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Metastases to the lungs
2%
17/757
Recurrence of the lesion
68%
518/757
Limb-length discrepancy of the affected side compared to the contralateral side
19%
146/757
Continued pain in the affected extremity
8%
60/757
Paraneoplastic disease
1%
4/757
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Recurrence of the lesion is the most likely complication to occur with curettage and bone grafting of a unicameral bone cyst. Unicameral bone cyst are commonly found in the proximal humerus and are often associated with a fracture. There is no ‘gold standard’ treatment for these lesions and they often recur no matter what treatment is chosen. Sung et al. reviewed 167 patients 20 years or younger who had unicameral bone cysts treated with either steroid injection, curettage and bone grafting or a combination of steroids, demineralized bone matrix and bone marrow aspirate. The recurrence rate for each treatment was 84%, 76% and 63%, respectively after the initial treatment. Canavese et al. reviewed 46 children with unicameral bone cysts treated with either autologous bone marrow injection, methylprednisolone acetate injection or percutaneous curettage alone. At the 2 year follow up mark, there was unsatisfactory healing in 30% of the percutaneous curettage group, 79% of the autologous bone marrow injection group and 59% of the methylprednisolone acetate injection group. Haidar et al. showed that recurrence of bone cysts after surgical treatment was more likely if cyst was located less than 2cm from open growth plate. Wilkins et al. states that the most common complication after treatment of a unicameral bone cyst is recurrence of the lesion. Although both complications do occur, limb length discrepancy does not occur as frequently. Figure A shows an unicameral bone cyst in the proximal humerus of a skeletally immature person. Incorrect Answers: Answer 1: Metastases to the lungs: Unicameral bone cysts do not metastasize. Answer 3: Limb-length discrepancy of the affected side compared to the contralateral side: This is not a common complication reported during the operative treatment of unicameral bone cysts. Answer 4: Continued pain in the affected extremity: Unicameral bone cysts are usually painless (unless fractured). Answer 5: Paraneoplastic disease: Unicameral bone cysts are not associated with paraneoplastic diseases.
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