Between 1979 and 2004, 167 patients younger than 20 years were treated surgically for humeral or femoral unicameral
bone cysts with either injection of
corticosteroids (
steroids),
curettage plus
bone grafting (
curettage), or a combination injection of
steroids, demineralized bone matrix, and bone marrow aspirate (SDB) at Children's Hospital of Boston and Massachusetts General Hospital (mean followup, 7.3 years; range, 1 month-27 years). Outcomes included treatment failure (defined clinically as subsequent
pathologic fracture or need for
retreatment to prevent
pathologic fracture) and complications. Information was obtained from medical records and by telephone questionnaire. After one treatment, 84% of
cysts treated with
steroids experienced failed treatment versus 64% with
curettage and 50% with SDB. For unicameral
bone cysts requiring
retreatment (regardless of first treatment), 76% retreated with
steroids had failed treatment versus 63% with
curettage and 71% with SDB.
Curettage was associated with the lowest rate of posttreatment
pathologic fractures and highest rate of
pain and other complications. Multivariate logistic regression indicated treatment with
steroids alone and younger age were independent predictors of failure. We believe SDB is a reasonable first treatment for unicameral
bone cysts in the humerus and femur in patients younger than 20 years, being less invasive yet comparable to
curettage in preventing recurrence.