Antje von Suchodoletz, Ross A A Larsen, Catherine Gunzenhauser, Anika Fäsche
Reading and spelling skills in German third graders: Examining the role of student and context characteristics
The British journal of educational psychology
simple bone cysts also known unicameral bone cysts solitary bone cysts common type benign bone lesion growing children cysts may lead repeated pathological fracture fracture occurs area bone weakened disease process occasionally fractures may result symptomatic malunion main goals treatment decrease risk pathological fracture enhance cyst healing resolve pain despite numerous treatment methods used simple bone cysts long bones children consensus best procedure update cochrane review first published 2014 assess effects benefits harms interventions treating simple bone cysts long bones children including adolescentswe intended following main comparisons invasive eg injections curettage surgical fixation versus noninvasive interventions eg observation plaster cast restricted activity different categories invasive interventions ie injections curettage drilling holes decompression surgical fixation continued decompression different variations category invasive intervention eg different injection substances autologous bone marrow versus steroid searched cochrane bone joint muscle trauma group specialised register cochrane central register controlled trials medline embase china national knowledge infrastructure platform trial registers conference proceedings reference lists date last search april 2016 randomised quasirandomised controlled trials evaluating methods treating simple bone cysts long bones children two review authors independently screened search results performed study selection resolved differences opinion review authors discussion consulting third review author two review authors independently assessed risk bias data extraction summarised data using risk ratios rrs mean differences mds appropriate 95 confidence intervals cis used grading recommendations assessment development evaluation grade system assess overall quality evidence update 2017 identify new randomised controlled trials rct inclusion identified one ongoing trial likely include future update accordingly results unchanged included trial multicentre rct conducted 24 locations north america india compared bone marrow injection steroid methylprednisolone acetate injection treating simple bone cysts three injections planned participants group trial involved 90 children mean age 95 years presented results 77 children twoyear followup although trial secure allocation concealment high risk performance bias major imbalances baseline characteristics reflecting study limitations downgraded quality evidence two levels low outcomes meaning unsure estimates effect outcomes serious imprecision downgraded quality evidence level lowthe trial provided low quality evidence fewer children bone marrow injection group radiographically assessed healing bone cysts two years steroid injection group 939 versus 1638 rr 055 favouring steroid injection 95 ci 028 109 however result uncertain may compatible difference small benefit favouring bone marrow injection based illustrative success rate 421 children healed bone cysts per 1000 children treated steroid injections equates 189 fewer 95 ci 303 fewer 38 children healed bone cysts per 1000 children treated bone marrow injections low quality evidence lack difference two interventions two years functional outcome based activity scale kids function score 0 100 higher scores equate better outcome md 090 95 ci 426 246 pain assessed using oucher pain score low quality evidence lack differences two interventions adverse events subsequent pathological fracture 939 versus 1138 rr 080 95 ci 037 170 superficial infection two cases bone marrow group recurrence bone cyst unacceptable malunion return normal activities participant satisfaction reported available evidence insufficient determine relative effects bone marrow versus steroid injections although bone marrow injections invasive noteably rate radiographically assessed healing bone cyst two years well 50 interventions overall lack evidence determine best method treating simple bone cysts long bones children rcts sufficient size quality needed guide clinical practice