improvement, such as cortical thickening within the area of the cyst or areas of new bone formation within the cyst. Whereas 24% of their patients required only one steroid injection, 76% required multiple injections. The image below shows the typical appearance of the fluid aspirated from UBCs.
Simple mechanical disruption of the cyst wall has also been investigated as a treatment option. Komiya et al called this trepanation, and they reported good results in 91% (10/11) of their patients. The technique consisted of aspiration of the cyst until venous hemorrhage became visible, perfusion of the cyst with saline, and cyst wall as well as proximal and distal medullary bone drilling with a Kirschner wire (K-wire).
Chigira et al reported similar success with multiple drilling in 86% (6/7) of their patients. Their technique included leaving the 2.0-mm K-wires in place in some instances to allow drainage of the fluid through the cyst wall.
Various other authors have reported their results and suggested refinements of the percutaneous steroid technique.[42, 43, 46, 54, 55, 56, 57, 58, 59] Rosenberg et al emphasized the importance of eliminating fibrous or osseous septa within UBCs to facilitate bathing the entire lesion with the injected steroids.
Capanna et al also pointed out that contrast examination allows the surgeon to identify noncontiguous septated areas of UBCs (see the image below). This is important if optimizing the treatment response is desired.
Injectable materials other than steroids, such as alcohol-based fibrosing agents, have also been suggested as treatment options for benign bone cysts.[62, 63]
Killian et al also reported the use of demineralized bone matrix via a similar percutaneous technique. No steroids were used. At 2-year follow-up, 82% (9/11) of their patients demonstrated completely healed cysts.
Several authors have investigated the effectiveness of autologous bone marrow injection as a treatment for UBCs.[7, 65] Spurred on by their earlier published work, a group of Israeli researchers reported marked improvement in cortical thickness and cyst remodeling in 10 of their patients following a single bone marrow injection. Highlights of their technique include the following :
A single puncture into the cyst with a thin trocar or needle
Aspiration of cyst fluid, which is sent for pathologic analysis
Disruption of the lining and septations within the cyst using the trocar or needle
Contrast media examination (may be used)
Injection of autologous bone marrow aspirated from the iliac crest (average volume, 25 mL)
All cysts healed completely with one procedure within 6-12 months.
Other authors have demonstrated similar results with the percutaneous bone marrow injection procedure.[65, 67] Yandow noted that 83% (10/12) of patients with UBCs responded satisfactorily to the procedure, and Delloye et al had good results in approximately 88% (7/8) of their patients.
Kose et al evaluated the outcome of the autologous bone marrow procedure in 12 patients. Only 42% (5/12) cases responded to the treatment, whereas 50% (6/12) recurred and 8% (1/12) exhibited no response at all. These authors concluded that the technique may be less effective in large cysts and in multiloculated cysts, and they recommended that the procedure be applied to selected patients only.
A Cochrane review published in September 2014 concluded that the available evidence was not sufficient to allow a determination of the relative merits of bone marrow injections and steroid injections for treatment of UBCs in the long bones of children.
Injury to the growth plate (physis) may occur secondary to direct cyst expansion, pathologic fracture, or unintended mechanical disturbance during surgical intervention.
Direct cyst expansion across the growth plate and into the epiphysis of the proximal humerus has been well documented by Gupta and Crawford via magnetic resonance imaging (MRI). Growth arrest has also been reported following treatment either with local steroid injection or with curettage and bone grafting. Growth disturbance leading to angular deformity or disturbed longitudinal growth has been estimated to occur in approximately 14% of cases.[7, 8]
Steroid injection has been a successful treatment, even in the setting of cyst extension into the epiphysis.
Outcome and Prognosis
The overall outcome and prognosis of a UBC is good. The lesion is believed to resolve spontaneously in most cases if given enough time.
Cases that present to the orthopedic surgeon are typically patients who demonstrate a combination of a cyst that has caused cortical thinning and the right stressful event (eg, being tackled while playing football). In general, treatment may be summarized as doing nothing more than trying to promote natural healing. The flexible intramedullary nail studies mentioned earlier may do nothing more than mechanically support the bone while the natural healing process occurs.
Few comparative studies have been conducted regarding the various treatment alternatives for individuals with UBCs.[28, 72, 73, 74] Some of the more important ones are summarized below.
In a retrospective study of 36 patients with UBCs who were surgically treated over a period of 45 years, Farber and Stanton found that curettage and bone grafting (with some patients receiving allograft and others receiving autograft) yielded a 53% (10/19) healing rate, whereas aspiration and injection with steroid yielded a 70% (12/17) success rate. In 25% (3/12) of the patients, only one injection was required. Although this difference in overall healing rates might appear clinically significant, it was not statistically significant.
Farber and Stanton also did not explicitly define their criteria for success. Because of the similar healing rates and the lower morbidity of the steroid injection, the authors concluded that they favored the percutaneous approach over traditional open curettage and bone grafting.
In a retrospective review, Canavese et al compared the outcomes of percutaneous curettage, intralesional injection of methlyprednisolone, and intralesional injection of bone marrow. The three treatment groups included 46 patients with radiologically confirmed unicameral bone cysts and at least 2 years of follow-up. Results showed that the rate of satisfactory healing was 70% in the percutaneous curettage group, 21% in the bone marrow injection group, and 41% in the methylprednisolone group.
Oppenheim and Galleno evaluated 37 patients treated via open surgical techniques (35 with curettage and bone grafting and two with subperiosteal total or subtotal resection) against 20 patients treated via steroid injection. They found a 40% recurrence rate and a 15% major complication rate in their open group, whereas the steroid injection group had only a 5% recurrence rate and a 5% major complication rate.
Although not calculated by the authors, this difference in recurrence rates was statistically significant (P < 0.02 via the Fisher exact test). These same authors used reconstitution of cortical thickness as their endpoint of healing rather than cyst obliteration.
Glaser et al published a comparative multicenter study focused on calcaneal UBCs. The calcaneus is a somewhat uncommon (ie, the third to sixth most common) site for UBC.[10, 11, 15, 76] The study by Glaser et al suggested that percutaneous steroid injection procedures were less effective in the calcaneal lesions and that curettage and bone grafting may be a more predictable and successful procedure for simple bone cysts in this location.
Flexible intramedullary nailing of UBCs in long bones, though not a new concept by any means, has been reported to yield good results.[77, 78] Roposch et al documented a 94% (30/32) good response rate to flexible nailing of UBCs of the long bones. Complete cyst healing or healing with minor residual lucent areas occurred at an average of 36 months. Thus, this technique appears to support the compromised bone while the UBC follows its natural history and spontaneously resolves.
Some authors have stated that they believe such flexible nails allow continuous decompression of the UBC, with a resulting decrease in intralesional pressure.[78, 79, 80] However, 28% of patients in a study by Roposch et al required at least one further operation because of inadequate nail length in the face of continued bone growth.
In a systematic review and meta-analysis by Kadhim et al that included 62 studies and 3211 patients with 3217 UBCs, active treatment of these lesions (eg, curettage, grafting, injection of steroid or bone marrow, flexible intramedullary nailing, and continuous decompression with cannulated screws) was associated with variable healing rates, and the outcomes were favorable in comparison with conservative treatment.
Future and Controversies
Despite the extensive literature available on this common benign bone tumor, much remains to be learned about UBCs. As Bensahel stated, "The solitary bone cyst has not revealed all its secrets." Among the questions that remain to be answered are the following:
What is the root cause of the UBC lesion?
Does a genetic basis to the problem exist?
Should pathologic fractures of the long bones (secondary to a UBC) be treated via immediate flexible intramedullary nailing?
Answering these and similar questions will require a far more coordinated research effort than has been made to date. A multicenter study (a combined effort of the Shriner's Hospital System and the Pediatric Orthopaedic Society of North America) holds some promise of refining the treatment approach to a UBC.
Lagier R, Kramar C, Baud CA. Femoral unicameral bone cyst in a medieval child. Radiological and pathological study. Pediatr Radiol. 1987. 17(6):498-500. [Medline].
Virchow R. [On the formation of bony cysts] [German]. Ueber die bildung von knochencysten. Berlin, Germany: Monatsber d Kgl Akad D Wissenschaften. Sitzung der Phisikalischen-mathemat Klasse vom; 1876 12 Juni. 369-81.
Jaffe HL, Lichtenstein L. Solitary unicameral bone cyst with emphasis on the roentgen picture, the pathologic appearance and the pathogenesis. Arch Surg. 1942. 44:1004-25.
Stanton RP, Abdel-Mota'al MM. Growth arrest resulting from unicameral bone cyst. J Pediatr Orthop. 1998 Mar-Apr. 18(2):198-201. [Medline].
Steinberg GG. Ewing's sarcoma arising in a unicameral bone cyst. J Pediatr Orthop. 1985 Jan-Feb. 5(1):97-100. [Medline].
Lokiec F, Ezra E, Khermosh O, Wientroub S. Simple bone cysts treated by percutaneous autologous marrow grafting. A preliminary report. J Bone Joint Surg Br. 1996 Nov. 78(6):934-7. [Medline]. [Full Text].
Lokiec F, Wientroub S. Simple bone cyst: etiology, classification, pathology, and treatment modalities. J Pediatr Orthop B. 1998 Oct. 7(4):262-73. [Medline].
Godette GA, Rooney RJ. Two different non-neoplastic lesions in the same long bone. Contemp Orthop. 1995. 30:395-98.
Park IH, Micic ID, Jeon IH. A study of 23 unicameral bone cysts of the calcaneus: open chip allogeneic bone graft versus percutaneous injection of bone powder with autogenous bone marrow. Foot Ankle Int. 2008 Feb. 29(2):164-70. [Medline].
Glaser DL, Dormans JP, Stanton RP, Davidson RS. Surgical management of calcaneal unicameral bone cysts. Clin Orthop Relat Res. 1999 Mar. 360:231-7. [Medline].
Zenmyo M, Komiya S, Hamada T, Inoue A. A solitary bone cyst in the spinous process of the cervical spine: a case report. Spine. 2000 Mar 1. 25(5):641-2. [Medline].
Chaudhary D, Bhatia N, Ahmed A, et al. Unicameral bone cyst of the patella. Orthopedics. 2000 Dec. 23(12):1285-6. [Medline].
Abdelwahab IF, Hermann G, Norton KI, Kenan S, Lewis MM, Klein MJ. Simple bone cysts of the pelvis in adolescents. A report of four cases. J Bone Joint Surg Am. 1991 Aug. 73(7):1090-4. [Medline]. [Full Text].
Gebhart M, Blaimont P. Contribution to the vascular origin of the unicameral bone cyst. Acta Orthop Belg. 1996 Sep. 62(3):137-43. [Medline].
Mirra JM, Bernard GW, Bullough PG, Johnston W, Mink G. Cementum-like bone production in solitary bone cysts (so-called "cementoma" of long bones). Report of three cases. Electron microscopic observations supporting a synovial origin to the simple bone cyst. Clin Orthop Relat Res. 1978 Sep. 135:295-307. [Medline].
Yu CL, D'Astous J, Finnegan M. Simple bone cysts. The effects of methylprednisolone on synovial cells in culture. Clin Orthop Relat Res. 1991 Jan. 262:34-41. [Medline].
Shindell R, Huurman WW, Lippiello L, Connolly JF. Prostaglandin levels in unicameral bone cysts treated by intralesional steroid injection. J Pediatr Orthop. 1989 Sep-Oct. 9(5):516-9. [Medline].
Gerasimov AM, Toporova SM, Furtseva LN, et al. The role of lysosomes in the pathogenesis of unicameral bone cysts. Clin Orthop Relat Res. 1991 May. 266:53-63. [Medline].
Komiya S, Tsuzuki K, Mangham DC, et al. Oxygen scavengers in simple bone cysts. Clin Orthop. 1994 Nov. (308):199-206. [Medline].
Vayego SA, De Conti OJ, Varella-Garcia M. Complex cytogenetic rearrangement in a case of unicameral bone cyst. Cancer Genet Cytogenet. 1996 Jan. 86(1):46-9. [Medline].
Vayego-Lourenco SA. TP53 mutations in a recurrent unicameral bone cyst. Cancer Genet Cytogenet. 2001 Jan 15. 124(2):175-6. [Medline].
Komiya S, Inoue A. Development of a solitary bone cyst--a report of a case suggesting its pathogenesis. Arch Orthop Trauma Surg. 2000. 120(7-8):455-7. [Medline].
Jordanov MI. The "rising bubble" sign: a new aid in the diagnosis of unicameral bone cysts. Skeletal Radiol. 2009 Jun. 38(6):597-600. [Medline].
Farber JM, Stanton RP. Treatment options in unicameral bone cysts. Orthopedics. 1990 Jan. 13(1):25-32. [Medline].
Kaelin AJ, MacEwen GD. Unicameral bone cysts. Natural history and the risk of fracture. Int Orthop. 1989. 13(4):275-82. [Medline].
Capanna R, Campanacci DA, Manfrini M. Unicameral and aneurysmal bone cysts. Orthop Clin North Am. 1996 Jul. 27(3):605-14. [Medline].
Reynolds J. The "fallen fragment sign" in the diagnosis of unicameral bone cysts. Radiology. 1969 Apr. 92(5):949-53 passim. [Medline].
Struhl S, Edelson C, Pritzker H, Seimon LP, Dorfman HD. Solitary (unicameral) bone cyst. The fallen fragment sign revisited. Skeletal Radiol. 1989. 18(4):261-5. [Medline].
McGlynn FJ, Mickelson MR, El-Khoury GY. The fallen fragment sign in unicameral bone cyst. Clin Orthop Relat Res. 1981 May. 156:157-9. [Medline].
Maas EJ, Craig JG, Swisher PK, Amin MB, Marcus N. Fluid-fluid levels in a simple bone cyst on magnetic resonance imaging. Australas Radiol. 1998 Aug. 42(3):267-70. [Medline].
Margau R, Babyn P, Cole W, Smith C, Lee F. MR imaging of simple bone cysts in children: not so simple. Pediatr Radiol. 2000 Aug. 30(8):551-7. [Medline].
Sullivan RJ, Meyer JS, Dormans JP, Davidson RS. Diagnosing aneurysmal and unicameral bone cysts with magnetic resonance imaging. Clin Orthop Relat Res. 1999 Sep. 366:186-90. [Medline].
Campanacci M, Capanna R, Picci P. Unicameral and aneurysmal bone cysts. Clin Orthop Relat Res. 1986 Mar. 204:25-36. [Medline].
Neer CS 2nd, Francis KC, Marcove RC, Terz J, Carbonara PN. Treatment of unicameral bone cyst. A follow-up study of one hundred seventy-five cases. J Bone Joint Surg Am. 1966 Jun. 48(4):731-45. [Medline]. [Full Text].
Oppenheim WL, Galleno H. Operative treatment versus steroid injection in the management of unicameral bone cysts. J Pediatr Orthop. 1984 Jan. 4(1):1-7. [Medline].
Bovill DF, Skinner HB. Unicameral bone cysts. A comparison of treatment options. Orthop Rev. 1989 Apr. 18(4):420-7. [Medline].
Carrata A, Garbagna P, Mapelli S, Zucchi V. The treatment of simple bone cysts by topical infiltrations of methylprednisolone acetate: technique and results. Eur J Radiol. 1983 Feb. 3(1):3-8. [Medline].
Clayer M. Injectable form of calcium sulphate as treatment of aneurysmal bone cysts. ANZ J Surg. 2008 May. 78(5):366-70. [Medline].
Hecht AC, Gebhardt MC. Diagnosis and treatment of unicameral and aneurysmal bone cysts in children. Curr Opin Pediatr. 1998 Feb. 10(1):87-94. [Medline].
Wright JG, Yandow S, Donaldson S, Marley L. A randomized clinical trial comparing intralesional bone marrow and steroid injections for simple bone cysts. J Bone Joint Surg Am. 2008 Apr. 90(4):722-30. [Medline].
Altermatt S, Schwöbel M, Pochon JP. Operative treatment of solitary bone cysts with tricalcium phosphate ceramic. A 1 to 7 year follow-up. Eur J Pediatr Surg. 1992 Jun. 2(3):180-2. [Medline].
Spence KF Jr, Bright RW, Fitzgerald SP, Sell KW. Solitary unicameral bone cyst: treatment with freeze-dried crushed cortical-bone allograft. A review of one hundred and forty-four cases. J Bone Joint Surg Am. 1976 Jul. 58(5):636-41. [Medline]. [Full Text].
Neer CS, Francis KC, Johnston AD, Kiernan HA Jr. Current concepts on the treatment of solitary unicameral bone cyst. Clin Orthop Relat Res. 1973 Nov-Dec. 97:40-51. [Medline].
Scaglietti O, Marchetti PG, Bartolozzi P. Final results obtained in the treatment of bone cysts with methylprednisolone acetate (depo-medrol) and a discussion of results achieved in other bone lesions. Clin Orthop Relat Res. 1982 May. 165:33-42. [Medline].
Komiya S, Minamitani K, Sasaguri Y, et al. Simple bone cyst. Treatment by trepanation and studies on bone resorptive factors in cyst fluid with a theory of its pathogenesis. Clin Orthop. 1993 Feb. (287):204-11. [Medline].
Capanna R, Dal Monte A, Gitelis S, Campanacci M. The natural history of unicameral bone cyst after steroid injection. Clin Orthop Relat Res. 1982 Jun. 166:204-11. [Medline].
Fernbach SK, Blumenthal DH, Poznanski AK, Dias LS, Tachdjian MO. Radiographic changes in unicameral bone cysts following direct injection of steroids: a report on 14 cases. Radiology. 1981 Sep. 140(3):689-95. [Medline]. [Full Text].
Mitchell EP, Fugle MJ, Limbert AB. The treatment of unicameral bone cysts with injections of methylprednisolone acetate: a case study and review of the literature. J Am Osteopath Acad Orthop. 1983. 2:19-23.
Scaglietti O, Marchetti PG, Bartolozzi P. The effects of methylprednisolone acetate in the treatment of bone cysts. Results of three years follow-up. J Bone Joint Surg Br. 1979 May. 61-B(2):200-4. [Medline]. [Full Text].
Thawrani D, Thai CC, Welch RD, Copley L, Johnston CE. Successful treatment of unicameral bone cyst by single percutaneous injection of alpha-BSM. J Pediatr Orthop. 2009 Jul-Aug. 29(5):511-7. [Medline].
Pavone V, Caff G, Di Silvestri C, Avondo S, Sessa G. Steroid injections in the treatment of humeral unicameral bone cysts: long-term follow-up and review of the literature. Eur J Orthop Surg Traumatol. 2013 Apr 3. [Medline].
Rosenborg M, Mortensson W, Hirsch G, Sisask G, Karlsson A. Considerations in the corticosteroid treatment of bone cysts. J Pediatr Orthop. 1989 Mar-Apr. 9(2):240-3. [Medline].
Capanna R, Albisinni U, Caroli GC, Campanacci M. Contrast examination as a prognostic factor in the treatment of solitary bone cyst by cortisone injection. Skeletal Radiol. 1984. 12(2):97-102. [Medline].
Garg NK, Carty H, Walsh HP, Dorgan JC, Bruce CE. Percutaneous Ethibloc injection in aneurysmal bone cysts. Skeletal Radiol. 2000 Apr. 29(4):211-6. [Medline].
Adamsbaum C, Kalifa G, Seringe R, Dubousset J. Direct Ethibloc injection in benign bone cysts: preliminary report on four patients. Skeletal Radiol. 1993. 22(5):317-20. [Medline].
Killian JT, Wilkinson L, White S, Brassard M. Treatment of unicameral bone cyst with demineralized bone matrix. J Pediatr Orthop. 1998 Sep-Oct. 18(5):621-4. [Medline].
Yandow SM, Lundeen GA, Scott SM, Coffin C. Autogenic bone marrow injections as a treatment for simple bone cyst. J Pediatr Orthop. 1998 Sep-Oct. 18(5):616-20. [Medline].
Wientroub S, Goodwin D, Khermosh O, Salama R. The clinical use of autologous marrow to improve osteogenic potential of bone grafts in pediatric orthopedics. J Pediatr Orthop. 1989 Mar-Apr. 9(2):186-90. [Medline].
Delloye C, Docquier PL, Cornu O, et al. Simple bone cysts treated with aspiration and a single bone marrow injection. A preliminary report. Int Orthop. 1998. 22(2):134-8. [Medline].
Köse N, Göktürk E, Turgut A, Günal I, Seber S. Percutaneous autologous bone marrow grafting for simple bone cysts. Bull Hosp Jt Dis. 1999. 58(2):105-10. [Medline].
Zhao JG, Ding N, Huang WJ, Wang J, Shang J, Zhang P. Interventions for treating simple bone cysts in the long bones of children. Cochrane Database Syst Rev. 2014 Sep 2. 9:CD010847. [Medline].
Gupta AK, Crawford AH. Solitary bone cyst with epiphyseal involvement: confirmation with magnetic resonance imaging. A case report and review of the literature. J Bone Joint Surg Am. 1996 Jun. 78(6):911-5. [Medline].
Malawer MM, Markle B. Unicameral bone cyst with epiphyseal involvement: clinicoanatomic analysis. J Pediatr Orthop. 1982 Mar. 2(1):71-9. [Medline].
Hou HY, Wu K, Wang CT, Chang SM, Lin WH, Yang RS. Treatment of unicameral bone cyst: a comparative study of selected techniques. J Bone Joint Surg Am. 2010 Apr. 92(4):855-62. [Medline].
Yildirim C, Mahirogullari M, Kuskucu M, Akmaz I, Keklikci K. Treatment of a unicameral bone cyst of calcaneus with endoscopic curettage and percutaneous filling with corticocancellous allograft. J Foot Ankle Surg. 2010 Jan-Feb. 49(1):93-7. [Medline].
Randelli P, Arrigoni P, Cabitza P, Denti M. Unicameral bone cyst of the humeral head: arthroscopic curettage and bone grafting. Orthopedics. 2009 Jan. 32(1):54. [Medline].
Canavese F, Wright JG, Cole WG, Hopyan S. Unicameral bone cysts: comparison of percutaneous curettage, steroid, and autologous bone marrow injections. J Pediatr Orthop. 2011 Jan-Feb. 31(1):50-5. [Medline].
Moreau G, Letts M. Unicameral bone cyst of the calcaneus in children. J Pediatr Orthop. 1994 Jan-Feb. 14(1):101-4. [Medline].
Imhäuser G. [Management of juvenile bone cysts using intramedullary nailing?] [German]. Z Orthop Ihre Grenzgeb. 1968 Oct. 105(3):110-1. [Medline].
Roposch A, Saraph V, Linhart WE. Flexible intramedullary nailing for the treatment of unicameral bone cysts in long bones. J Bone Joint Surg Am. 2000 Oct. 82-A(10):1447-53. [Medline].
Santori F, Ghera S, Castelli V. Treatment of solitary bone cysts with intramedullary nailing. Orthopedics. 1988 Jun. 11(6):873-8. [Medline].
Catier P, Bracq H, Canciani JP, Allouis M, Babut JM. [The treatment of upper femoral unicameral bone cysts in children by Ender's nailing technique] [French]. Rev Chir Orthop Reparatrice Appar Mot. 1981. 67(2):147-9. [Medline].
Bensahel H, Jehanno P, Desgrippes Y, Pennecot GF. Solitary bone cyst: controversies and treatment. J Pediatr Orthop B. 1998 Oct. 7(4):257-61. [Medline].
Atar D, Lehman WB, Grant AD. Unicameral bone cysts. Contemp Orthop. 1991. 23:249-53.
Capanna R, Van Horn J, Ruggieri P, Biagini R. Epiphyseal involvement in unicameral bone cysts. Skeletal Radiol. 1986. 15(6):428-32. [Medline].
Choong PF, Pritchard DJ, Rock MG, et al. Low grade central osteogenic sarcoma. A long-term followup of 20 patients. Clin Orthop Relat Res. 1996 Jan. 322:198-206. [Medline].
de Palma L, Santucci A. Treatment of bone cysts with methylprednisolone acetate. A 9 to 11 year follow-up. Int Orthop. 1987. 11(1):23-8. [Medline].
Delling G, Sopta J. [Solitary bone cysts of the pelvis : A frequently misinterpreted entity.] [German]. Pathologe. 2008 Mar 7. [Medline].
Gakuu LN. Solitary unicameral bone cyst. East Afr Med J. 1997 Jan. 74(1):31-2. [Medline].
Galey JP. Ten year retrospection of the treatment of unicameral bone cysts. J Bone Joint Surg [Br]. 1986. 68-B:675.
Gartland JJ, Cole FL. Modern concepts in the treatment of unicameral bone cysts of the proximmal humerus. Orthop Clin North Am. 1975 Apr. 6(2):487-98. [Medline].
Gitelis S, Wilkins R, Conrad EU 2nd. Benign bone tumors. Instr Course Lect. 1996. 45:425-46. [Medline].
Haims AH, Desai P, Present D, Beltran J. Epiphyseal extension of a unicameral bone cyst. Skeletal Radiol. 1997 Jan. 26(1):51-4. [Medline].
Inoue O, Ibaraki K, Shimabukuro H, Shingaki Y. Packing with high-porosity hydroxyapatite cubes alone for the treatment of simple bone cyst. Clin Orthop Relat Res. 1993 Aug. 293:287-92. [Medline].
Kiesler TW, Kling TF, Rougraff BT. Unicameral bone cysts. Curr Opin Orthop. 1994. 5:75-81.
Lin PP, Brown C, Raymond AK, Deavers MT, Yasko AW. Aneurysmal bone cysts recur at juxtaphyseal locations in skeletally immature patients. Clin Orthop Relat Res. 2008 Mar. 466(3):722-8. [Medline].
Madhavan P, Ogilvie C. Premature closure of upper humeral physis after fracture through simple bone cyst. J Pediatr Orthop B. 1998 Jan. 7(1):83-5. [Medline].
Makley JT, Joyce MJ. Unicameral bone cyst (simple bone cyst). Orthop Clin North Am. 1989 Jul. 20(3):407-15. [Medline].
Mirzayan R, Panossian V, Avedian R, Forrester DM, Menendez LR. The use of calcium sulfate in the treatment of benign bone lesions. A preliminary report. J Bone Joint Surg Am. 2001 Mar. 83-A(3):355-8. [Medline].
Robbins H. The treatment of unicameral or solitary bone cysts by the injection of corticosteroids. Bull Hosp Jt Dis Orthop Inst. 1982 Spring. 42(1):1-16. [Medline].
Schreuder HW, Conrad EU 3rd, Bruckner JD, Howlett AT, Sorensen LS. Treatment of simple bone cysts in children with curettage and cryosurgery. J Pediatr Orthop. 1997 Nov-Dec. 17(6):814-20. [Medline].
Spence KF, Sell KW, Brown RH. Solitary bone cyst: treatment with freeze-dried cancellous bone allograft. A study of one hundred seventy-seven cases. J Bone Joint Surg Am. 1969 Jan. 51(1):87-96. [Medline]. [Full Text].
Wilkins RM. Unicameral bone cysts. J Am Acad Orthop Surg. 2000 Jul-Aug. 8(4):217-24. [Medline].