Related Experiment Videos
Growth arrest resulting from unicameral bone cyst
R P Stanton1, M M Abdel-Mota'al
1duPont Hospital for Children, Wilmington, Delaware 19899, USA.
Insights
Unicameral bone cysts in the proximal humerus can cause growth arrest in pediatric patients. This complication, seen in 10% of cases, leads to limb length discrepancies and requires careful monitoring.
Area of Science:
- Pediatric Orthopedics
- Skeletal Dysplasias
- Bone Pathology
Background:
- Unicameral bone cysts (UBCs) are benign bone lesions often affecting children and adolescents.
- Complications of UBCs can include pathological fractures and growth disturbances.
- The proximal humerus is a common site for UBCs, potentially impacting upper limb growth.
Observation:
- A series of five patients (10% of 51 consecutive cases) presented with growth arrest secondary to proximal humerus UBCs.
- Patients ranged from 6 to 14 years at initial presentation, with follow-up up to 57.2 months.
- Pathologic fracture was the consistent initial clinical presentation across all affected patients.
Findings:
- Growth arrest was diagnosed via limb-length discrepancies and radiographic evidence of physeal (growth plate) closure and humeral deformity.
- In two cases treated surgically, growth arrest was evident pre-operatively.
- The exact etiology of growth arrest in UBCs remains unclear, with direct physeal damage deemed unlikely.
Implications:
- Growth arrest is a more frequent complication of proximal humerus UBCs than previously recognized.
- Early recognition and monitoring are crucial for managing growth disturbances in pediatric patients with UBCs.
- Further research is needed to elucidate the mechanisms underlying UBC-associated growth arrest.
Abstract:
Growth arrest complicating unicameral bone cyst of the proximal humerus is reported in five patients. These patients represented 10% of 51 consecutive patients treated by the senior author at our hospital from 1988 through 1995. The youngest patient at first clinical presentation was aged 6 years, and the oldest was 14 years 9 months. The follow-up ranged from 35 to 69 months (average, 57.2). The youngest patient at final follow-up was 9 years 1 month, and the oldest was 20 years 5 months. Pathologic fracture was the common clinical presentation in all patients. Growth arrest was diagnosed by limb-length discrepancies, as well as radiographic evidence of premature closure of the physis and deformity of the upper humerus. Treatment was either aspiration of the cyst and local injection of corticosteroids or curettage and bone grafting. Growth arrest was documented, both clinically and radiographically, before the surgery in the two cases treated by curettage and grafting. The origin of growth arrest resulting from unicameral bone cyst remains uncertain. Direct iatrogenic damage to the physis was not a likely cause of growth arrest in this series. Growth arrest as a complication of unicameral bone cyst of the proximal humerus is more common than is generally appreciated (10%).