The Efficacy of Nonsurgical and Surgical Interventions in the Treatment of Pediatric Wrist Ganglion Cysts

Active Treatment of Pediatric Ganglia of the Wrist: What is the Risk of Recurrence?

BACKGROUND

Ganglion cysts are the most common soft tissue mass in the hand and wrist in both adults and children. More is known about wrist ganglia and their treatment outcomes in adults than in children. Current literature to guide the management of pediatric wrist ganglia is limited. The purpose of this study is to report on the rates of recurrence of pediatric wrist ganglia after active intervention-aspiration or surgical excision-at a single center, as well as to explore factors associated with recurrence in one of the largest samples to date of pediatric wrist ganglia.

METHODS

In all, 205 pediatric patients with wrist ganglia from our institution with at least 2-year follow up were included. The primary outcome was the recurrence rate after treatment type (aspiration vs. surgery). Secondary outcomes were demographic factors (age, sex, etc.), cyst location (volar vs. dorsal), duration of cyst before intervention, and surgeon specialty training (hand vs. non-hand).

RESULTS

Recurrence was seen in 58.4% (n=94) of patients undergoing their first aspiration.Recurrence was seen in 34% (n=97) of patients after the first surgery, but there was a significant difference in recurrence rate based on the surgeon's fellowship training.

CONCLUSION

In conclusion, surgery does appear to offer a higher chance of definitive resolution of pediatric wrist ganglia. Differences in technique among surgeons should be explored as a possible factor to explain the range of recurrence rates described in the limited literature on this topic.

LEVEL OF EVIDENCE

Level III-Retrospective Review.

Natural History of Pediatric Hand and Wrist Ganglion Cysts: Longitudinal Follow-Up of a Prospective, Dual-Center Cohort

PURPOSE

This investigation describes the outcomes of pediatric ganglion cysts in a prospective cohort that elected not to undergo cyst aspiration or surgical treatment. Our primary aim was to investigate the rate of spontaneous resolution over time among the subset of patients who did not undergo specific treatments.

METHODS

Children (aged ≤18 years) who presented to the clinic with ganglion cysts of the hand or wrist were enrolled in a prospective two-center registry between 2017 and 2021. Enrolled subjects who never elected to undergo cyst aspiration or surgical treatment were analyzed. The data collected included age, sex, cyst location and laterality, hand dominance, Wong-Baker pain scale scores, and Patient-Reported Outcome Measurement Information System upper-extremity scores. Follow-up surveys were completed for up to 5 years.

RESULTS

A total of 157 cysts in 154 children, with an average age of 9.4 years and a female-to-male ratio of 1.4:1, were eligible. The most common ganglion location was dorsal wrist (67/157, 42.7%), followed by volar wrist (49/157, 31.2%), the flexor tendon sheath (29/157, 18.5%), and the extensor tendon synovial lining (8/157, 5.1%). The average follow-up duration was 2.5 years after initial presentation to the clinic, and 63.1% (99/157) of the patients responded to follow-up surveys. Among them, 62.6% (62/99) of cysts spontaneously resolved; the resolution rates ranged from 51.9% of volar wrist ganglions to 81% of flexor tendon sheath cysts, with an average time to resolution of 14.1 months after cyst presentation. Cysts were more likely to resolve in the hand than in the wrist (84.0% vs 55.4%, respectively). Cysts present for >12 months at initial evaluation were less likely to resolve spontaneously (41.2% vs 67.1%).

CONCLUSIONS

Of children who elected not to undergo aspiration or surgical treatment, approximately two-thirds of families reported that their child's ganglion cyst resolved spontaneously. Cysts that resolve spontaneously usually do so within 2 years of presentation.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

News in paediatric orthopaedic surgery: an overview of the latest advances in paediatric orthopaedics and traumatology (2020-2023)

PURPOSE

We propose to survey - even if arbitrarily - the publications in paediatric orthopaedics and traumatology that have had the greatest impact on the specialty during the period extending from the beginning of the COVID-19 pandemic in December 2020 and the end of all health restrictions in March 2023.

METHODS

Only studies with a high level of evidence or clinical relevance were selected. We briefly discussed the results and conclusions of these quality articles to situate them in relation to the existing literature and current practice.

RESULTS

Publications are presented by dividing traumatology and orthopaedics whose publications are further subdivided according to anatomical districts; articles concerning neuro-orthopaedics, tumours, and infections were presented separately while sports medicine is jointly presented with knee-related articles.

CONCLUSIONS

Despite the difficulties encountered during the global COVID-19 pandemic (2020-2023), orthopaedic and trauma specialists, including paediatric orthopaedic surgeons, have maintained a high level of scientific output, in terms of quantity and quality of production.