Solitary bone cyst: a comparison of treatment options with special reference to their long-term outcome

Background: Solitary bone cysts (SBC) are benign, tumor-like lesions, which most frequently occur in the proximal metaphyseal-diaphyseal region of the humerus and femur of children and adolescents. The lack of a clear pathoetiology has impeded the development of treatment strategies. Up to date there is no consensus or official guideline for when and how treat SBC. The purpose of this study was to evaluate the effectiveness and the longterm clinical outcome of the treatment of SBC. Different techniques have been used dependant of the site of lesion, dimension, medical history and activity status. Methods: 135 skeletal immature patients with a solitary bone cyst were included. A follow up of 36 months or more was available for all patients. 22 patients were treated conservatively. All the other patients had at least one surgical intervention. The following four surgical treatment modalities were used: injection of methylprednisolon acetat (steroids), intramedullary nailing (IN), IN + steroids and curettage plus bone grafting. Results: There was no significant difference between the treatment groups with respect to secondary fractures, function, pain, or complications. In the individual groups the failure rate after initial treatment was 36,6 % with steroids, 50 % with intramedullary nailing, 21,4 % with intramedullary nailing plus steroids and none in the remaining group. Conclusion: Steroid injection remains a reliable method for treating solitary bone cysts owing to its low invasiveness. To prevent fractures and allow a full weight bearing, internal fixation in combination with methylprednisolon acetat injections seems to be the most favorable in weight bearing bones.