Operative treatment versus steroid injection in the management of unicameral bone cysts

The operative treatment of 37 patients with unicameral bone cysts was compared with the newer method of steroid injection in 20 patients whose cysts were similarly predisposed with respect to mode of presentation, location, age, and sex. In the surgical group the average operative time was 100 min, with a mean estimated blood loss of 300 ml. The recurrence rate was 40%, rising to 88% in patients under the age of 10 years with active cysts (less than 1 cm from the physis). Major complications occurred in 15% and included infection, refracture, coxa vara, extremity shortening, and physeal damage. A minimum follow-up of 2 years was necessary to rule out recurrence. In contrast, the steroid-injected group had a recurrence rate of 5%, although 50% required more than one injection for maximum obliteration. The average operative time was 30 min, with negligible blood loss and a minimum hospital stay and rehabilitation. The only complications were a mild steroid flush in one patient and extremity shortening due to preexisting fracture in another. The end point of healing was reconstitution of cortical thickness, rather than total obliteration at the cyst. No secondary fractures were encountered. Both operative treatment and percutaneous steroid injection exhibited a high rate of recurrence or persistence. The greater simplicity and lesser morbidity associated with the steroid technique favored it as the method of choice.