The Journal of Bone and Joint Surgery (American). 2008;90:722-730.
doi:10.2106/JBJS.G.00620
© 2008 The Journal of Bone and Joint Surgery, Inc.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow [Supplementary Material]
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow Rights and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Wright, J. G.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Wright, J. G.
Related Collections
Right arrow Pediatrics
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Facebook   Add to Technorati   Add to Twitter  
What's this?

A Randomized Clinical Trial Comparing Intralesional Bone Marrow and Steroid Injections for Simple Bone Cysts

James G. Wright, MD, MPH1, Suzanne Yandow, MD2, Sandra Donaldson, BA3, Lisa Marley, BA4 on Behalf of The Simple Bone Cyst Trial Group*

1 Department of Surgery, The Hospital for Sick Children, 1218-555 University Avenue, Toronto, ON M5G 1X8, Canada. E-mail address: james.wright{at}sickkids.ca
2 Central Texas Pediatric Orthopedics, 1301 Barbara Jordan Boulevard, Suite 300, Austin, TX 78723. E-mail address: smyandow{at}ctpomd.com
3 Division of Orthopaedic Surgery, The Hospital for Sick Children, S107-555 University Avenue, Toronto, ON M5G 1X8, Canada. E-mail address: sandra.donaldson{at}sickkids.ca
4 Shriners Hospital for Children, Fairfax Road at Virginia Street, Intermountain, Salt Lake City, UT 84103. E-mail address: ldmarley{at}comcast.net

* The Simple Bone Cyst Trial Group included D. Stephens, J. Crim, K.A. Murray, B. Alman, D. Armstrong, G. Baird, R.M. Bernstein, J. Boakes, J. Bollinger, K. Carroll, P. Caskey, W. Cole, J. D'Astous, R. Durkin, H. Epps, D. Feldman, R. Ferguson, J. Fisk, K. Guidera, D. Grogan, D. Hedden, A. Howard, M.A. James, B. Joseph, H. Kim, J. Lubicky, R. Lyon, R. McCall, J. McCarthy, C. Mehlman, M. Murphy-Zane, U. Narayanan, C. Novick, C. Ono, N.Y. Otsuka, E. Raney, J. Sanders, D. Scher, P. Schoenecker, P. Smith, A. Stans, S. Sundberg, V. Talwalkar, J. Tavares, C. Tylkowski, H. van Bosse, K. Walker, J. Walker, J.G. Wright, and S. Yandow.

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Arthur Huene Award, Pediatric Orthopaedic Society of North America (POSNA) research grant, Salter Chair in Surgical Research, and Shriners Hospitals for Children. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Background: Simple bone cysts are common benign lesions in growing children that predispose them to fracture and are sometimes painful. The purpose of this trial was to compare rates of healing of simple bone cysts treated with intralesional injections of bone marrow with rates of healing of those treated with methylprednisolone acetate.

Methods: Of ninety patients randomly allocated to treatment with either a bone-marrow or a methylprednisolone acetate injection, seventy-seven were followed for two years. The primary outcome, determined by a radiologist who was blind to the type of treatment, was radiographic evidence of healing. The cyst was judged to be either not healed (grade 1 [a clearly visible cyst] or grade 2 [a cyst that was visible but multilocular and opaque]) or healed (grade 3 [sclerosis around or within a partially visible cyst] or grade 4 [complete healing with obliteration of the cyst]). Patient function was assessed with use of the Activity Scale for Kids, and pain was assessed with the Oucher Scale.

Results: Sixteen (42%) of the thirty-eight cysts treated with methylprednisolone acetate healed, and nine (23%) of the thirty-nine cysts treated with bone marrow healed (p = 0.01). There was no significant difference between the treatment groups (p > 0.09) with respect to function, pain, number of injections, additional fractures, or complications.

Conclusions: Although the rate of healing of simple bone cysts was low following injection of either bone marrow or methylprednisolone, the latter provided superior healing rates.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Facebook Facebook   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 JBJSHome page
V. O. Lewis
What's New in Musculoskeletal Oncology
J. Bone Joint Surg. Am., June 1, 2009; 91(6): 1546 - 1556.
[Full Text] [PDF]

Home page
 JBJSHome page
Y.-J. Kim and K. J. Noonan
What's New in Pediatric Orthopaedics
J. Bone Joint Surg. Am., March 1, 2009; 91(3): 743 - 751.
[Full Text] [PDF]