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Forum Name: Bone trauma and fractures

Question: Fractured Humerus and Bone Cyst in 5 yr old boy


 ann1221 - Tue Jan 13, 2009 11:02 pm

Hello,

I'm looking for some information regarding "bone cysts". We recently visted the E.R. with our son after a minor fall because he was unable to move his arm and in a lot of pain. The X-rays revealed a fracture on the upper part of the humerus as well as a large "bone cyst," occupying at least 2/3 of his humerus. We were told that the cyst had weakend his bone causing the break. That was the only information given to us, and we were sent home with pain medicine and a sling. We have made an appointment with an orthepedic surgeon, and are waiting for more information. I would like information on what exactly is a bone cyst? What are the causes? And the types of treatment?

Thank You!
 Tom Plamondon PA-C - Wed Jan 14, 2009 8:40 pm

User avatar Hello,
I am sorry to hear about your son's fracture.

A simple bone cyst is not a neoplasm but it can damage bone, cause fracture and prevent the limb from fully growing.

Your orthopedist will review your son's prognosis, expectations for normal growth, risk of reinjury or fracture, and treatment options.

Let me know if you have any further questions and how things turn out with your son.

Take care.
 Dr. mnermis - Thu Jan 15, 2009 4:15 pm

bone cysts weakens bone and bone can be fracture easly.

bone cyst have two kinds: simple bone cyst and aneurysmal bone cyst

Simple bone cysts are more common, it weakens bone, and fractures are not rare with this pathology. But after fracture more than half of this lessions heals simultaneously with fracture healing. so it does not needs any surgical treatment. And 3-6 months later maybe it will disappear.

if it doesn't heal with fracure, we have some surgical options for treatment like;
streoid injection
curetage
curetage and graftting

don't worry, take care of you and your son
 Muffinmule - Wed May 13, 2009 5:58 am

To whom it may concern,

I've stumbled across this site while searching for unanswered question and or information on UBC (Bone Cyst in the upper Humerus) of my 9yr old son. Yesterday was the third fracture in this area after the cyst went undetected on the first occurrence. Only later (second fracture) we were recommended to a peadiatric orthopedic surgeon who later prognosed time as the cure. Firstly, for the fracture to heal then another period of 6-8 weeks for the cyst or bone to repair on it's own, as we were told that there is a high percentage of cases that do recover that way. Five months ago we seemed to be heading on the right track as the Doctor asked us to return six months later to review the progress.

Unfortunately we have not made it and are back at square one i.e . Day two of another fracture and the cyst still there. After a telephonic conversation with our orthopedic surgeon, who plans to see us in two weeks time to discuss the options/ path forward, has requested that we consider supporting or strengthening the bone
with "rods". This of course, I'm assuming will be major surgery and will come with its own complications.

In order for my own education could you assist with the following:

- Where could I find detail on this bone support procedure the surgeon may use?
- Why won't the surgeon treat the cyst by injection? or other?
- Supporting the bone does nothing for the root cause. i.e. treating the cyst.

Kind regards,
 ann1221 - Fri May 15, 2009 3:05 pm

Hello,
First of all, my sympathies for you and your son. Here is an update on my son, that may or may not help you. After our intial visit to the E.R in January, we were refered to a local orthopedic surgeon. He treated only the fracture, which consisted of wearing a sling for a few weeks, and then monthly checkups with x-rays to monitor the fracture. Once the fracture healed, the doctor then refered us to an specialist in bone tumors/cysts in Spokane, WA. Dr. Andrew Howlett from Providence Orthopedics Specialties. I don't know your location, but here is the number (509) 464-7880, maybe speaking to someone here may help you find a specialist in your area.
Anyway, in April we went to see the specialist he suggested two possible options for treatment. The first treatment was bone cutterage and graphing. This procedure involves removing the cyst and inserting bone graft material from a cadaver into the hollowed cavity. There is no need to find a match for this bone graft. This treatment is supposed to stimulate new bone growth. The second option was to wait and see if the bone cyst would correct itself or move farther away from the growth plate so a more conclusive surgery can be performed. I say this because my son's cyst was so close to the growth plate that the doctor wouldn't risk going near it to remove all the the cyst. Of course everything is patient specific, the location of cyst, the existing fractured area, the size and the risk for re-injury. My son's cyst was very large and close to the growth plate. If my son were to have fallen and recieve a break on the growth plate this could have stunted the growth of his arm.
So, we decided to have the surgery, however we were informed that there was ~20% chance the cyst would reoccur. My very confident doctor informed us that his success rate for this surgery was higher than the norm. He specifically said that steroid injections(which I researched online) is hardly practiced anymore and not effective. We could've waited but that would have meant putting my very active boy in a bubble for at least a year, and hope that nothing would happen to his arm in the meantime. My son's bone we were later informed was "less than an eggshell" as far as stability. So the doctor had to place a metal rod on his bone during surgery for added strength. This rod doesn't need to be removed because it will not disrupt growth in his arm, the growth plate is above and below the metal rod. So basically the section of bone the rod is attached to will not grow. Two weeks after surgery we went for a follow-up appt, the x-rays revealed no new bone growth, but it really is too soon to tell. The good news is that we could clearly see the bone graft material, which is good because sometimes this can be reabsorbed into the bone. I was informed that my doctor freezes the bone with liquid nitrogen during surgery to help prevent this from happening, which I believe is a fairly new procedure.
So now its another ~4 weeks in the sling with orders for physical therapy. After 4 weeks we will get another set of x-rays and it's my prayer that we'll see new bone growth. Feel free to keep e-mailing me with questions.

Blessings!
 ann1221 - Tue May 19, 2009 1:04 pm

Maybe our road for treatment regarding my son's cyst will be helpful. First of all we had to wait for the intial fracture to heal(~6 wks) Then we were referred to a specialist in bone/tumors. At our first visit he recommend surgery: cutterage and bone graft. The only other option was to wait for the cyst to move away from the growth plate so a more conclusive surgery could be performed. Putting a 5 yr old in a bubble for at least a year didn't seem very appealing, so we decided to have the surgery. My son's cyst is very large ~50-60% of his humerous, and the risk for re-injury was too great. After the surgery the doctor informed us that his bone was "less than an egg shell", so along with the surgery he also had to put in a metal rod for added stability. We are now in week 3 recovery from surgery, that last x-rays at 2 weeks post-op revealed no new bone growth. But it really is too soon to tell. The good news is that we can still see the bone graft, sometime this can be reabsorbed into the bone. I learned later that my doctor freezes the bone during surgery with liquid nitrogen to prevent this from happening and he has had good results. The success rate for this surgery is 80%, but my doctor informed me that his rate was higher than the norm. If you have any more questions feel free to ask.
 Tom Plamondon PA-C - Tue May 19, 2009 7:54 pm

User avatar Hello,
You are correct in that an active cyst will continue to increase the risk of fracture.

Injecting steroids or bone marrow, scraping, and bone fusion are all treatment options.

A good website for detailed descriptions can be found at www.wheelessonline.com and search for simple bone cyst.

Take care.
 sam6 - Wed Feb 10, 2010 5:11 pm

ann,

My best wishes for your son.God is definately protecting him.
Can we know the updates as my son is also having same problem and has been recently diagnosed with Simple Bone Cyst?

He had a fracture in his upper Left arm and we are considering various options.

Thanks
Sam
 ann1221 - Mon Feb 15, 2010 5:46 pm

Well, I'm SO relieved to say that my son is healed! Six months after surgery and we have seen almost 100% bone regrowth in the x-rays. We still have a 1 year appt. this coming April, but I think it's safe to say GOODBYE BONE CYST!!!!

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