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CT scan of the chest
6%
188/3302
Wide excision
0%
8/3302
MRI
18%
578/3302
Whole body bone scan
2%
52/3302
Open curettage and bone augmentation
75%
2463/3302
Select Answer to see Preferred Response
Figures A to C show a lucent lesion involving the anterior calcaneus most consistent with a unicameral bone cyst. Patients treated with open curettage and bone augmentation have significant improvements in heel pain and radiographic cyst consolidation. The calcaneus is the most common tarsal bone affected by unicameral bone cysts (UBCs), yet treatment remains controversial. Often they are found incidentally on plain radiographs after minor foot and ankle trauma. Further formal workup is usually not necessary with stable lesions on sequential radiographs. UBCs that are symptomatic and large (100% of the medial–lateral width of the calcaneus and at least 30% of the anterior–posterior length) are thought to be at risk for pathologic fracture, and are often considered for surgical intervention (e.g. cannulated screw fixation, open curettage and bone augmentation, etc.). Levy et al. performed a systematic review of treatment of UBCs of the calcaneus. They showed that only 1.1% of UBCs treated conservatively had healed on radiographs over time, compared with 93.0% of the cysts after surgery (p < .001). Autograft had a significantly higher rates of radiographic cyst consolidation compared to allograft and cannulated screw fixation alone. Ishikawa et al. reviewed conditions of the calcaneus in skeletally immature patients. They noted that the calcaneus is the sixth most common site for unicameral bone cysts. They usually present as well-circumscribed lucencies that are located inferior to the anterior aspect of the posterior facet. Surgery usually involves curettage of the cyst through a lateral calcaneal window, followed by bone grafting. Figure A is a lateral radiograph of the left foot showing a UBC involving the anterior calcaneus. Figures B and C are axial and sagittal CT images of the foot showing the UBC with cortical expansion and thinning. Incorrect Answers: Answers 1-4: No local or systemic workup is required with this characteristic, benign-appearing lesion which is common in this age group.
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