[Surgical management of juvenile and aneurysmal bone cysts in children and adolescents : Curettage, ceramic bone graft substitution and adjuvants].
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OBJECTIVE: The aim of treating juvenile (UBC) and aneurysmal bone cysts (ABC) is complete defect filling with subsequent bony consolidation, restoration of stability, pain reduction, and minimization of recurrence risk. INDICATIONS: Symptomatic or pathologic fractures due to confirmed UBC or ABC based on imaging and/or histology. CONTRAINDICATIONS: Suspected malignancy based on clinical or radiologic findings. SURGICAL TECHNIQUE: After fluoroscopic localization, the lesion is exposed via a tissue-sparing approach. The cyst wall is opened, and complete curettage is performed. The defect is filled with ceramic bone substitute and/or allogeneic cancellous bone soaked in methylprednisolone (UBC) or polidocanol (ABC). In ABC, the cyst lining is completely removed. In UBC, curettage combined with elastic-stable intramedullary nailing (ESIN) for stabilization is frequently sufficient. POSTOPERATIVE MANAGEMENT: Fractures are managed like nonpathologic fractures. Radiographic follow-up is performed at 4, 12, 26, and 52 weeks. If ABCs fail to respond, repeated percutaneous polidocanol injections are administered. RESULTS: In a cohort of 44 patients (22 UBC, 23 ABC), after a follow-up of up to 6 years, 82% achieved a favorable radiological outcome (Capanna 1-2). Recurrence with refracture occurred in 4 patients after ESIN removal. The overall complication rate was low.