Abstract
Purpose. This is a case report of a patient with an osteoid osteoma of the proximal fibula. The objective is to illustrate a rare tumor location that requires open surgery due to closeness of neurological structures. Methods. Clinical and roentgenographic findings, treatment, and histological appearance are presented. Results. Local pain and swelling of the proximal fibula with improvement under salicylates led to the diagnosis of an osteoid osteoma, what was confirmed with an MRI scan. Due to proximity to the common peroneal nerve, we decided for open surgery. During the operation, the nerve was seen to cross the tumor site making it necessary to retract it to expose the entire tumor. Histologically, typical features of osteoid osteoma with a rather well-defined nidus surrounded by sclerotic bone were seen. A complete removal was performed. Conclusion. Osteoid osteomas of the proximal fibula are rare. When planning surgery, the common peroneal nerve must be identified, and its further distal course should be taken into account to avoid iatrogenic damage to the nerve.
Highlights
Osteoid osteoma is a well-described small benign osteoblastic tumor that primarily affects the diaphysis and metaphysis of the femur and tibia [1]
Due to proximity to the common peroneal nerve, we decided for open surgery
We present a case of a 14-year-old girl, whose local pain and swelling of the proximal fibula with improvement under salicylates led to the diagnosis of an osteoid osteoma
Summary
Osteoid osteoma is a well-described small benign osteoblastic tumor that primarily affects the diaphysis and metaphysis of the femur and tibia [1]. Osteoid osteoma affects men more than women (about 3 : 1), and 90% of the patients are younger than 25 years [2, 3] It is clinically characterized by pain which is not related to physical exercise and is often exacerbated at night. Prostaglandin production in osteoid osteoma leads to an intense and chronic local inflammatory response with an accompanying periosteal reaction and sclerosis, seen in radiographs as a radiolucent nidus surrounded by reactive sclerosis. It is described as the “double-density sign.”. Radiographs showed complete removal of the osteoid osteoma, including the nidus, with a resulting lesion the size of one-third of the shaft width (Figure 5)
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