Aneurysmal Bone Cysts of the Hand, Wrist, and Forearm

PurposeTo determine the outcomes of surgical management of aneurysmal bone cysts (ABCs) in the hand, wrist, and forearm.MethodsThe medical records of 11 patients undergoing surgical treatment of ABCs distal to the elbow from 1994 to 2011 with at least 12 months follow-up were reviewed retrospectively. Mean follow-up was 29 months (range, 13–56 months). There were 7 males and 4 females. Four lesions presented in the radius, 3 in the ulna, 2 in the metacarpals, and 2 in the phalanges.ResultsTen patients underwent wide unroofing and intralesional curettage with 9 undergoing associated high-speed burring. Multiple chemical and thermal adjuvants were used. One patient underwent en bloc resection with reconstruction. There was 1 recurrence in a periphyseal lesion in a 2-year-old boy treated with curettage, burring, and adjuvant chemotherapy. Ten patients incorporated the bone graft and healed without further surgery. One patient required revision bone grafting.ConclusionsThe diagnosis of ABC should remain in the differential diagnosis for cystic lesions in the upper extremity in pediatric and adult patients. Low recurrence has been obtained predominantly with intralesional curettage and high-speed burring with and without chemical and thermal adjuvant therapy. Appropriate healing has been obtained with both allograft and autograft reconstructions. Periarticular and periphyseal lesions remain challenging and provide the highest chance for incomplete resection and recurrence. Follow-up with plain radiographs did not lead to any delay in diagnosis of recurrence in any case.Type of study/level of evidenceTherapeutic IV.