The development of post-traumatic cyst-like lesions in bone.
ABSTRACT Cyst-like lesions in the radius and tibia were observed in two children as a post-fracture event. The pathogenesis of these lesions is discussed. Cut sections from anatomic specimens display extensive hemorrhage in subperiosteal as well as endosteal and trabecular bone. Cysts arising from hemorrhagic resorption in various locales may explain the occasional atypical appearance of these lesions.
Article: Musculoskeletal Case ofthe Day
[Show abstract] [Hide abstract]
ABSTRACT: BACKGROUND:: Pediatric postfracture cystic bone lesions are most commonly found on routine follow-up radiographs of distal radius fractures. After their discovery, there is often a discussion of the need for further radiologic imaging or operative intervention. METHODS:: We present 3 cases in which all the 3 pediatric patients had a history of a healing fracture and had the lesions diagnosed incidentally on average 3 months after initial injury. RESULTS:: These similar cases demonstrate the nearly identical radiographic characteristics of postfracture cystic lesions of the distal radius. The radiographs consistently demonstrate a well-circumscribed lytic lesion without surrounding sclerosis (geographic 1B) within the elevated periosteum of the healing fracture. These lesions appeared to sit on top of the previous cortex without causing any erosion or having any other aggressive characteristics. All of the lesions were consistent with adipose tissue on all sequence including T1, T2, and fat-suppressed T1-weighted imaging. CONCLUSIONS:: Although postfracture pediatric cysts are apparently rare, we feel that there is sufficient literature to support that there is no longer any need for advanced imaging modalities to diagnose these lesions in the setting of an appropriate history without confounding variables and classic radiographic appearance. Biopsy, in particular, is decidedly unnecessary, unless the lesion progresses on subsequent radiographs or demonstrates more overtly aggressive initial features. CLINICAL RELEVANCE:: This will allow for faster diagnosis with substantially less burden on the health care system and decreased the stress that is placed on the patients and families involved by requiring magnetic resonance imaging with or without conscious sedation in order to make the final diagnosis. LEVEL OF EVIDENCE:: IV-case series.Journal of pediatric orthopedics 04/2013; 33(3):239-243. DOI:10.1097/BPO.0b013e318280a63f · 1.23 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Posttraumatic cortical defect of bone is a rare entity which occurs in a maturing skeleton following green stick or torus fracture. Most of the cases are asymptomatic and they are detected incidentally on radiograph. These lesions usually require no treatment. However, the appearance of these lesions can mimic various pathological conditions affecting bone. Knowledge about this entity is important as it avoids unnecessary investigations. We present this case as the occurrence of this entity in femur is very rare and the child was symptomatic.01/2013; 2013:815460. DOI:10.1155/2013/815460