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Percutaneous Curettage and Suction for Pediatric Extremity Aneurysmal Bone Cysts: Is it Adequate?

Ibrahim, Talal MB BS (Hons), MD, FRCS (Tr & Orth), FRCSC; Howard, Andrew W. MD, MSc, FRCSC; Murnaghan, M. Lucas MD, MEd, FRCSC; Hopyan, Sevan MD, PhD, FRCSC

Journal of Pediatric Orthopaedics: December 2012 - Volume 32 - Issue 8 - p 842–847
doi: 10.1097/BPO.0b013e31825d3619

Background: The purpose of our study was to evaluate the effectiveness of treating extremity aneurysmal bone cysts (ABC) by percutaneous curettage compared with open intralesional excision.

Methods: A retrospective review of 17 patients with histologically proven primary ABCs and no evidence of a secondary lesion treated either by percutaneous curettage or open intralesional excision with at least 24-month follow-up was undertaken. The percutaneous curettage group was uniformly treated on an outpatient basis using angled curettes under image guidance followed by intralesional evacuation. The primary outcome was radiographic healing using the Neer/Cole 4-grade classification. Complications were noted.

Results: Seventeen patients with a mean age of 11.7 years (range, 1.7 to 17.5) were evaluated. Nine patients underwent percutaneous curettage and 8 had an open intralesional excision. The 2 treatment groups were comparable with regard to age, sex, number of procedures, morphologic type of ABC, and follow-up period. At follow-up, the proportion of patients with satisfactory healing (Neer/Cole grades I and II) were similar among the 2 groups (P=0.74). In the percutaneous curettage group, 2 cases recurred necessitating repeat procedures, whereas 1 case recurred in the open intralesional excision group and was successfully treated percutaneously.

Conclusions: Percutaneous curettage is a safe and minimally invasive alternative for extremity ABCs that can be performed as an outpatient procedure. Not all ABCs require wide exposure and an open intralesional excision.

Level of Evidence: III.

The Hospital for Sick Children, Division of Orthopaedic Surgery, Toronto, ON, Canada

The authors declare no conflict of interest.

Reprints: Talal Ibrahim, MB BS (Hons) MD, FRCS (Tr & Orth) FRCSC, The Hospital for Sick Children, Division of Orthopaedic Surgery, 555 University Ave., Toronto, ON, Canada M5G 1X8. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.