[Surgical management of juvenile and aneurysmal bone cysts in children and adolescents : Curettage, ceramic bone graft substitution and adjuvants].

OBJECTIVE

The aim of treating juvenile (UBC) and aneurysmal bone cysts (ABC) is complete defect filling with subsequent bony consolidation, restoration of stability, pain reduction, and minimization of recurrence risk.

INDICATIONS: Symptomatic or pathologic fractures due to confirmed UBC or ABC based on imaging and/or histology.

CONTRAINDICATIONS: Suspected malignancy based on clinical or radiologic findings.

SURGICAL TECHNIQUE: After fluoroscopic localization, the lesion is exposed via a tissue-sparing approach. The cyst wall is opened, and complete curettage is performed. The defect is filled with ceramic bone substitute and/or allogeneic cancellous bone soaked in methylprednisolone (UBC) or polidocanol (ABC). In ABC, the cyst lining is completely removed. In UBC, curettage combined with elastic-stable intramedullary nailing (ESIN) for stabilization is frequently sufficient.

POSTOPERATIVE MANAGEMENT: Fractures are managed like nonpathologic fractures. Radiographic follow-up is performed at 4, 12, 26, and 52 weeks. If ABCs fail to respond, repeated percutaneous polidocanol injections are administered.

RESULTS

In a cohort of 44 patients (22 UBC, 23 ABC), after a follow-up of up to 6 years, 82% achieved a favorable radiological outcome (Capanna 1-2). Recurrence with refracture occurred in 4 patients after ESIN removal. The overall complication rate was low.