Subperiosteal resection of fibular aneurysmal bone cyst

Aneurysmal bone cyst (ABC) of the fibula poses a challenge as to the most appropriate treatment particularly in children and adolescents. A prospective study was conducted to evaluate the results of subperiosteal resection of fibular ABCs. Eleven patients (six boys and five girls) with an average age of 12.4 years (6-18 years) were treated by subperiosteal resection of ABC of the fibula. The lesion was juxtaphyseal in three patients (two distal and one proximal), metaphyseal in seven and diaphyseal in one. All cysts were active and centrally located type 2. The modified Enneking scoring system was used for final functional evaluation while a scale proposed by the author was used for final radiological assessment. At the final follow-up, there was no difference in the range of movement, alignment or stability of the ankle or the knee when compared with the opposite side. Three patients complained of mild discomfort on heavy activity. One patient had failure of healing that was related to the use of suction drain. After a mean follow-up of 41.6 months (24-64 months), the mean functional score was 98.8% (93-100%). According to the proposed radiological scale, six patients were rated excellent, three good, one fair and one poor. In conclusion, subperiosteal resection is effective in eradicating fibular ABCs, regenerates a new bone and avoids the morbidity of other techniques.