ArticleJournal of the Pediatric Orthopaedic Society of North America2026
Elastic Stable Intramedullary Nailing for High-Risk Proximal Femoral Unicameral Bone Cysts in Children: A Retrospective Case Series.
Article in Journal of the Pediatric Orthopaedic Society of North America, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Proximal femoral unicameral bone cysts (UBCs) are challenging in children because the lesions occur in a weight-bearing region near the proximal femoral physis. This study describes outcomes after elastic stable intramedullary nailing-(ESIN)-based treatment and the indication-based use of selective transphyseal nail advancement. Methods: We retrospectively reviewed consecutive skeletally immature patients with pathologically confirmed proximal femoral UBCs treated at 2 centers with curettage, high-speed burring, allogeneic bone grafting, and 2 titanium elastic nails. Minimum follow-up was 12 months. Outcomes included Ratliff and modified Neer status, recurrent or persistent cystic change, unplanned reoperation, complications, and growth-related radiographic findings. Results: Thirty-eight patients were included: 31 underwent physeal-sparing ESIN, and 7 underwent selective transphyseal ESIN because physeal-sparing fixation provided insufficient proximal purchase. Median follow-up was 30.0 months. At the final follow-up, all patients had good Ratliff outcomes; modified Neer grade I was achieved in 26 patients (68.4%) and grade II in 12 (31.6%). Recurrent or persistent cystic change occurred in 9 patients, and 10 underwent unplanned reoperation. Among the 7 transphyseal cases, no clinically apparent progressive proximal femoral angular deformity or definite growth disturbance attributable to nail placement was identified during available follow-up. Conclusions: ESIN-based management yielded satisfactory final outcomes. A physeal-sparing trajectory should remain preferred. Selective transphyseal advancement may provide proximal purchase in carefully selected juxtaphyseal lesions, but the small subgroup and absence of follow-up to skeletal maturity preclude conclusions regarding long-term physeal safety. Key Concepts: (1)Elastic stable intramedullary nailing-based treatment produced good final clinical and radiographic outcomes in this high-risk pediatric proximal femoral unicameral bone cyst series.(2)A physeal-sparing nail trajectory should remain preferred when stable proximal purchase can be achieved.(3)Selective transphyseal advancement may be considered when a juxtaphyseal lesion prevents secure physeal-sparing fixation.(4)No definite growth disturbance attributable to nail passage was identified in 7 transphyseal cases during available follow-up.(5)The small subgroup and lack of follow-up to skeletal maturity preclude conclusions about long-term physeal safety. Level of Evidence: IV, Case Series.
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