Neoplasms

Symptoms and General Pathology

All Conditions

Musculoskeletal Diseases

Cysts

Bone Cysts

Pathological Conditions, Anatomical

Bone Diseases

Z-score measurements will be taken from the mid-shaft tibia and distal third of the radius of both extremities where possible using quantitative ultrasound at baseline and once annually for 2 years.

There will also be optional blood samples taken o measure bone alkaline phosphatase.

Z-score measurements will be taken from the mid-shaft tibia and distal third of the radius of both extremities where possible using quantitative ultrasound at baseline, after 3 months and at future follow-up visits as clinically indicated or at a one year follow-up visit.

There will also be optional blood samples taken to measure bone alkaline phosphatase.

Z-score measurements will be taken from the mid-shaft tibia and distal third of the radius of both extremities where possible using quantitative ultrasound at baseline, after 3 months and at a one year follow-up visit.

There will also be optional blood samples taken to measure bone alkaline phosphatase.

Sunlight Omnisense Quantitative Ultrasound

Andrew Howard, MD

James G. Wright, MD

Simple bone cysts (SBCs), also known as unicameral bone cysts (UBCs), are benign bone lesions. Literature to date describes little agreement between clinicians on specific prognostic criteria for the prediction of cyst healing, recurrence or fracture. Evidence has shown that bone mineral density (BMD) is a reliable indicator of risk to SBC patients given its association with the mechanical properties of bone. There has been further exploration into the use of quantitative ultrasound to assess bone density by measuring the velocity of the ultrasound transmission over the bone. To determine whether the QUS can provide prognostic information with respect to cyst healing, recurrence or fracture with a SBC, further study is needed.

Quantitative Ultrasound for the Evaluation of Simple Bone Cyst Healing

The Hospital for Sick Children

Orthopaedic Surgeon

All Drugs and Chemicals

Bone Density Conservation Agents

Calcium

Calcium, Dietary

Hormones

Curettage with puncture (C \& P) will be performed alone

A predetermined amount of Vitoss morsels will be injected following the curettage and puncture (C \& P)

A curette will be inserted to scrape the contents of the cyst (curettage) and a hole in the cyst wall will be made (puncture) near the bone marrow cavity

Curettage with puncture (C & P)

A small surgical instrument with a rounded edge designed for scraping

Curette

A bone substitute intended for use as a filler for voids or gaps in bones

Vitoss morsels

Project Manager

Elisabeth Clarke

Martin Morrison III

Carly Strohbach

Jamie Burgess

Joseph A Janicki

Julie Titter

Anna Vergun

Grace Anand

Vinitha R Shenava

Melissa Formosa

Brian Loh

Yoga Dhanapala

Elaine Joughin

Harpreet Chhina

Tony Cooper

Kishore Mulpuri

Jennifer Hurry

Karl Logan

Jacob Davidson

Debra Bartley

Holly Livock

Sasha Carsen

Julie Shiu

Sevan Hopyan

Emma Spink

Dan Perry

Kim Gardiner

Andreas Roposch

Imelda Mayor

Mohamed Kenawey

Rebecca Harmer

Tim Theologis

Aimee Corcoran

Nicolas Nicolaou

James G. Wright

Simple bone cysts (SBCs) are cysts filled with fluid that occur most frequently in the long bones (arms or legs) of children. There are many ways to treat SBCs but it is unclear if one is better than another. The purpose of this research trial is to compare the effectiveness of two common treatments that are used by surgeons today.

In general, few randomized clinical trials have been undertaken in paediatric orthopaedics, and only one to date has addressed the problem of simple bone cysts (SBCs). Also known as unicameral bone cysts, they are the commonest bone lesion in children. Despite general opinion, these cysts do not resolve at skeletal maturity.

Many forms of treatment have been recommended but none, including the popular methods of corticosteroid or bone marrow injections, have reliably eradicated SBC. Although the lesions are considered benign (non-cancerous), they cause pain, frequently interfere with function, dramatically restrict play activity, may re-fracture leading to growth arrest and/or deformity, and cause enormous anxiety for children and their families.

With a well-developed network of surgeons and researchers, we will provide evidence comparing the effectiveness of two treatment interventions for SBC. More specifically, our goals for this study are:

1. to compare the rate of radiographic healing between two standard treatments including curettage with puncture alone, and curettage with puncture followed by injection with Vitoss morsels;
2. to identify prognostic radiographic factors associated with simple bone cyst healing and fracture;
3. to determine the impact of simple bone cyst on children/family functioning.

Simple Bone Cysts in Kids

Simple Bone Cysts in Kids (SBoCK)

Healing will be graded according to a 4-point modified Neer's classification by radiologists

Cyst features (ie. appearance, size) will be described or measured from X-rays taken annually after treatment

Function in participants will be evaluated using self-reported questionnaires for activity level, perception of illness, and pain annually after treatment

Canadian Institutes of Health Research (CIHR)

Anti-Inflammatory Agents

Antineoplastic Agents

Antiemetics

Neuroprotective Agents

Gastrointestinal Agents

Prednisolone

Methylprednisolone

Methylprednisolone Acetate

Methylprednisolone Hemisuccinate

Prednisolone acetate

Prednisolone hemisuccinate

Prednisolone phosphate

michael M. gerges

Evaluation of the efficacy of methyl prednisolone injection in treatment o f simple bone cyst to prevent all possible complications as pathological fractures and to avoid prolonged restriction of physical activity

unicameral bone cysts (UBCs) are benign, fluid-filled cavities that develop in tubular and flat bones (eg,humerus, femur). These cysts tend to expand and weaken the local bone,but they are not true neoplasms. In 1876, Virchow1 first described these lesions as cystic structures caused by abnormalities in local circulation.

UBCs are also known as simple or solitary bone cysts. They occur almost exclusively in children and adolescents (up to 85% of cases), with a reported peak between ages 3 and14 years and the average age at diagnosis being 9 years.

These lesions represent approximately 3% of all bone tumors and occur more commonly in boys than in girls (2:1). Several treatment options exist for unicameral bone cysts (UBCs), including observation, steroid injection, bone marrow injection, and Surgical procedures have ranged from simple curettage with autologous bone graft or allograft to sub periosteal resection with internal fixation and grafting

.Treatment by multiple injection of steroids produce minimal surgical approach, no hospital stay, and very low morbidity. Three or four injections over a period of 12 month may be enough

The Results of Multiple Aspirations and Injections of Unicameral Bone Cyst by Methyl Prednisolone Acetate

radiological follow up of patients after one month of injection follow up again by x.ray after three months clinical outcome of patients after injection by visual analogue scale of pain

1. Modified Neer classification

   1. Healed cyst : Cyst filled by new bone, with or without small radiolucent area(s) \< 1 cm in size
   2. Healing with defect: Radiolucent area(s) \< 50% of the diameter of bone, with enough cortical thickness to prevent fracture
   3. Persistent cyst: Radiolucent area \> 50% of diameter of the bone and with a thin cortical rim. No increase in the size of the cyst. Continued restriction of activity or repeated treatment is required
   4. Recurrent cyst: Cyst reappeared in a previously obliterated area, or a residual radiolucent area has increased in size
2. the cyst index which predict the risk of pathological fracture .The cyst index can be calculated as the area of the cyst divided by the square of the diaphysis diameter cyst index equal to or greater than 3.5 indicates a high fracture risk

clinical healing by asking the patient or his relevant about improvement of symptoms

Assiut University

principal investigator

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Quantitative Ultrasound for the Evaluation of Simple Bone Cyst Healing	NCT02616757	Simple Bone Cys...	Sunlight Omnise...	2 Years - 21 Years	The Hospital for Sick Children
Quantitative Ultrasound for the Evaluation of Simple Bone Cyst Healing	NCT02616757	Simple Bone Cys...	Sunlight Omnise...	2 Years - 21 Years	The Hospital for Sick Children
Simple Bone Cysts in Kids	NCT02193841	Bone Cyst	Curettage with ... Curette Vitoss morsels	2 Years - 21 Years	The Hospital for Sick Children
The Results of Multiple Aspirations and Injections of Unicameral Bone Cyst by Methyl Prednisolone Acetate	NCT03724630	Simple Bone Cys...		- 18 Years	Assiut University

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