Simple Bone Cyst

The simple bone cyst sometime also cxalled a unicameral bonr cyst is a tumor like lrsson of
unknown etiology, it has been atributed to a local disturbance of bone growth. More common in
males than females, it is ordinarily seen during the first two decades of life. The vast majority of
simple bone cyst are located in the proximal diaphysis of the humerus and femur,especially in
patients under the age of 17 years. In older patients, the incidence of bone cysts in atypical sites
such as the calcaneus,talus and ilium rises significantly.
Radiographically, a simple bone cyst appears as a radiolucent.centrally located, well
circumscribed lesion with sclerotic margins. There is no periosteal reaction a feature
distinguishing a simple bone cyst from an aneurysmal bone cyst, which invariably shows some
degree of periosteal response, however in the presence of pathologic fracture,there is periosteal
reaction. Plain film radiography usually suffices to make a diagnosis, tomography is used only
exceptionally, in equivocal cases.
Complications and differential diagnosis. The most common complication of simple bone cyst is
pathologic fracture, which occurs in about 66% of cases. Occasionally,one can identify a piece of
fractured cortex in the interior of the lesion the fallen fragment sign indicating that the lesion is
either hollow or fluid-filled as most simple bone cysts are. This sign permits the differentiation
of bone cyst,particularly radiolucent,radiographically similar lesions containing solid fibrous or
cartilaginous tissue such as fibrous dysplasia, non ossifying fibroma, and enchondroma. A bone
abscess may occasionally mimic a simple bone cyst, particularly if it is located in the upper
humerus or upper femur the sites of predilection of simple bone cysts. In such cases the presence
of a periosteal reaction and extension beyond the growth plate are important differentiating
feature favoring a bone abscess.
Treatment. The treatment of simple bone cysts is based on the premise that the introduction of
osteogenesis results in complete healing of the lesion. The simplest inducement of bone repaire
is fracture, but this alone is insufficient to completely obliterate the lesion and very view simple
bone cysts disappear following spontaneous fracture. The most common treatment for bone cysts
is curretage followed by grafting with small pieces of cancellous bone. With this procedure,
however, there is higher rate of recurrence in patients under 10 years of age. Moreover this
approach may also lead to damage to the growth plate, since most solitary bone cysts abut the
physis.recently scaglietti reprted treating bonre cysts with methylprednisolone acetate ,given by
simple injection. In younger patients treated in this way, complete bone repair occured more
rapidly than in older patients who sometimes had to be given several injections.