Daniel Gonzales-Luna, MD (PGY4) presents the #interestingcase of 7 y.o. male with a history of multiple (5) pathologic fractures to the (L) proximal #humerus over the last 2 yrs. He presents with (L) shoulder pain for 3 wks for a 2nd opinion

Pt. has been treated with immobilization and observation in the past resulting in periods of painless activity followed by recurrence of #fracture what would you do?

Radiographs show a large lytic metaphyseal lesion adjacent to the physis in the (L) proximal humerus with a pathologic fracture involving the lateral cortex. Pre Op AP

Pre Op Lateral

Left proximal humerus with anterior cortical window 6 cm in length

#Cryotherapy using liquid nitrogen

Cortical fibular allograft cut into 6 thin segments and placed as intramedullary struts

Void filled with crushed cancellous autograft

Procedure: #openbiopsy #curettage cryotherapy using liquid nitrogen and allograft #bonegrafting

3 month follow up. Pt. with painless range of motion. Cleared for full activity

Biopsy consistent with unicameral bone cyst