There are several methods to treat simple bone cysts. Injection with steroids and bone marrow has only limited success. Curettage and filling with bone graft and bone graft substitute has fairly good results. The concept of opening the bony canal and connecting the cyst in the canal has gained popularity over the recent years. In some cases, opening of the cavity to connect with the canal is the most difficult part of the procedure and can lead to fracture of the adjacent cortex. The authors report the use of a titanium elastic nail of varying sizes to open the intramedullary canal and connect it to the bone cyst. The authors recommend the use of the AO titanium elastic nail as the instrument for opening the canal. The nails are available in diameters ranging from 2 mm to 4 mm and are flexible. The nails have a sharp and stiff, curved end, which allows opening of the canal. The nail is fixed to the nail holder and advanced using manual pressure or gentle taps. Once the canal has been opened, the nail is withdrawn and the cyst is filled with bone graft substitute. The incision is then closed.
The authors report excellent results on a small cohort of seven patients. The size of the adjacent cortical hole was one centimeter in diameter at most, without any evidence of adjacent fracture. Using the titanium elastic nail as a device to open the canal adjacent to the cyst makes great sense. The elastic nature of the nail and sharp tip facilitates opening without disruption of the adjacent cortex.
Journal of Pediatric Orthopaedics