Bone cyst: features of course and treatment in children and adults

A bone cyst is a limited cavity inside bone tissue filled with blood, serous, serous-hemorrhagic fluid. According to the International Histological Classification of Bone Tumors, a cyst is classified as a tumor-like process. Moreover, among all primary bone formations they occupy 3rd place and most often form in childhood, although the formation of cysts in the bones of adults is not excluded.

A neoplasm of this kind can occur in any of the bones of the skeleton, but the proximal humerus (50%) and femur (25%) are most often affected. Much less often, bone cysts are found in the tibia, fibula, calcaneus, and spine. Initially, they may not appear in any way, but as they grow, pain and other symptoms appear. The cyst disrupts the normal structure of the bone and increases the likelihood of fractures even with light loads. It can also lead to bone deformation, which in severe cases creates pronounced aesthetic defects.

Bone cysts in children

Cystic cavities of various types are one of the most common skeletal pathologies in children. Basically, neoplasms are formed in the zone of increase in bone length, i.e., its metaphysis - an area located near the epiphysis (head) of the bone and formed during the growth of the skeleton due to the division and subsequent ossification of cells of the epiphyseal plates.

After the end of the period of growth and formation of the skeleton, the epiphyseal plates are replaced by the epiphyseal line and ossify.

A bone cyst in children usually forms against the background of the development of a degenerative process, which becomes a consequence of vascular defects. As a result of emerging hemodynamic disorders and disruption of the outflow of interstitial (tissue) fluid in the metaphyseal section of the bones, an increase in intraosseous pressure in a specific area is observed. This causes the formation of a cavity that fills with liquid.

Impaired blood supply to the bone, a decrease in the supply of nutrients and oxygen leads to the activation of the production of specific enzymes that provoke resorption, i.e., bone resorption. This causes a decrease in bone mass. As a result, it becomes less strong and therefore more susceptible to fractures.

Subcortical bone cysts are most often diagnosed in children:

• solitary or simple (SKS);
• aneurysmal (ACC).

Solitary

SBS is one of the most common pathologies of the childhood skeleton. According to various authors, they account for 21-57% of all benign tumors in children. They are intramedullary, i.e., single-chamber cavities formed inside the bone marrow substance. They are filled with serous fluid and lined with a fibrous membrane of varying thickness, formed by connective tissue and single giant cells.

They can form in any bone, but are more often localized in long tubular bones, especially in the proximal (located closer to the body) metaphysis of the humerus and femur, and somewhat less commonly in the tibia. When the bone reaches a large size, it can “swell”, which leads to the formation of a characteristic swelling.

In 80% of cases, solitary cysts are diagnosed before the age of 20. Moreover, they are observed 3 times more often in boys than in girls. The peak incidence occurs between 10 and 15 years. Only 20% of patients are children under 10 years of age.

Features and types of hand cysts

The upper limb consists of the shoulder girdle, forearm and hand. In turn, the shoulder girdle is formed by the scapula, collarbone and humerus. The forearm consists of the ulna and radius bones. The structure of the hand is the most complex. The wrist alone is formed by 8 bones. It also contains 5 metacarpal bones and phalanges of the fingers.

A cyst can form in each of these bones. But more often the structures of the shoulder girdle are affected, especially the humerus. Much less often, neoplasms of this kind are found in the forearm and especially in the hand. This is due to the fact that most often cysts form in the metaphyses of long tubular bones. And since small and short bones do not have a pronounced cavity width for the formation of a cyst and do not have a high growth rate during human growth, such neoplasms are extremely rare in them.

In children, solitary or aneurysmal cysts are usually found. The first are single-chamber intramedullary neoplasms filled with serous fluid.

Aneurysmal cysts are multi-chambered and have hemorrhagic contents. This is a more aggressive type of neoplasm, prone to rapid growth, and therefore clinically manifested much more intensely than solitary cysts. But both types can also occur in adults, although they are usually diagnosed before age 20.

Subchondral cysts are typical for older patients. They accompany degenerative-dystrophic changes in joints, including the elbow, and therefore can be a companion to arthritis, arthrosis and especially polyarthritis. In the latter case, patients usually have multiple subchondral cysts in different parts of the skeleton. A distinctive feature of formations of this type is their small size and location directly in the epiphysis of the humerus, radius, ulna, etc., while solitary and aneurysmal ones are more often localized in the metaphyseal areas.

All cysts are capable of self-regression. But this process takes more than 2 years, during which there is a constant risk of complications. Indeed, during the development of a cyst, local destruction and bone resorption are always observed. Gradually, the formation moves towards the body of the bone, but most often this is not accompanied by an inflammatory process or other disorders. In addition, the cavity often decreases in size during this period, but does not disappear completely.

Aneurysmal

An aneurysmal bone cyst is a benign tumor-like formation, which, unlike a solitary cyst, has numerous vascular spaces filled with blood. It progresses rapidly and predominantly affects the pelvic bones, vertebrae and knee joint (metaphyses of the femur and tibia), but is less common than solitary.

ACC can be present in children of any age and gender, but most often this bone cyst is diagnosed in adolescents, namely girls 10-20 years old. Among all bone neoplasms, it accounts for 1–9.1%.

For what reasons degenerative bone cysts of this type are formed have not yet been fully studied, but it is also assumed that its formation provokes a local disturbance of venous outflow. Trauma can also cause the formation of an aneurysmal cyst. Less commonly, this bone cyst in children acts as an element in the structure of another tumor.

Subchondral cyst

This term refers to multiple small cavities in the articular surfaces of bones, the size of which does not exceed 1.5 cm. Most often, subchondral cysts are found in older people and are a consequence of degenerative diseases of the joints (arthrosis), inflammatory processes in them (arthritis) and other pathological changes . Although, due to the “rejuvenation” of degenerative-dystrophic diseases, today neoplasms of this kind are often found in middle-aged people, especially those engaged in heavy physical labor, in athletes and obese patients leading a sedentary lifestyle.

Most often, subchondral cysts occur in the hip and knee joints.

The manifestations of cysts are similar to the symptoms of arthrosis and arthritis. Therefore, they are usually discovered by chance during a routine examination of the joint to assess the dynamics of the underlying disease. If the patient neglects such procedures, the tumor tends to increase in size and deform the joint. This is accompanied by increased pain during movements, as well as impaired motor activity and even disability. Therefore, it is important not only to treat arthrosis and similar pathologies, but also to regularly undergo scheduled examinations and examinations.

Intraosseous ganglion

An intraosseous ganglion or juxtaarticular bone cyst is a non-neoplastic cystic formation that has a fibrous wall and forms in the subchondral areas of the bone, i.e., adjacent to the hyaline cartilage. Often the neoplasm is multilocular.

Thus, it is localized directly in the joint, which leads to the appearance of characteristic symptoms, although more often it occurs hidden. Manifestations of juxtaarticular bone cartilage may include pain in the area of ​​the affected joint that occurs during physical activity, local soreness, and rarely swelling.

The development of the pathology is based on mucoid degeneration of connective tissue, which is not associated with degenerative processes in the joint. The contents of the cyst are represented by mucinous mucous fluid.

The disease is rare, mainly in people 30-50 years old. Its development is associated with microtrauma of the joints and manifestations of local aseptic necrosis. This leads to bone marrow vascular disorders in the subchondral layer of bone. Therefore, the intraosseous ganglion has much in common with subchondral cysts that accompany degenerative-dystrophic pathologies of the joints.

Aseptic necrosis is a chronic non-infectious disease that provokes the systematic destruction of bone tissue of the epiphyses and restriction of movements in the joint. This is accompanied by a gradual flattening of the bone head due to the destruction of the bony partitions of the cancellous bone. The disease is characterized by pain that constantly intensifies and persists even at rest.

Epidermal inclusion cyst

An inclusion epidermal cyst is a cavity inside the bone, lined with stratified squamous keratinizing epithelium. It is most often a consequence of penetrating trauma, during which epithelial cells enter the bone tissue. This type is more common in the finger bones and skull and may not manifest itself in any way, and pathological fractures are rare.

Stages of development

In its development, a bone tissue cyst goes through 3 stages:

• Active (osteolysis phase). It lasts about 1 year and is accompanied by an increase in the size of the tumor, the appearance of swelling and other symptoms, and an increased risk of pathological fractures.
• Passive (demarcation phase). Lasts 6-8 months. The cavity gradually decreases in size, mainly due to compaction of the peripheral part of the bone. Symptoms gradually decrease.
• Regenerative (recovery phase). It occurs on average 2 years after the onset of the pathology. There are no symptoms, but there is still an increased risk of fracture because there is a residual cavity or limited area of ​​osteosclerosis (hardening of the bone that reduces its elasticity and resistance to stress).

Symptoms

The clinical manifestations of a bone cyst depend on its location, size, shape and degree of bone destruction. When long tubular bones (humerus, ulna, femur, tibia, fibula) are affected, which is observed in the vast majority of cases, pain occurs. They are bursting, pressing, and arise or intensify during physical activity. With aneurysmal cysts, the pain is more intense and becomes constant over time. This is caused by a progressive increase in size of the cyst, which leads to bone degeneration, thinning of the cortical plate, stretching and thinning of the periosteum.

You may also experience:

• a swelling not fused to the skin in the projection of the cyst, which can be felt (with an aneurysmal cyst it is painful);
• stiffness, decreased range of active movements in the adjacent joint;
• contracture, i.e. incomplete extension or flexion;
• decreased supporting function of the leg, lameness due to the formation of neoplasms in the bones of the lower extremities;
• change in the shape of the limb in the affected area;
• swelling of soft tissues, redness and local increase in temperature;
• slight muscle dystrophy;
• joint deformation (in severe cases in combination with arthrosis);
• neurological disorders (shooting pains, impaired sensitivity and mobility, up to paresis and paralysis, dysfunction of internal organs) with damage to the spine and compression of the spinal roots.

Often the first symptom of a cyst is a fracture obtained in the absence of a serious traumatic factor. As a result, the limb is in a forced position, pronounced swelling of the soft tissues is observed, and compaction is determined. Sometimes the cause of the injury cannot even be determined. In such cases, the cyst becomes an accidental finding on an x-ray that explains the cause of the fracture.

But after a fracture occurs, the pathological cavity inside the bone can completely heal, which makes it possible to initially resort to traditional conservative treatment. In some cases, the fracture does not lead to a cure, and the cyst continues to progress, and sometimes becomes more aggressive.

Pathological fractures of the vertebrae are especially dangerous, which can provoke severe neurological complications.

Hygroma of the wrist

27.09.2019

Wrist hygroma is a benign tumor , more precisely a formation that is localized mainly on the hand, in the area of ​​the wrist and nearby joints . The formation of a tumor occurs in the tendon tissue, causing local swelling , redness and pain.

For some time the disease does not manifest itself in any way, but if left untreated it becomes chronic. The hygroma of the wrist may increase in volume, resembling a soft ball in appearance. Over time, the mobility of the hand is limited, the fluid-filled tissues of the hand become inflamed, making it difficult to carry out everyday activities.

Causes that provoke the appearance of hygroma of the hand

Despite the fact that the disease is a benign tumor , it never degenerates into a malignant one. Currently, doctors identify several reasons why hygroma of the hand develops.

1. Constant physical activity on the wrist area. Various types of monotonous work associated with stress on the hand provoke inflammation and growth of formation. Most often, this is encountered by people whose work involves a computer, as well as those who work monotonously with their hands for a long time.
2. Anatomical structure of the hand. In some people, the structure of the wrist is especially fragile; the surrounding tissues are located at the base of the surface of the hand and are not protected by anything, so they can be more often injured under load.
3. Chronic course of bursitis and tendovaginitis. Inflammation of the soft tissues of the tendons and mucous bursae, which is permanent, can cause the formation of hygroma.
4. Removal of the seal surgically . Unfortunately, removal of the lump does not exclude the reappearance of hygroma, since the disease has a tendency to recur.
5. Female gender and heredity. According to statistics, women are more likely than men to develop the disease. The likelihood of getting a hand hygroma is higher if someone in the family has already been sick.

Symptoms, diagnosis

First of all, at the appointment, the doctor questions the patient and listens to the nature of the complaints. Next, he conducts an initial visual examination with palpation and palpation of the tumor. The patient is asked to rotate the hand in different directions and around its axis, identifying which movements cause pain. During palpation, the doctor determines the location of the ball and feels its soft contents.

For a more accurate diagnosis, the patient is prescribed an MRI and ultrasound of the wrist. Computer diagnostic methods are used when the question of surgical intervention is raised.

Symptoms of hygroma of the wrist are pronounced and noticeable externally:

• the neoplasm is clearly visible on the hand, it is round, similar to a ball;
• The seal is soft to the touch, but hurts when pressed;
• turning the hand will cause pain and discomfort;
• with prolonged loads on the hand, the hygroma increases in size;
• the skin at the site of the tumor is hyperemic and inflamed.

How is hygroma of the wrist treated?

Treatment of wrist hygroma is carried out mainly surgically . This method is chosen if the formation grows rapidly, becomes inflamed, infringing neighboring nerves and tissues. The surgeon can choose the method of excision of the tumor with complete removal of the formation. Hygroma can also be removed using laser surgery - this method is more gentle and does not leave a scar. There are also conservative treatment methods - the tumor is punctured and then medications are injected into the cavity. The disadvantage of conservative treatment is the high rate of relapse.

Timely seeking medical help will help avoid the disease becoming chronic.

Published in Surgery Premium Clinic

Diagnostics

If signs of a cyst appear, as with fractures, you should contact an orthopedic traumatologist. If the integrity of the bone is maintained, the doctor can palpate to detect a painless lump and perform tests to assess range of motion.

But the main way to diagnose a bone cyst is an x-ray examination. A bone cyst on x-ray looks like a single- or multi-chamber formation, combined with swelling and thinning of the cortical bone layer, and axial deformations. Sometimes abnormally healed pathological bone fractures and joint changes are found. But each type of cyst has its own radiological signs:

· An aneurysmal cyst is distinguished by metaphyseal lesions. Has an eccentric lytic lesion that often extends beyond the normal anatomical boundaries of the bone. There is thinning of the cortex, as well as the presence of a sclerotic “rim” along the periphery, which indicates a periosteal reaction. The neoplasm is septate, i.e. it is multi-chambered and has the appearance of “soap bubbles”.

• On X-ray, a solitary bone cyst looks like a centrally located lytic formation with a clear border. It can expand from the center to the periphery, but never penetrates the cortex and does not extend above the epiphyseal plate. Sometimes bone septa protruding inward are observed. They can create a deceptive multi-camera appearance. But, unlike an aneurysmal cyst, there is no periosteal reaction.
• Subchondral cysts are defined as single or multiple lesions that can mimic a tumor. There is always a narrowing of the joint space and signs of dystrophic changes.
• The intraosseous ganglion (juxtaarticular bone cyst) has the appearance of a clearly demarcated oval or round formation. It is eccentrically located and located subchondral in the epiphysis but not in the metaphysis. Deformation of the periosteum may be observed. The formation is delimited by a sclerotic rim, which is associated with the absence or mild severity of dystrophic changes in the joint.

Additionally, in order to differentiate the cyst from other bone tumors, the patient may be prescribed:

• Ultrasound – indicated for diagnosing degenerative changes in the cartilage tissue of joints;
• CT scan – allows you to detect specific signs (symptom of “horizontal levels”), determine the relative density, area, volume of the tumor, the number of chambers;
• MRI is the best method for diagnosing pathologies of soft tissue structures, used to diagnose joint diseases and in preparation for surgery, as it allows one to assess the location of the neurovascular bundle and avoid its injury during surgery.

If a specialist has doubts about the nature of the neoplasm, he may recommend performing a puncture of the cyst with further study of the obtained material in the laboratory. In particular, this is indicated for differentiating benign aneurysmal cysts from malignant telangiectatic osteosarcoma.

Additionally, a general urine and blood test and a biochemical blood test may be prescribed to assess the general condition of the body, identify signs of inflammatory processes, and exclude certain diseases.

Baker's cyst - symptoms and treatment

Complications associated with the presence of popliteal cysts include:

• infection;
• gap;
• neurovascular compression.

It is also known about purulent popliteal cysts , which are a complication of purulent arthritis. They arise from ordinary cysts as a result of suppuration caused by bacteria. Microorganisms can enter the knee joint both hematogenously (through the blood) and exogenously (from the external environment), when intra-articular manipulations are performed on the knee joint, or puncture of a cyst.

Rheumatologists even described a patient with rheumatoid arthritis who had persistent suppurative knee arthritis despite two consecutive knee arthroscopic procedures and treatment with appropriate antibiotics. After removing such a cyst, the improvement was rapid.

Patients with suppurative arthritis, a popliteal cyst, or a history of rheumatoid arthritis are recommended to have an ultrasound, computed tomography, or MRI. If the patient's condition does not improve after standard treatment for purulent arthritis, it is necessary to conduct an examination to exclude the presence of a popliteal cyst, which may be the cause of a localized purulent infection.

Popliteal cysts can cause compression of the neurovascular bundle, leading to thrombophlebitis, compartment syndrome (increased pressure between soft tissues, which can lead to impaired blood flow and tissue death), and compression neuropathies.

Thrombophlebitis can be ascending, in this case a thrombus from the great saphenous vein moves from the low-lying sections of the vein on the lower leg upward to the inguinal fold. With this form, there is a threat of thrombosis spreading to the deep veins. If there is doubt about the diagnosis or there is a suspicion of deep vein thrombosis, an ultrasound scan should be performed.

Sometimes, due to the presence of a popliteal cyst, compression of the popliteal vein or artery , leading to stenosis or thrombosis. If vascular compression is present, urgent surgical intervention is indicated.

Internal bleeding after popliteal cyst rupture can lead to compartment syndrome . Because of the risk of blood clots (due to compression of blood vessels), patients with Baker's cysts are often prescribed antithrombotic drugs, which make the blood thinner. For this reason, bleeding may be more profuse and may not stop for a long time, which leads to increased pressure between soft tissues and disruption of the blood supply to the tissues. If a cyst ruptures, increasing pain or swelling may occur, which should raise suspicion of compartment syndrome. Pain with passive stretching of the calf muscles (Homan's sign) may be positive for either deep vein thrombosis or compartment syndrome, and diagnosis may be difficult.

Compression neuropathies are most often associated with compression of the tibial nerve; rarely, the peroneal nerve may also be involved.

Open excision is the preferred treatment for these compressive cysts to prevent further nerve damage [13][14][15][16][17][18][19][20]. Typically, surgical excision is recommended only in cases where conservative interventions have failed and where there is significant functional impairment that can be attributed to cysts.

Ischemia of the lower extremities can be caused by compression of the popliteal artery. In contrast to asymptomatic cysts, cases with neuropathy or deep vein thrombosis, lower extremity ischemia may have some features associated with compression of the popliteal artery. Firstly, a Baker's cyst may be located in an atypical location. It may be located directly under the popliteal artery. Secondly, its structure can be polycystic, whereas the usual manifestation is a single cyst. Located between several surrounding cysts, the main cyst can expand in the posterior-superior direction and compress the popliteal artery, despite its modest size. In addition, the polycystic nature may lead to limited effectiveness of such a treatment method as puncture with aspiration of the contents of the cyst. In this case, surgical resection of the cyst is inevitable, since it is necessary to relieve pain and avoid severe ischemia of the limb [23].

Treatment

Treatment of bone cysts can be done conservatively or surgically. Tactics are always chosen based on the type of neoplasm, its location, stage of development, degree of influence on the functions and structure of the bone. If possible, preference is given to non-surgical treatment, especially in children, since the possibility of damage to the epiphyseal plates that ensure bone growth cannot be ruled out. In such cases, there may be a delay in the growth of a body part in the future.

But in some cases it is impossible to do without surgery. Radical removal of a bone cyst is indicated for:

• threat of development of spinal canal stenosis;
• risk of extensive bone destruction;
• the size of the tumor is more than 2/3 of the cross-section of the bone;
• localization in the loaded area, dangerous proximity to the epiphyseal plate, which creates a high risk of pathological fracture;
• prolonged, severe pain that cannot be eliminated by conservative methods;
• no tendency to shrink the cavity 6-8 months after the start of conservative treatment.

In case of a fracture, a plaster cast or polymer cast is applied to immobilize the limb, since when it heals, there is a possibility of self-healing.

Regardless of the chosen treatment method, control x-rays are taken 2, 6 and 12 months after the start of therapy. This allows you to track the dynamics of changes in the condition of the cyst and, if necessary, adjust treatment tactics.

Treatment of bone cysts

The conservative treatment method includes a course of therapeutic punctures (two needles are inserted into the body of the cyst, with the help of which fluid is sucked out, medications are administered to reduce bone destruction), the application of a plaster cast (if there is a fracture), physiotherapeutic treatment, and a course of therapeutic exercises. If there is no result from conservative treatment, the patient undergoes surgical treatment.

Neglect of the disease and lack of necessary treatment can lead to destruction and death of bone tissue, which may entail complete removal of the damaged part.

Aseptic bone necrosis

- a disease in which death (necrosis) of bone areas and bones as a whole occurs as a result of disruption or complete cessation of blood flow in a certain area of ​​the bone. Idiopathic aseptic necrosis develops spontaneously without any particular reason. There are complete and partial necrosis of the bone, and also a distinction is made between superficial and deep necrosis depending on its location in the bone. The disease occurs in several stages.

Conservative treatment

The basis of treatment is drug therapy. It includes the use of NSAIDs and puncture of the cyst. NSAIDs have analgesic and anti-inflammatory properties. They are usually prescribed orally; for severe pain, intramuscular administration is possible. Contraindicated for gastrointestinal diseases.

Puncture of the cystic cavity is performed under local anesthesia. It involves inserting a needle into the cyst, through which its contents are aspirated. Perforation of the walls is also performed to reduce pressure. The cavity is washed with saline and then with a 5% solution of aminocaproic acid and an antienzyme drug is administered. For patients over 12 years of age, corticosteroids may be injected into the cyst cavity.

For large cysts in the active phase of osteolysis, punctures can be performed every 3 weeks, after its transition to the stage of demarcation - every 4-5 weeks. But in most cases, 6-10 punctures are enough to close the cyst. If the cyst is located in a hard-to-reach place, the puncture is carried out under CT control.

The liquid obtained during aspiration is sent for histological examination. This makes it possible to accurately determine the nature of the formation and exclude oncology, in particular malignant giant cell tumor.

The advantages of using puncture to treat cysts are undeniable. This minimally invasive procedure:

• allows you to quickly improve your well-being;
• high degree of security;
• quick and easy recovery period;
• no scars.

But in some cases, puncture is only a stage of preparation for open osteoplastic surgery.

Drug therapy is supplemented by courses of physiotherapeutic procedures and exercise therapy. Their main tasks are to maintain joint mobility at the proper level and consolidate the results of drug treatment. If there is a high risk of pathological fracture, patients may be advised to wear orthopedic products, in particular orthoses and braces.

If degenerative bone cysts lead to a fracture, immobilization using a plaster cast, plastic splints or other orthopedic devices is indicated.

Diagnosis of diseases.

Bone cysts and necrosis can be diagnosed using the following methods:

• Examination by a doctor (collection of complaints, palpation of the sore spot)
• X-ray of the affected bone in several projections
• Computed tomography (CT) or magnetic resonance imaging (MRI)
• Puncture (for bone cysts, contents are taken for examination)
• Blood tests (to identify concomitant pathologies)

Surgery for bone cyst

Surgery is a last resort measure for the treatment of bone cysts, used when other methods are ineffective or there is a risk of developing serious complications, for example, the formation of a cystic cavity in the vertebra and compression (squeezing) of the spinal cord or its roots. If there are indications, in most cases local excision of the affected area of ​​the bone is performed, i.e., marginal resection with careful treatment of the bone cavity. The formed defect is filled with the patient’s own bone graft or synthetic material.

When segments of the upper or lower extremities are affected, excochleation of the cyst is sometimes performed, i.e., removal of its contents with a blunt spoon without affecting the walls, followed by filling the resulting defect. For large defects, bone grafting can be performed using DHS and DCS systems, a locking plate, an intramedullary locking rod, screws, and the application of an Ilizarov apparatus.

In case of complex fractures with displacement, open reposition of bone fragments is performed with internal, or less often external, fixation in the correct position.

In some cases, removal of the cyst requires a bone osteotomy. The cut is made in the area between the healthy and changed areas of the bone. After this, intraosseous resection of the formation is performed and a bone graft is installed in the remaining cavity. To restore the integrity of the bone, a distraction regenerate is formed and compression-distraction osteosynthesis according to Ilizarov is performed.

After surgery, relapses practically do not occur.

If subchondral cysts are observed, especially those arising from severe deforming arthrosis or avascular necrosis, which is typical in adults and is accompanied by severe pain, patients may be offered various types of surgical interventions to solve these problems. Basically, today in such cases endoprosthetics of the affected joint is used, which involves replacing destroyed bone fragments with artificial prostheses. In terms of functionality, they are practically not inferior to a natural joint, and their service life is on average 20 years.

Causes of bone cysts.

The causes of bone cysts have not yet been studied in detail. The disease can appear as a result of previous injuries (dislocations, falls, bruises, etc.). It also affects people suffering from rheumatoid arthritis, osteoarthritis and chronic gout. Bone cysts increase the risk of developing fractures because... when they form, the volume of bone tissue decreases, and the bones can no longer withstand the previous load and break easily.

The disease can be asymptomatic for a long time and be discovered accidentally during a fracture or during an X-ray examination for another reason. Sometimes a bone cyst can cause swelling and pain.

Rehabilitation

After surgical removal of a bone cyst, the body needs to create favorable conditions for recovery. For this purpose, a rehabilitation program is being developed. But its duration and nature are determined by the type of operation performed, its volume and degree of complexity.

All patients, without exception, are prescribed antibacterial therapy, designed to reduce the risk of developing postoperative inflammatory processes. In parallel, antifungal drugs and probiotics are prescribed to reduce the risk of adverse events after taking antibiotics.

Taking NSAIDs is also indicated to reduce the severity of pain. Exercise therapy is mandatory, designed to eliminate the risk of developing muscle atrophy, improve blood circulation and restore normal range of motion in the joints. The physical therapy program, the nature of the exercises, and the number of repetitions are selected strictly individually for each patient in accordance with the type of surgery performed, the general level of physical fitness and the nature of existing chronic diseases.

The prognosis for bone cysts is favorable. With timely and adequate treatment after closure of the cavity, complete recovery usually occurs, and the patient’s quality of life does not decrease.

Thus, bone cysts are far from uncommon, especially among children. However, adults are not protected from this disease. Moreover, under the guise of harmlessness and the absence of clinical manifestations, such benign neoplasms can lead to complex pathological fractures that deform the limbs and provoke the development of various kinds of complications. Therefore, if a cyst is accidentally discovered or its symptoms appear, you should contact an orthopedic traumatologist. Only a doctor can correctly assess the condition of the bone and choose the optimal treatment for the current situation. However, you should not be afraid of surgery. Treatment usually begins with conservative methods, which in most cases allow for recovery. Surgery is indicated only if they are ineffective or there is a high probability of complications. And modern surgical techniques ensure minimal intra- and postoperative risks, rapid recovery and complete recovery.

Hand surgery

The hand is our intermediary in the material world, it transmits information and fulfills our will, expresses feelings. This is the finest living instrument, which even the most advanced machines cannot come close to. “It’s like having no hands,” we say about the most necessary things. “Lending a helping hand” is about a noble act.

And who will lend a helping hand if trouble happens to the limb itself? This cannot be done without qualified, partly narrow, specialists. The fact is that the hand has many specific differences from other parts of the body. Small but very important anatomical formations that require exceptional attention are concentrated in a small area. Damage to tendons and nerves that are only a few millimeters in diameter can lead to permanent disability in an instant. The hand has complex and delicate biomechanics. Hand treatment requires special skills, deep knowledge, special tools and equipment. Hand surgery is by no means a minor surgery and there are no size discounts.

Hand surgery formed into a separate area of ​​traumatology and orthopedics in the middle of the last century and since then has been constantly developing, opening up new horizons of possibilities. It combines orthopedics, traumatology, vascular, plastic surgery, and neurosurgery.

Our clinic provides state-of-the-art treatment for injuries, consequences of injuries and diseases of the upper limb.
Injuries:

• Open and closed fractures of the metacarpal bones and phalanges of the fingers, carpal bones, radius
• Damage to nerves at the level of the fingers, hand, and forearm.
• Damage to tendons at all levels of extensors and flexors.
• Dislocations of open and closed phalanges of the fingers, metacarpal bones, bones of the wrist, hand, head of the ulna.
• Combined injuries, gunshot wounds, severe injuries.

Consequences of injuries:

• Fractures healed with displacement, false joints.
• Old dislocations.
• Old flexor tendon injuries.
• Old extensor tendon injuries.
• Old nerve damage.
• Post-traumatic contractures – tenogenic, neurogenic, arthrogenic, cicatricial, mixed origin.
• Amputation shortening of the phalanges of the fingers and metacarpal bones.

Diseases:

• Diseases of the synovial membranes (chronic tenosynovitis, synovial cyst, nodular tenosynovitis, stenosing ligamentitis, de Quervain's disease)
• Tumors and tumor-like diseases (lipoma, gigantoma, glomus tumor, hemangioma, exostoses and bone osteophytes, enchondroma, ecchondroma, osteoid osteoma, neurofibroma, oleoma, mucosal cyst, vascular aneurysm, epidermal cyst, bone cyst)
• Degenerative-dystrophic diseases (Dupuytren's contracture, Sudeck's syndrome, tunnel syndromes, Ollier's disease, Kienbeck's disease, deforming arthrosis of the wrist and finger joints).
• Congenital hand diseases (clinodactyly, polydactyly, syndactyly).

Contact a specialist - a hand surgeon if:

• There was an accident and you injured your hand. Pay attention to such points as the presence of a wound, deformation, abnormal mobility, lack of normal mobility, decreased sensitivity, change in skin color, and the presence of foreign bodies.
• You have an old injury, and you are worried about pain, limitation of movements, deformation, the presence of a scar, non-healing wound, or foreign body.
• You have discovered a tumor.
• Decreased mobility, sensitivity and strength of the limb

The most common hand diseases:

• Subcutaneous extensor tendon rupture

Most often, such injuries are the result of sharp, forced bending of a tense finger. The tendon tissue at the level of the extreme joint cannot withstand it. The phalanx “hangs” and stops straightening. The pain is usually minor.

Treatment.

The essence of treatment is to fix the nail phalanx in the position of maximum extension. In this position, the ends of the damaged tendon come closer together, and within the prescribed 6 weeks they grow together with a strong scar. The easiest and safest way is external fixation using a special splint. It is given the required shape and placed on the finger. The disadvantage of this method is the need to take care of the splint for a month and a half, making sure that the fixation continues to remain reliable and the position is correct. If the patient’s work is manual, and a month and a half of incapacity for work is an unaffordable luxury, or if you don’t want to appear in public with a bandage, or you simply need a reliable result, then surgical treatment is indicated in these cases. The phalanx is fixed using a knitting needle. The needle sinks under the skin and allows full use of the hand. During your consultation, your doctor will help you choose the treatment method that is right for you.

A slightly different situation is a rupture of the extensor pollicis longus tendon. Most often this occurs some time after a fracture of the radius. The tendon undergoes a degenerative change and at one point cannot withstand it and ruptures. The thumb does not straighten. The peculiarity here is that it will not be possible to sew such a tendon end-to-end, as with a fresh injury with a sharp object. Transposition (transplantation) of one of the extensor tendons of the index finger into the position of the extensor of the thumb is used. After a short “retraining”, the patient begins to use the redirected muscle in accordance with its new role.

Synovial cyst

A synovial cyst (the outdated name is hygroma) is not a tumor in the strict sense of the word. It is a protrusion of the joint shell beyond its capsule. It appears in the form of a “bump” above the joint, its favorite localization is the radiocarpal joint, others are also affected.

Appears as a result of injury, constant overload, due to inflammation. There may be no visible reason; in these cases, the constitution of the body is “to blame” - weakness of the connective tissue. The most common complaint is pain during exercise, but often a synovial cyst does not cause complaints, creating only aesthetic discomfort.

Treatment

In some cases, conservative treatment (immobilization, anti-inflammatory therapy, pressure bandages) leads to success, but not always. The decision on the need for surgical intervention is made taking into account the severity of the process, the nature of the complaints and subjective sensations. In any case, it is necessary to exclude the presence of diseases with similar external manifestations - tumor and tenosynovitis.

Dupuytren's contracture

This is a cicatricial degeneration of the palmar aponeurosis, the dense “lining” of the palm, leading to persistent limitation of finger extension. Without treatment it progresses.

Treatment

Mostly surgical. Excision of the altered areas of the aponeurosis is performed, followed by gradual removal of the fingers from the vicious position. To achieve the best results in the postoperative period, it is necessary to wear a special splint that prevents bending of the fingers and the occurrence of relapse.

Dislocations.

For a completely unknown reason, many people have the belief that a dislocation is “no big deal, just a dislocation.” In fact, unlike many other injuries, it is a dislocation that necessarily requires medical intervention. Precisely medical. Pulling it like in the movies or applying ointment like in the commercials won’t work. Dislocation is a severe damage to the joint, accompanied by separation of the articular surfaces, in 100% of cases leading to permanent impairment of joint function. The simplest thing that may be required is the removal of a dislocation, a medical procedure aimed at restoring the normal relationship of the bones. Let us emphasize, medical manipulation. The best thing to do on your own is to rest the limb and seek help immediately. It is usually not difficult to recognize a dislocation - after the injury, there is an unnatural position of the limb or its segment, pain, severe swelling and almost complete impossibility of movement.

Dislocation of finger, phalanges

Even with timely treatment, it is not always possible to eliminate the dislocation closed, without surgery. The situation becomes much more complicated if a week or more has passed since the injury. Old (more than 3 weeks) dislocations can only be treated surgically.

Fracture-dislocation of a finger, phalanx, metacarpal bone

This is an injury in which the articular end of the bone is fractured, and part of it remains in place, held by ligaments, while the entire bone moves out of its place - dislocates. The main method of treatment is surgical.

Dislocations in the wrist joint.

There is a wide variety of dislocations and fracture-dislocations in the wrist joint. In all cases this is a serious injury. Without treatment - loss of function, often neurological disorders. In some cases, treatment costs “little blood”, but only with timely treatment.

Old dislocation.

One of the most unpleasant situations in traumatology. Damaged tissues, including the joint capsule and ligaments, turn into rough, hard scars and make it impossible to eliminate the dislocation without surgery. Surgical treatment often has to be carried out in two stages. First, the joint is stretched using a special apparatus, then open or closed reduction is performed, followed by metal fixation.