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DICOM HelpSource: Local (us-east1-c)
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Demographics:
5 years old, Male
Indication:
Arm injury
Findings
- Large lucent expansile lesion in the left humeral diaphysis with smooth overlying cortical thinning
- Acute minimally displaced fracture through this lesion in the mid humeral diaphysis with mild apex lateral bowing
Diagnosis
Pathological fracture through a simple bone cyst
Sample Report
Acute minimally displaced pathological fracture of the mid humeral diaphysis through a large diaphyseal simple bone cyst. Mild apex lateral bowing.
No joint malalignment.
Discussion
- Simple bone cysts (SBCs) are most commonly found in children and adolescents and most commonly present with pathologic fracture
- The risk for fracture in an incidentally discovered SBC is multifactorial (one metric involves dividing the cyst area by the cortical diameter squared with a value of > 4 in the humerus indicating high risk for fracture), but certainly if you see marrow space expansion with overlying cortical thinning, it is important to notify the referring physician of this risk
- The "fallen fragment" sign may accompany these fractures with a piece of fractured bone layering dependently in the lesion, which confirms the cystic nature of the lesion
- Treatment typically involves fracture immobilization first following by treatment of the lesion with curettage and bone grafting
References