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Oncology: H. S. Cho, J. H. Oh, H.-S. Kim, H. G. Kang, and S. H. Lee Unicameral bone cysts: A COMPARISON OF INJECTION OF STEROID AND GRAFTING WITH AUTOLOGOUS BONE MARROW J Bone Joint Surg Br 2007; 89-B: 222-226 [Abstract] [Full text] [PDF]

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Pressure within "unicameral" bone cysts

Jon P Driver-Jowitt   (20 December 2007)

Pressure within "unicameral" bone cysts 20 December 2007
Jon P Driver-Jowitt, Orthopaedic Surgeon Private Practice Send letter to journal: Re: Pressure within "unicameral" bone cysts driver-jowitt{at}kingsley.co.za Jon P Driver-Jowitt	Sir, We read this paper with interest and would like to make the following comments. The progression and recurrence of some bone cysts could be related to continued high pressure within the cyst. This might explain the benefit of leaving Kirschner1 wires implanted into the cyst and, perhaps, injecting the cyst with cortico-steroid. The following seems to support this thesis: A 38-year-old opera singer presented with a fracture of the surgical neck of the humerus, associated with an extensive ’simple’ bone cyst. For some years she had been having an 'aching discomfort' in the arm. The fracture was treated by forearm support for six weeks, and consolidated. A protecting support was supplied in anticipation of the cyst healing. However, the cyst remained, slowly increasing in size. Bone grafting was considered, but the patient wished to avoid a scar which would detract from her stage appearance, and she was unable to set aside time for a protracted convalescence. At four years post-injury, needling the cyst revealed a pressure of about 90 mm of clear fluid within. A Spitz-Holtzer ventricular drain was inserted into the cyst, draining into the peritoneal cavity and was removed after 22 months. Follow-up radiology over the year after insertion of the drain showed reduction in the size of the cyst, thickening of the cortex, reduction of scalloping and deposition of visible bone within the cyst and around the drain. The support was abandoned. Because the 'aching' pain experienced prior to the breakage had not recurred the patient declined further radiology. The limb has withstood the rigours of bringing up children as a single mother, and all the stresses and strains of daily life with full upper limb function, over a 23-year post-surgical follow-up. J.P. Driver-Jowitt, Orthopaedic Surgeon, Private Practice, Cape Town, South Africa. 1. Chigira M, Shimizu T, Arita S, Watanabe H, Heshiki A. Radiological evidence of healing of a simple bone cyst after hole drilling. Arch Orthop Trauma Surg 1986;105:150-3.