Treatment outcome in 60 children with pathological fractures of the humerus caused by juvenile or aneurysmal bone cysts

Treatment of pathological fractures caused by juvenile or aneurysmal bone cysts (JBC/ABC) should be a single approach with a high success and low complication rate. This study evaluates the day by day treatment concepts. Methods: Children (<15ys) with a pathological fracture of the humerus caused by a JBC or ABC between 2001 and 2010, were investigated by chart review in four paediatric trauma centres. Outcome was assessed by the Capanna classification.Results: 60 children with 105 treatment cycles were included. First treatment was non-operatively in 33 cysts; of these 27 did not improve; likewise the installation of cortisone in six did not change anything. 13 children got elastic stable intramedullary nailing as 1st treatment and six reached resolution (I/II). Overall the combined mechanical and biological treatment with curettage, elastic stable intramedullary nailing, (artificial) bone substitute and growth factors was performed in 21 patients as 1st-, 2nd or 3rd line treatment. More than two third reached resolution: 12x I, 5x II, 1x III, 4x IV.Conclusion: Healing rates for pathological fractures of bone cysts in children are low for non-operative treatment. Data support a combined mechanical and biological treatment with curettage, elastic stable intramedullary nailing, (artificial) bone substitute and the use of growth factors