Combined curettage, fibular and iliac bone grafting, and dynamic hip screw fixation for a femoral neck simple bone cyst in a child with excellent functional outcome: a case report.

BACKGROUND

Simple bone cysts are benign, fluid-filled lesions commonly affecting the metaphyseal regions of long bones in children and adolescents. While often asymptomatic, they may present clinically when complicated by pathological fractures. Diagnosis is primarily radiographic, and management ranges from observation to surgery. This report highlights a rare femoral neck simple bone cyst with fracture, focusing on the technical nuances of definitive surgical treatment in a weight-bearing location.

CASE PRESENTATION: A 14-year-old Arab female with no prior medical history presented with acute left hip pain after a minor fall. Radiographs revealed a displaced sub-capital femoral neck fracture overlying a well-defined cystic lesion. Surgical management included dynamic hip screw-guided cortical windowing, meticulous curettage, alcohol irrigation, tightly packed cancellous grafting from the iliac crest, and structural fibular strut grafts placed above and below the screw path. Internal fixation was achieved with a femoral head screw and dynamic hip screw plate. Histopathology confirmed a simple bone cyst.

CONCLUSION

This case underscores the value of a tailored, multi-component surgical technique in managing simple bone cyst-associated pathological fractures in pediatric weight-bearing bones. The approach resulted in excellent structural stability and functional recovery, with the patient regaining independent, unrestricted ambulation by 10 weeks postoperatively and no complications observed.