If there is a high probability of a fracture resulting from the<unk> , then surgical treatment is necessary. Specific methods can be determined by the physician based upon the patient’s age, medical history, tolerance for certain medical procedures or medicine, health, and extremity of the disease. The treatment can involve or incorporate one or more of the following surgical methods, which are performed by a pediatric orthopedic surgeon: *Curettage: :Surgeons create an incision or opening in the bone to drain out the fluids inside the cyst. After the fluid is drained, a curette is used to scrape the lining tissue out of the lesion. *Bone Grafting: :Bone grafting is proceeded with after curettage; the empty cavity is transplanted with donor bone tissue, bone chips taken from another bone, or artificial material. *Steroid injection: :An injection of methylprednisolone acetate into the lesion helps reduce the levels of prostaglandin. Prostaglandin is a fatty acid that reduces cyst’s ability to be reabsorbed into the bone. To begin an operation using steroids, biopsy needles are placed into the cyst and the interstitial fluids are drained. The cyst is then filled with radiographic contrast to determine the volume and shape of the cyst. If the cyst can be filled, it will be injected with methylprednisolone acetate in several intervals for a time span of six to twelve months. Once the level of prostaglandin decreases, the cyst will be reabsorbed into the bone and disappear. Treatments using steroid injections are preferred over curettage, but there are few risks from the method, which are limited to infection, fracture, and reappearance of the cyst. If a patient needs to be treated with surgery, a standard surgical procedure would be called for; the patient would be resting in Fowler’s position, a semi-sitting position, under general anesthesia. The exact size, shape, and distance between the acromion to the midpoint of the cyst are measured by a digital radiograph or MRI scan. A small, longitudinal skin incision, about 1 cm long, is made at the center of the cyst. Next, by using a trephine or drill bit, a small aperture is made inside the incision. Fluids contained in the cyst are drained and curved, metal impactors are used to break any septa, or membranes, within the cyst. Curettes are then used to remove the entire cyst from the diaphysis. After the removal of the cystic membrane, a 95% ethanol solution is injected into the cavity to produce a chemical cauterization to burn away any residual active membrane for 30 seconds and then aspirated. Saline solution is then immediately injected into the cavity to wash out any residual ethanol solution and to mitigate any damage to healthy tissue; this irrigation process of ethanol and saline solutions is repeated for another 2 to 3 times. A curved impactor is inserted into the cavity and used to penetrate the boundary between the cyst and bone marrow; the intentional penetrations will allow bone marrow cells to migrate into the cavity to produce a source of osteoinductive cells, cells that induce bony growth. Furthermore, the cavity is completely filled with bone graft substitute, such as calcium sulfate. Finally, one cannulated screw is placed into the aperture.
Unicameral bone cyst
Bone cyst
Peripheral ossifying fibroma
Aneurysmal bone cyst
Osteoid osteoma
Leri pleonosteosis
Osteoma cutis
Osteochondroma