Management of unicameral bone cyst of proximal femur: Experience of 14 cases and review of literature

ABSTRACT

To assess the results of surgical treatment of unicameral bone cyst [UBC] involving the proximal femur Retrospective study of 14 cases of UBC of proximal femur Al-Razi Orthopedic Hospital, Kuwait Fourteen cases of UBC seen and treated at Al-Razi hospital were included in the study. Their presentation and the method of treatment were recorded. Thirteen cases were treated surgically using intra-lesional excision [ILE]. The cavity was filled with autogenous bone graft in three cases, hydroxyapatite matrix [HA] in eight cases, and combined autogenous graft and hydroxyapatite matrix in two cases. Internal fixation was carried out in six cases. External fixator was applied in one case from iliac bone to femur crossing the hip joint. Patients were followed up post-operatively for an average period of 42 months [range = 9-120 months]. They were observed for recurrence, complications and fracture healing. Recurrence was observed in one case while other cases showed healing of the cyst with consolidation and varying degrees of remodeling in one years time. A case developed mal-union and growth arrest with subsequent shortening. Avascular necrosis and coxa vara was detected in another case. All the fractures healed in the usual expected time according to age. UBC of the proximal femur exhibits unique characters and complications. Hydroxyapatite matrix is a useful and effective bone substitute. Post-excision stabilization of the cyst is recommended to avoid malunion and to facilitate post-operative rehabilitation and earlier return to normal activities