How the Anatomic Location Affects the Surgical Outcomes of Simple Bone Cysts in Children: A Single-Center Retrospective Cohort Study

Objective We aimed to investigate the effect of anatomical location on the efficacy of surgical intervention for simple bone cysts (SBC) among children, with a particular focus on comparing differences in clinical characteristics, treatment strategies, and prognosis between humeral and femoral SBCs. Methods A single-centre retrospective cohort of paediatric patients with SBC undergoing primary surgery (2014–2024) was stratified by location, including humerus, femur, and other sites. Demographic, imaging, and treatment data were collected. Twelve-month postoperative radiographic outcomes (cure/partial residual/recurrence/no response) were analysed using ANOVA and chi-square tests (α = 0.05). Results In total, 106 patients were included, comprising 57 humeral (53.8%), 36 femoral (34.0%), and 13 other sites (12.2%). Patients with femoral SBC exhibited shorter stature, lower weight, and larger cyst area (all p < 0.05). Humeral SBCs presented more pathological fractures, a higher proportion of active fractures, and thinner cortices (all p < 0.05). At 12 months, 55 patients were cured, 21 exhibited partial residual characteristics, 17 recurred, and 13 showed no response. Anatomical location was significantly correlated with treatment outcome, with humeral cysts revealing higher recurrence rates. Other associated factors included cyst size, cyst index, time from fracture to surgery, distance to growth plate, initial surgical technique, and internal fixation type (all p < 0.05). Conclusion The anatomical location is a critical factor affecting the postoperative efficacy and recurrence risk of paediatric SBC surgery. Clinical decision-making should integrate location-specific structural risks with the morphological severity of the lesion to optimise surgical timing and technique selection and implement stratified follow-up, thereby improving treatment outcomes for children with high-risk locations.