Unicameral bone cyst with fracture - humerus

Case contributed by Assoc Prof Frank Gaillard

Presentation

Child presenting with severe pain in arm following a minor fall.

Patient Data

Age: Child
Gender: Male

X-ray humerus

X-ray

Two x-rays of the right humerus demonstrate a lucency within the proximal diaphysis with slight expansion and a fracture. Lying medially within the cyst is a fragment of cortex.

Fallen fragment sign

Annotated image

The so-called fallen fragment sign is specific for a unicameral bone cyst, with a pathological fracture. Part of the thinned cortex 'falls' into the cyst, thus indicating that the lucency is A) fluid B) uni-loculated.  

Distribution of unicameral bone cysts

Diagram

Distribution of unicameral bone cysts. Layout and distribution: Frank Gaillard 2012, Line drawing of skeleton: Patrick Lynch 2006, Creative Common NC-SA-BY

Case Discussion

Typical appearances of a large unicameral bone cyst with a pathological fracture and fallen fragment sign. 

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