Fractured Aneurysmal Bone Cyst in Children – Is Conservative Treatment an Option?

Abstract

Objective: The objectives are to evaluate the outcomes of conservatively managed pathological fractures through aneurysmal bone cysts (ABCs) in children and to assess the potential for spontaneous cyst healing post-fracture. Methods: A retrospective review was conducted of hospital records between January 2014 and October 2024. Children aged ≤14 years with fractured long bone ABCs and managed conservatively with at least 6 months of radiographic follow-up were included. Cases treated surgically or with recurrent/previously treated lesions were excluded. Radiographs were reviewed for lesion characteristics, Enneking staging, and radiographic features (loculation, cortical rim, tubulation, and bone scalloping). Outcomes were assessed using fracture union and cyst healing according to Rastogi’s criteria. Results: Eight patients (6 males, 2 females; mean age 7.3 ± 3.2 years) met the inclusion criteria. The proximal humerus (n = 5) was the most frequently affected site, followed by the proximal femur (n = 2) and distal radius (n = 1). All lesions were metaphyseal and classified as Enneking stage II. At a mean follow-up of 7 ± 1.1 months, all fractures united radiologically. Partial cyst healing occurred in 3 patients (37.5%), while 5 patients (62.5%) showed no significant healing. No deformities or complications were reported. Conclusion: Conservative management of pathological fractures through ABCs in children achieves fracture union and may induce partial cyst healing. Larger, multi-center studies are required to better define the predictors of healing after a fracture through the cyst. Keywords: Aneurysmal bone cyst, pathological fracture, benign bone tumor, spontaneous healing, pediatric.