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To treat a fracture in unicameral bone cyst, allow the fracture to heal with nonsurgical management. Then, follow the patient clinically and with serial radiographs. After the fracture heals, aspiration and injection of the cyst may be necessary. Some of these cysts have the pathognomonic radiologic finding known as the “fallen leaf sign”. The fallen leaf sign is part of the fracture cortex that settles to the most dependent part of the cyst. The most common sites for unicameral bone cysts are the proximal humerus and proximal femur, and you really do not need work-up for patients with unicameral bone cysts. When you look at the x-ray, you see thinning of the cortical bone with central lucency and no obvious matrix. These are the typical findings of a unicameral bone cyst. The most common presentation of a benign bone tumor in childhood is an incidental finding. The unicameral bone cyst is a simple bone cyst. It is a benign cystic lesion that is prone to pathologic fracture and recurrence. Approximately 85% of the patients are under the age of 20 years old. The lesion tends to occur in the metaphysis and the diaphysis. It abuts the epiphysis in the proximal humerus and in the proximal femur. The cystic lesion is lined by a fibrous membrane and filled with clear, yellow fluid. Aneurysmal bone cysts are different (eccentric). An aneurysmal bone cyst enlarges the metaphysis more than the width of the epiphyseal plate. Unicameral bone cysts are most likely to present with a pathologic fracture in children. The goal of treatment is to prevent pathologic fracture. In 50% of patients with unicameral bone cysts, the lesion remains asymptomatic until a fracture occurs, usually due to minor trauma. When the lesion expands the bone, the bone is weakened and this may cause pain or a fracture. Fractures of the humerus are usually minimally displaced and treated by immobilization and allowed to heal. If the lesions are persistent or progressive, they may need surgical treatment such as curettage and bone graft or injection of lesion, or percutaneous injection of bone graft or bone graft substitute. Curettage and bone graft of the proximal femur and in the subtrochanteric area may be needed because it is a high stress area and is prone to a fracture. Supplemental fixation may be necessary.