CASE REPORT OF SIMPLE BONE CYST / UNICAMERAL BONE CYST OF PROXIMAL HUMERUS WITH PATHOLOGICAL FRACTURE IN A PAEDIATRIC PATIENT TREATED WITH G-BONE (CALCIUM HYDROXYAPATITE)+ INTRAMEDULLARY NAILING (TENS)

Abstract

Humeral bone cysts are commonly identified after pathological fractures, with simple unicameral bone cysts (UBC) and aneurysmal bone cysts (ABC) being the most prevalent benign lesions affecting the proximal humerus. Diagnosing these cysts often requires additional imaging. The treatment approach depends on factors such as the cyst's size, location, and the potential for remodelling, particularly in children up to puberty.
Treatment options include conservative management or surgical intervention, which may involve elastic stable intramedullary nailing (ESIN), curettage, and cyst filling. However, no randomized controlled trials have currently determined a clearly superior treatment method.
In this report, we present a case of successful surgical management for a 12-year-old boy who had a solitary bone cyst (SBC) and presented with a pathological fracture of the proximal humerus. The patient underwent bone cyst excision, biopsy, curettage, artificial bone grafting, and tension fixation of the left proximal humerus.
Surgical treatment performed under general anaesthesia has advantages, including obtaining histopathological confirmation, achieving permanent medullary decompression, and enabling early mobilization. Various materials, such as calcium sulfate or tissue-engineered bone, have been utilised for cyst filling, resulting in varying outcomes. Non-invasive treatments, such as intracystic injections of steroids or antibiotics, report success rates ranging from 50% to 90%.
In managing pediatric pathological fractures due to UBC, the standard principles include confirming the benign nature of the cyst, considering cyst curettage and decompression, stabilising the bone through either conservative or surgical methods, applying ESIN principles for fixation, and ensuring follow-up until the cyst resolves.