Unicameral Bone Cyst (UBC) Specialist Surgeon Singapore 

Decompression and Biological Filling of Simple Bone Cysts

We manage unicameral bone cysts (UBC)—also known as simple bone cysts—as a pediatric challenge of skeletal weakening. Under the clinical direction of Dr. Saminathan Suresh Nathan, we focus on "active" cysts that threaten the growth plate or the strength of the humerus and femur. Our approach combines minimally invasive decompression with biological stimulation to encourage the bone to fill the void and return to its natural strength. The unicameral bone cyst or simple bone cyst is a developmental condition of unknown origin. It is believed to occur from childhood and represents a cyst of fluid within the bone. If next to the growth plate it is considered active and continues to grow with the bone. The inactive ones move away from the growth plate and tend to not be at risk for fracture. Because of the risk of fracture and disruption of childhood, they are usually best managed with curettage and bone graft. We studies the natural history of a number of these cases managed by Professor Nathan's team in 2009 and have made certain recommendations on treatment as listed below.

Surgical Considerations

• Growth Plate Protection: Strategic surgical entry points and techniques to avoid iatrogenic damage to the physis in young patients.

• Decompression Techniques: Use of cannulated screws or drainage to neutralize the cyst's internal pressure and facilitate healing.

• Biological Augmentation: Integration of bone marrow aspirate or osteoinductive materials to stimulate a more robust healing response within the cystic cavity.

Figure 1. We conducted this study on the natural history of unicameral bone cysts and published the results in 2009. It was heartening to note that up to 30% of these fractures do heal spontaneously. Surgery should be considered for large active cysts in the upper limbs in order to minimise the fracture risk. (Journal of Orthopaedic Surgery 2009;17(2):157-60. Active unicameral bone cysts in the upper limb are at greater risk of fracture. Tey IK, Mahadev A, Lim KB, Lee EH, Nathan SS). 

Figure 2. This unusual unicameral bone cyst occurred in the neck of the glenoid (socket of the shoulder). It caused a lot of pain as it was prone to fracturing in this active young man. It represented a difficult approach deep in the shoulder. Nevertheless we were able to decompress it and fill it with an absorbable cement. The success of this procedure was recently reported by us in the literature (Musculoskelet Surg. 2012 Dec;96(3):227-31. An unusual presentation of a simple bone cyst in the scapula. Jain SK, Nathan SS).