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\def\makelabel##1{\upshape ##1}}% } {\end{list}\end{raggedright}} \newenvironment{specHead}[2]% {\vspace{20pt}\hrule\vspace{10pt}% \phantomsection\label{#1}\markright{#2}% \pdfbookmark[2]{#2}{#1}% \hspace{-0.75in}{\bfseries\fontsize{16pt}{18pt}\selectfont#2}% }{} \def\TheFullDate{1970-01-01 (revised: 01 January 1970)} \def\TheID{\makeatother } \def\TheDate{1970-01-01} \title{Intraosseous Synovial Cysts of the Scaphoid Bone: A Rare Case of Fracture and Surgical Management} \author{}\makeatletter \makeatletter \newcommand*{\cleartoleftpage}{% \clearpage \if@twoside \ifodd\c@page \hbox{}\newpage \if@twocolumn \hbox{}\newpage \fi \fi \fi } \makeatother \makeatletter \thispagestyle{empty} \markright{\@title}\markboth{\@title}{\@author} \renewcommand\small{\@setfontsize\small{9pt}{11pt}\abovedisplayskip 8.5\p@ plus3\p@ minus4\p@ \belowdisplayskip \abovedisplayskip \abovedisplayshortskip \z@ plus2\p@ \belowdisplayshortskip 4\p@ plus2\p@ minus2\p@ \def\@listi{\leftmargin\leftmargini \topsep 2\p@ plus1\p@ minus1\p@ \parsep 2\p@ plus\p@ minus\p@ \itemsep 1pt} } \makeatother \fvset{frame=single,numberblanklines=false,xleftmargin=5mm,xrightmargin=5mm} \fancyhf{} \setlength{\headheight}{14pt} \fancyhead[LE]{\bfseries\leftmark} \fancyhead[RO]{\bfseries\rightmark} \fancyfoot[RO]{} \fancyfoot[CO]{\thepage} \fancyfoot[LO]{\TheID} \fancyfoot[LE]{} \fancyfoot[CE]{\thepage} \fancyfoot[RE]{\TheID} \hypersetup{citebordercolor=0.75 0.75 0.75,linkbordercolor=0.75 0.75 0.75,urlbordercolor=0.75 0.75 0.75,bookmarksnumbered=true} \fancypagestyle{plain}{\fancyhead{}\renewcommand{\headrulewidth}{0pt}} \date{} \usepackage{authblk} \providecommand{\keywords}[1] { \footnotesize \textbf{\textit{Index terms---}} #1 } \usepackage{graphicx,xcolor} \definecolor{GJBlue}{HTML}{273B81} \definecolor{GJLightBlue}{HTML}{0A9DD9} \definecolor{GJMediumGrey}{HTML}{6D6E70} \definecolor{GJLightGrey}{HTML}{929497} \renewenvironment{abstract}{% \setlength{\parindent}{0pt}\raggedright \textcolor{GJMediumGrey}{\rule{\textwidth}{2pt}} \vskip16pt \textcolor{GJBlue}{\large\bfseries\abstractname\space} }{% \vskip8pt \textcolor{GJMediumGrey}{\rule{\textwidth}{2pt}} \vskip16pt } \usepackage[absolute,overlay]{textpos} \makeatother \usepackage{lineno} \linenumbers \begin{document} \author[1]{Marouane Dinia} \author[2]{Yassine Ben Bouzid} \author[3]{Othmane ibnoussina} \author[4]{Rida-Allah Bassir} \author[5]{Monsef Boufettal} \author[6]{Jalal Mekkaoui} \renewcommand\Authands{ and } \date{\small \em Received: 1 January 1970 Accepted: 1 January 1970 Published: 1 January 1970} \maketitle \begin{abstract} Intraosseous synovial cysts (ISCs) are rare occurrences characterized by synovial proliferation within the bone. This article presents a case report of a 19-year-old patient with a carpal scaphoid bone fracture and an incidentally detected intraosseous cyst. The patient underwent surgical treatment involving careful curettage of the cystic cavity, addition of a spongy bone graft, and fracture stabilization. The histopathological examination confirmed the presence of an intraosseous synovial cyst. The patient achieved a satisfactory functional outcome, with early consolidation and resumption of daily activities. The study emphasizes the importance of accurate diagnosis and appropriate surgical management, highlighting the favorable prognosis and rarity of recurrences in intraosseous synovial cysts of the scaphoid bone. \end{abstract} \keywords{intraosseous synovial cysts, scaphoid bone, fracture surgical management, histopathological examination, radiography and computed tomography.} \begin{textblock*}{18cm}(1cm,1cm) % {block width} (coords) \textcolor{GJBlue}{\LARGE Global Journals \LaTeX\ JournalKaleidoscope\texttrademark} \end{textblock*} \begin{textblock*}{18cm}(1.4cm,1.5cm) % {block width} (coords) \textcolor{GJBlue}{\footnotesize \\ Artificial Intelligence formulated this projection for compatibility purposes from the original article published at Global Journals. However, this technology is currently in beta. \emph{Therefore, kindly ignore odd layouts, missed formulae, text, tables, or figures.}} \end{textblock*} \begin{textblock*}{10cm}(1.05cm,3cm) {{\textit{CrossRef DOI of original article:}} \underline{}} \end{textblock*}\let\tabcellsep& \section[{Introduction}]{Introduction}\par ntraosseous synovial cysts (ISCs) are characterized by the presence of a specific radiological image and histology indicating synovial proliferation within the bone \hyperref[b0]{(1)}. Intraosseous synovial cysts of the scaphoid bone are an extremely rare cause of wrist and hand pain. The localization of this cyst specifically in the scaphoid bone is sparsely documented in the literature. This article presents a case report of a 19-year-old patient who experienced a carpal scaphoid bone fracture following a sports-related accident. Additionally, during the evaluation, an intraosseous cyst was incidentally detected. \section[{II.}]{II.} \section[{Case Report}]{Case Report}\par It is about a 19-year-old patient with no notable medical history. He came to the emergency department of CHU Avicenne after sustaining an injury to his left upper limb during a sports accident, with his hand landing in hyperextension. During the interview, he mentioned having experienced previous injuries and suffering from chronic wrist pain for the past 3 months, which is relieved by symptomatic treatment with painkillers and non-steroidal anti-inflammatory drugs. Upon clinical examination, the patient exhibited slight limitation of wrist function, accompanied by swelling and filling of the anatomical snuffbox. Palpation elicited pain during thumb retroversion and wrist pronation, as well as tenderness upon pressure in the anatomical snuffbox.\par The standard radiographic assessment revealed a scaphoid fracture with an underlying gap, suggesting the possibility of a cyst or pseudarthrosis of the scaphoid (figure \hyperref[fig_0]{1}). The wrist CT scan confirmed the scaphoid fracture with a probable intraosseous cyst (figure \hyperref[fig_1]{2}). The patient underwent surgery via an anterior approach. Careful curettage of the cavity was performed after distraction of the fracture site. The bone defect was filled with autologous cancellous graft harvested from the lower metaphysis of the ipsilateral radius. Fracture stabilization was achieved with 2 pins (figure \hyperref[fig_2]{3}). The histopathological examination of the curettage specimen showed that the cyst wall was lined with flattened fibroblastic cells resembling synovial cells, without true epithelial appearance. There was no mucoid degeneration or myxoid transformation. The patient was immobilized for 2 months in a resin splint. After this period, the hardware was removed under local anesthesia. Several sessions of functional rehabilitation were initiated after plaster removal. At the latest follow-up at 6 months after treatment, the patient had regained good wrist function, with painlessness and resumption of leisure and professional activities. \section[{I}]{I} \section[{III.}]{III.} \section[{Discussion}]{Discussion}\par Cysts of the carpal scaphoid are uncommon in daily practice. Most often, they are either mucoid cysts or synovial cysts. These cysts typically develop at an advanced age, with an average age of 41 and 47 years in the two largest series \hyperref[b1]{[2]}.\par The pathophysiology of bone cysts remains controversial, with two main opposing hypotheses. Some authors argue that the bone cyst forms through synovial inclusion from the outside to the inside. Others suggest synovial metaplasia originating within the bone itself, potentially influenced by local microtrauma or ischemic phenomena \hyperref[b2]{[3,}\hyperref[b3]{4]}.\par Intraosseous synovial cysts can present in two distinct ways: they may not exhibit any symptoms or they can result in moderate pain that typically does not respond well to painkillers. Other clinical manifestations may arise due to complications associated with intraosseous synovial cysts \hyperref[b0]{[1,}\hyperref[b4]{5,}\hyperref[b5]{6]}, such as wrist swelling caused by the rupture of the cysts and the spread of its contents within the joint. Moreover, a pathological fracture can occur, exacerbating the pain \hyperref[b0]{[1,}\hyperref[b4]{5]}.\par From a radiological perspective, typical images show osteolytic lesions of a few millimeters in diameter, either solitary or multilobulated, accompanied by a peripheral rim of osteosclerosis \hyperref[b6]{[7]}. This description corresponds to the lesion observed on our patient's radiographs, along with a discontinuity at the scaphoid neck, indicating a pathological fracture due to weakening of the scaphoid neck. Computed tomography, whether performed with or without contrast agent injection, allows for precise determination of the nature of the intracystic contents and any cortical involvement \hyperref[b0]{[1,}\hyperref[b6]{7]}. It also helps establish a surgical protocol by specifying the most appropriate approach, including the preferred surgical access route.\par The only patients requiring surgical intervention are those who experience persistent pain or swelling of soft tissues, as well as those with a pathological fracture, as in our case. Additionally, preventive intervention may be considered for lesions at risk of fracture due to their location (scaphoid neck) and volume (large geode with significant cortical thinning) \hyperref[b7]{[8]}. The surgical procedure involves a thorough excision by curetting the contents of the cystic cavity as completely as possible. A spongy bone graft is systematically added, along with osteosynthesis if necessary, as recommended by most authors \hyperref[b8]{[9,}\hyperref[b9]{10]}. The functional prognosis is generally favorable, and recurrences are exceptional \hyperref[b4]{(5)}. In our case, we observed an early consolidation (55 days) compared to the usual timeframe of 3 months, with a highly satisfactory functional outcome.\par IV. \section[{Conclusion}]{Conclusion}\par The functional prognosis of intraosseous synovial cysts of the scaphoid bone is generally favorable, with exceptional recurrences. In our case, we observed an early consolidation occurring in just 55 days compared to the usual timeframe of 3 months, with a highly satisfactory functional outcome. This case report highlights the importance of accurate diagnosis and appropriate surgical management for patients with intraosseous synovial cysts of the scaphoid bone. Careful curettage of the cystic cavity and the systematic addition of a spongy bone graft, along with possible osteosynthesis, were recommended to ensure complete excision and optimal consolidation. Standard radiography and computed tomography were valuable tools in confirming the diagnosis and guiding the surgical treatment. Through appropriate management, the patient was able to regain satisfactory wrist function and resume daily activities. However, long-term monitoring is necessary to detect any potential recurrences. This study also emphasizes the importance of ongoing research and documentation of intraosseous synovial cysts of the scaphoid bone to improve understanding of their pathophysiology and treatment options.\begin{figure}[htbp] \noindent\textbf{1}\includegraphics[]{image-2.png} \caption{\label{fig_0}Figure 1 :}\end{figure} \begin{figure}[htbp] \noindent\textbf{2}\includegraphics[]{image-3.png} \caption{\label{fig_1}Figure 2 :}\end{figure} \begin{figure}[htbp] \noindent\textbf{3}\includegraphics[]{image-4.png} \caption{\label{fig_2}Figure 3 :}\end{figure} \begin{figure}[htbp] \noindent\textbf{} \par \begin{longtable}{} \end{longtable} \par \begin{quote} appropriate surgical management, highlighting the favorable prognosis and rarity of recurrences in intraosseous synovial cysts of the scaphoid bone. Radiography and computed tomography are valuable tools in confirming the diagnosis and guiding treatment. Long-term monitoring is essential to detect any potential recurrences, and further research is needed to improve understanding of the pathophysiology and treatment options for these cysts.\end{quote} \caption{\label{tab_0}}\end{figure} \backmatter \subsection[{Funding}]{Funding}\par This research received no specific grant from any funding agency in the public, commercial, or not-forprofit sectors. \subsection[{Ethics approval and consent to participate}]{Ethics approval and consent to participate}\par Ethical approval was not sought. Written consent was obtained from the patients. \subsection[{Availability of data and materials}]{Availability of data and materials}\par The datasets used and analysed during the study are available from the corresponding author. \subsection[{Declaration of conflicting interest}]{Declaration of conflicting interest}\par The authors declare that there is no conflict of interest. \subsection[{Authors contributions}]{Authors contributions}\par All authors Have read and approved the final manuscript. \begin{bibitemlist}{1} \bibitem[Logan et al. ()]{b4}\label{b4} ‘Bilateral scaphoid ganglion cysts in an adolescent’. S E Logan , L A Gilula , M Kyriakos . \textit{J Hand Surg Am} 1992. 17 p. . \bibitem[Logan et al. (1992)]{b1}\label{b1} ‘Bilateral scaphoid ganglion cysts in an adolescent’. S E Logan , L A Gilula , M Kyriakos . \textit{J Hand Surg Am} 1992 May. 17 (3) p. . \bibitem[Chantelot et al. ()]{b0}\label{b0} ‘Fracture du scaphoide carpien sur kyste intraosseux’. C Chantelot , P Laffargue , M Masmejean , B Peltier , P Barouk , C Fontaine . \textit{Ann Chir Main} 1998. 17 p. . \bibitem[Masmejean et al. ()]{b6}\label{b6} ‘Géodesdites primitives du carpe’. E Masmejean , C Chantelot , J Y Alnot , G Hayem . \textit{Rev ChirOrthop} 2000. 86 p. . \bibitem[Forstner ()]{b8}\label{b8} ‘Intra-osseous ganglion in the area of the wrist’. H Forstner . \textit{Chirurgie} 1992. 63 p. . \bibitem[Waizenegger ()]{b9}\label{b9} ‘Intraosseous ganglia of carpal bones’. M Waizenegger . \textit{J Hand Surg [Br]} 1993. 18 p. . \bibitem[Uriburu and Levy ()]{b5}\label{b5} ‘Intraosseous ganglia of the scaphoid and lunate bones: report of 15 cases in 13 patients’. Ijf Uriburu , V D Levy . \textit{J Hand Surg Am} 1999. 24 p. . \bibitem[Mestdagh et al. ()]{b7}\label{b7} ‘Les kystes synoviaux intraosseux du carpe. À propos de trois cas’. H Mestdagh , Y Butruille , C Maynou , J M Delobelle , M Lecomte-Houcke . \textit{Ann Chir Main Membr Super} 1993. 12 p. . \bibitem[Yakoubi et al. (2009)]{b3}\label{b3} ‘Pathological fracture of the carpal scaphoid (intra-osseous synovial cyst) Clinical and therapeutic aspect: case report’. M Yakoubi , N Meziani , Yahia Cherif , M Zemmouri , A Benbakouche , R . \textit{Chir Main} 2009 Feb. 28 (1) p. . \bibitem[Masmejean et al. (2000)]{b2}\label{b2} ‘Primary carpal bone defect’. E Masmejean , C Chantelot , J Alnot , G Hayem . \textit{Rev ChirOrthopReparatriceAppar Mot} 2000 Feb. 86 (1) p. . \end{bibitemlist} \end{document}