PMID- 30925579
OWN - NLM
STAT- MEDLINE
DCOM- 20200306
LR  - 20210209
IS  - 1539-2570 (Electronic)
IS  - 0271-6798 (Linking)
VI  - 40
IP  - 1
DP  - 2020 Jan
TI  - Current Trends and Variations in the Treatment of Unicameral Bone Cysts of the 
      Humerus: A Survey of EPOS and POSNA Members.
PG  - e68-e76
LID - 10.1097/BPO.0000000000001376 [doi]
AB  - BACKGROUND: A variety of treatment methods have so far been described for 
      unicameral bone cysts (UBC). However, to the best of our knowledge, no particular 
      consensus has yet been reached on when to operatively treat a patient with a 
      humeral UBC. Therefore, members of the European Pediatric Orthopedic Society 
      (EPOS) and Pediatric Orthopedic Society of North America (POSNA) were surveyed to 
      characterize current treatment preferences. METHODS: An online electronic 
      questionnaire was sent out to all registered EPOS and POSNA members. The survey 
      comprised 45 questions related to the diagnosis, treatment, and follow-up 
      characteristics of patients with UBCs of the humerus. Particular questions 
      related to the nonoperative or surgical treatment of pathologic proximal humerus 
      and humeral shaft fractures were also included. RESULTS: In total, 444 
      participants (132 EPOS and 292 POSNA members) responded, of whom 400 were 
      actively involved in UBC treatment. The preferred diagnostic modalities to 
      confirm the diagnosis of a UBC in the humerus were radiographs (88%), MRI in 
      cases of questionable diagnosis (58%) or CT scan (8%). For painless UBCs 67% 
      prefer no treatment at all except when the fracture risk is deemed high (then 53% 
      recommend surgery); 71% of respondents would treat painful UBCs with surgery. 
      Most common surgical techniques comprise curettage (45%), artificial bone 
      substitutes (37%), corticosteroid injection (29%), or intramedullary 
      stabilization (eg, rodding; 24%).Fractured, nondisplaced and mildly displaced 
      proximal humerus UBCs and mildly displaced pathologic humerus shaft fractures are 
      all preferably treated nonoperatively (94%, 91%, 83%, respectively). Severely 
      displaced pathologic proximal humerus fractures are treated less often 
      conservatively (36%) than surgically (40%), and severely displaced humerus shaft 
      fractures are preferably treated surgically (63%) by intramedullary stabilization 
      (60%). CONCLUSIONS: There is great variation among EPOS and POSNA members with 
      regards to the diagnosis and treatment of UBCs in the humerus. Although some 
      consensus on general treatment principles is seen, specific surgical treatment 
      indications vary.Prospective randomized-controlled studies are needed to evaluate 
      the outcomes of the different surgical approaches compared with nonoperative 
      strategies. LEVEL OF EVIDENCE: Level V-expert opinion.
FAU - Farr, Sebastian
AU  - Farr S
AD  - Orthopaedic Hospital Speising, Department of Pediatric Orthopaedics and Adult 
      Foot and Ankle Surgery.
FAU - Balaco, Ines Maria Spencer
AU  - Balaco IMS
AD  - Department of Pediatric Orthopaedics, Pediatric Hospital of Coimbra-CHUC, EPE, 
      Coimbra, Portugal.
FAU - Martinez-Alvarez, Sergio
AU  - Martinez-Alvarez S
AD  - Orthopedic Surgery and Traumatology Service, Hospital Infantil Universitario, 
      Nino Jesus, Madrid, Spain.
FAU - Hahne, Julia
AU  - Hahne J
AD  - Vinzenz Gruppe Center of Orthopedic Excellence, Vienna, Austria.
FAU - Bae, Donald S
AU  - Bae DS
AD  - Department of Orthopaedic Surgery, Children's Hospital Boston, Boston, MA.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Pediatr Orthop
JT  - Journal of pediatric orthopedics
JID - 8109053
SB  - IM
MH  - Bone Cysts/complications/diagnostic imaging/*therapy
MH  - Conservative Treatment
MH  - Europe
MH  - Fractures, Spontaneous/diagnostic imaging/etiology/*therapy
MH  - Humans
MH  - Humeral Fractures/diagnostic imaging/etiology/*therapy
MH  - Magnetic Resonance Imaging
MH  - Musculoskeletal Pain/etiology
MH  - North America
MH  - Orthopedic Procedures/methods
MH  - Orthopedics
MH  - Pediatrics
MH  - Practice Patterns, Physicians'/*trends
MH  - Prospective Studies
MH  - Shoulder Fractures/diagnostic imaging/etiology/*therapy
MH  - Surveys and Questionnaires
MH  - Tomography, X-Ray Computed
EDAT- 2019/03/30 06:00
MHDA- 2020/03/07 06:00
CRDT- 2019/03/30 06:00
PHST- 2019/03/30 06:00 [pubmed]
PHST- 2020/03/07 06:00 [medline]
PHST- 2019/03/30 06:00 [entrez]
AID - 01241398-202001000-00020 [pii]
AID - 10.1097/BPO.0000000000001376 [doi]
PST - ppublish
SO  - J Pediatr Orthop. 2020 Jan;40(1):e68-e76. doi: 10.1097/BPO.0000000000001376.