Department of Orthopaedic Surgery
Stellenbosch University

Management of benign cystic lesions of bone

Common Bone lesions appearing cystic on X ray

  1. Simple Bone Cyst
  2. Aneurysmal bone cyst
  3. Ganglion cyst
  4. Chondromyxiod Fibroma
  5. Eosinophyllic grannuloma
  6. Non ossifying fibroma
  7. Fibrous dysplasia
  8. Infection
  9. Hydatid cyst (fairly common in South Africa)

Patients with cystic bone lesions may present with pain or swelling or the cyst may be noticed incidentally on an X Ray taken for other reasons.

Pain may indicate that the cyst is developing a stress fracture and needs urgent treatment, or it may be present for other reasons such as in the case of a ganglion cyst secondary to degenerative joint disease.

The patient commonly presents with an established fracture through a lesion that appears cystic.

Fracture through a simple bone cyst
Pathological fracture through a simple bone cyst in a 17 year old

Not all cysts require treatment. In some lesions the danger of biopsy or other surgery may outweigh any benefit.

The following lesions generally do not require operative treatment. Biopsy of bone infarct will create to a stress riser in dead bone. A stress fracture will develop which can not heal and leads to complete fracture of the bone. Similarly a biopsy of a stress fracture will yield callus which may be mistaken by the pathologist as osteoid, leading to misguided surgery such as an amputation or block resection.

Tumor and tumor-like lesions for non operative treatment

  • Bone infarct
  • Fibrous cortical defect
  • Small, solitary focus of fibrous dysplasia
  • Intraosseous ganglion
  • Stress fracture
  • Myositis ossificans
  • Hyperparathyroidism - Brown Tumour
  • Bone island (enostosis)
  • Enchondroma in a short, tubular bone
  • Avulsion fracture (healing stage)

As with everything medical, there are exceptions. Any lesion in the above list which is painful, fast growing or large (appears as if it may immanently cause a fracture) will require surgery.

Fracture through a large non ossiying fibroma This large non ossifying fibroma  required internal fixation
This non ossifying fibroma was so large it lead to a pathological fracture and required internal fixation