Background: Calcaneal bone cysts with pathological fractures are rare. There is no clear consensus on their management with a few reports of open curettage, bone grafting and internal fixation in the treatment of pathological calcaneal fractures. No minimally invasive management has been reported before. Methods: We reviewed our experience in treating five patients with pathologic calcaneus fractures associated with preexisting bone cysts who underwent percutaneous cyst curettage, fracture reduction, screw fixation and calcium sulfate cement injection between 2004 and 2009. Results: All of the pathologic fractures healed with satisfactory radiological results. There were no soft tissue complications or cyst recurrences. Partial weightbearing with plaster cast immobilization was allowed at 4 weeks postoperatively and full weightbearing was allowed at 6 weeks postoperatively. Conclusion: This percutaneous technique provided a minimally invasive option for treatment of a calcaneal bone cyst with pathologic fracture.
. AbidiNADhawanSGruenGSVogtMTContiSF: Wound-healing risk factors after open reduction and internal fixation of calcaneal fractures. Foot Ankle Int.19:856–861, 1998.
2.
. AltermattSSchwobelMPochonJP: Operative treatment of solitary bone cysts with tricalcium phosphate ceramic. A 1 to 7 year follow-up. Eur J Pediatr Surg.2:180–182, 1992. http://dx.doi.org/10.1055/s-2008-1063435
. BibboCPatelDV: The effect of demineralized bone matrix-calcium sulfate with vancomycin on calcaneal fracture healing and infection rates: a prospective study. Foot Ankle Int.27:487–493, 2006.
5.
. BrecelJSuhodolcanL: Continuous decompression of unicameral bone cyst with cannulated screws: a comparative study. J Pediatr Orthop B.16:367–372, 2007. http://dx.doi.org/10.1097/BPB.0b013e32826d1ad6
6.
. ChangCHStantonRPGluttingJ: Unicameral bone cysts treated by injection of bone marrow or methylprednisolone. J Bone Joint Surg Br.84:407–412, 2002. http://dx.doi.org/10.1302/0301-620X.84B3.12115
7.
. ChoHSOhJHKimHSKangHGLeeSH: Unicameral bone cysts: a comparison of injection of steroid and grafting with autologous bone marrow. J Bone Joint Surg Br.89:222–226, 2007. http://dx.doi.org/10.1302/0301-620X.89B2.18116
. CsizyMBuckleyREFennellC: Benign calcaneal bone cyst and pathologic fracture–surgical treatment with injectable calcium-phosphate bone cement (Norian): a case report. Foot Ankle Int.22:507–510, 2001.
10.
. DeWallMHendersonCEMcKinleyTO: Percutaneous reduction and fixation of displaced intra-articular calcaneus fractures. J Orthop Trauma.24:466–472, 2010. http://dx.doi.org/10.1097/BOT.0b013e3181defd74
11.
. DormansJPDormansNJ: Use of percutaneous intramedullary decompression and medical-grade calcium sulfate pellets for treatment of unicameral bone cysts of the calcaneus in children. Orthopedics.27:137–139, 2004.
12.
. DormansJPSankarWNMorozLErolB: Percutaneous intramedullary decompression, curettage, and grafting with medical-grade calcium sulfate pellets for unicameral bone cysts in children: a new minimally invasive technique. J Pediatr Orthop.25:804–811, 2005. http://dx.doi.org/10.1097/01.bpo.0000184647.03981.a5
13.
. ElsnerAJubelAhProkopA: Augmentation of intraarticular calcaneal fractures with injectable calcium phosphate cement: densitometry, histology, and functional outcome of 18 patients. J Foot Ankle Surg.44:390–395, 2005. http://dx.doi.org/10.1053/j.jfas.2005.07.003
14.
. HannaSJDasicDFloydA: Simple bone cysts of the calcaneus: a report of five cases and a review of the literature. Foot Ankle Int.25:680–684, 2004.
15.
. HarveyEJGrujicLEarlyJSBenirschkeSKSangeorzanBJ: Morbidity associated with ORIF of intra-articular calcaneus fractures using a lateral approach. Foot Ankle Int.22:868–873, 2001.
16.
. KellyCMWilkinsRMGitelisS: The use of a surgical grade calcium sulfate as a bone graft substitute: results of a multicenter trial. Clin Orthop Relat Re: 42–50, 2001.
17.
. MainardDGaloisL: Treatment of a solitary calcaneal cyst with endoscopic curettage and percutaneous injection of calcium phosphate cement. J Foot Ankle Surg.45:436–440, 2006. http://dx.doi.org/10.1053/j.jfas.2006.09.014
18.
. MikGArkaderAManteghiADormansJP: Results of a minimally invasive technique for treatment of unicameral bone cysts. Clin Orthop Relat Res.467:2949–2954, 2009. http://dx.doi.org/10.1007/s11999-009-1008-2
19.
. MirzayanRPanossianVAvedianRForresterDMMenendezLR: The use of calcium sulfate in the treatment of benign bone lesions. A preliminary report. J Bone Joint Surg Am.83-A:355–358, 2001.
20.
. ParkIHMicicIDJeonIH: A study of 23 unicameral bone cysts of the calcaneus: open chip allogeneic bone graft versus percutaneous injection of bone powder with autogenous bone marrow. Foot Ankle Int.29:164–170, 2008.
. RammeltSAmlangMBarthelSGavlikJMZwippH: Percutaneous treatment of less severe intraarticular calcaneal fractures. Clin Orthop Relat Res.468:983–990, 2010. http://dx.doi.org/10.1007/s11999-009-0964-x
24.
. RoposchASaraphVLinhartWE: Flexible intramedullary nailing for the treatment of unicameral bone cysts in long bones. J Bone Joint Surg Am.82-A:1447–1453, 2000.
. TurnerTMUrbanRMGitelisSKuoKNAnderssonGB: Radiographic and histologic assessment of calcium sulfate in experimental animal models and clinical use as a resorbable bone-graft substitute, a bone-graft expander, and a method for local antibiotic delivery. One institution's experience. J Bone Joint Surg Am. 83-A Suppl2:8–18, 2001.
28.
. WeeATWongYS: Percutaneous reduction and injection of Norian bone cement for the treatment of displaced intra-articular calcaneal fractures. Foot Ankle Spec.2:98–106, 2009. http://dx.doi.org/10.1177/1938640009334153
29.
. WuXTJiangXJZhangSDYangHL: Biomechanical evaluation of vertebroplasty using calcium sulfate cement for thoracolumbar burst fractures. Chin J Traumatol.10:327–333, 2007.
