Management strategies and outcomes of pediatric unicameral bone cyst: a narrative review

Unicameral bone cysts (UBCs) are benign, fluid-filled lesions that predominantly occur in the long bones of children and adolescents. Although histologically non-neoplastic, these cysts can weaken bone structure and predispose patients to pathological fractures. Despite extensive research, the optimal management of UBCs remains controversial. Current treatment strategies—ranging from simple observation to minimally invasive procedures and open surgery—lack standardized guidelines, and clinical decisions are often driven by lesion activity, fracture risk, and surgeon experience. This narrative review provides a comprehensive overview of the current understanding of pediatric UBCs, with particular emphasis on their etiology, natural history, and the evolution of management strategies. It summarizes major therapeutic approaches while focusing on their underlying rationale rather than technical details. By integrating current evidence and expert perspectives, this review highlights existing challenges and aims to assist clinicians in formulating individualized, evidence-based treatment plans that optimize both safety and long-term functional outcomes in affected children.