Excision Of Osteochondroma Research Articles

Pseudoaneurysm of the popliteal artery in a child with multiple hereditary exostosis

Multiple hereditary exostosis (MHE) is a rare condition that tends to be overlooked because of its benign nature. The formation of pseudoaneurysm is a rare complication in association with osteochondromatosis. An 8-year-child with MHE presented with a mass behind her left thigh. Imaging confirmed pseudoaneurysm of the popliteal artery. The patient was operated for closure of rent in the arterial wall with a polytetrafluroethylene graft and excision of osteochondroma. At 2 years of follow-up, circulation was normal and the patient was symptom free, without any growth disturbance. This case report highlights the rare possibility of pseudoaneurysm with osteochondroma and focuses on thorough evaluation and proper management of these patients.

Multiple Hereditary Exostoses. Clinical problems and therapeutic options

Abstract Multiple Hereditary Exostoses (MHE) is a rare autosomal dominant disorder characterized by the presence of multiple osteochondromas. Patients often present with growth disturbances and angular deformities of the long bones, and a limited range of motion of the joints. In adults, the risk of malignant transformation of osteochondroma into chondrosarcoma exists, with an estimated incidence of 3–6%. In addition to the physical deformities, pain is a significant problem for patients with MHE and the disease has a profound negative influence on activities of daily living, occupation and school performance. In the treatment of patients with MHE, knowledge about the various disorders encountered and the natural course of the disease, as well as appropriate timing of interventions are essential. Surgical treatment may not only include the excision of osteochondromas but also limb reconstruction procedures to correct deformities. During childhood, however, this may be limited to procedures such as hemiepiphysiodesis for valgus deformity of the knee and ankle to prevent more extensive surgery at older age. Furthermore, early recognition of malignant degeneration of osteochondroma and the immediate treatment of chondrosarcoma are of the utmost importance for patient survival. Therefore, periodic screening in children as well as adults is highly recommended.

“Globus Symptoms”: A Rare Case of Giant Osteochondroma of the Axis Treated with High Cervical Extrapharyngeal Approach

Background Osteochondroma is the most common primary bone tumor, composing 35% of benign bone tumors and 9% of all bone tumors; 1.3 to 4.1% of all osteochondromas originate from the spine. A rare differential diagnosis for globus symptoms is an osteochondroma originating from the anterior surface of the axis. We describe a rare case of osteochondroma of the dens resulting in “globus symptoms” (the subjective sensation of a mass in the throat) treated with excision via the high cervical extrapharyngeal approach. Purpose To discuss the surgical management of this problem, with an emphasis on surgical approach used. The clinical history, examination, and investigations are presented and illustrated, along with clinical patient outcome. Study Design/Setting This article is a case report of a patient treated at the Department of Trauma and Orthopaedics in an active university teaching hospital. Methods Case presentation. For the discussion, we used handpicked articles, as well as MEDLINE and PubMed database searches with the keywords “C2,” “dens,” “osteochondroma,” “globus,” “extrapharyngeal approach.” Results Uncomplicated procedure. Histological analysis confirmed a benign osteochondroma with no evidence of malignancy. The patient underwent an uncomplicated postoperative recovery and was discharged 24 hours after surgery, fully ambulatory and eating and drinking well. Conclusions The high cervical retropharyngeal approach is safe and reproducible for the excision of osteochondromas or osteophytes of the upper cervical spine.

Management of forearm deformities with ulnar shortening more than 15 mm caused by hereditary multiple osteochondromas

Treatment for forearm deformities caused by hereditary multiple osteochondromas is still controversial. The purpose of the study was to describe the outcome of treatment with the combined use of ulnar lengthening and excision of osteochondromas. Fourteen patients with hereditary multiple osteochondromas had forearm deformities which belongs to type I Masada deformity. The mean relative ulnar shortening was 19.9 mm (range, 16-23). All patients ranging from 4 to 15 years old had operative treatment. Clinical evaluation involving the assessment of pain, activities of daily living, and range of motion of the wrist and forearm was performed. The radiographic evaluation was relative ulnar shortening (RUS), radial articular angle (RAA), carpal slip (CS), and radial bowing. Besides, we also evaluated the amount of ulnar lengthening, external fixation time, and external fixation index. The mean EFT was 101 days (range, 84-133), and the mean external fixation index was 44.4 days/cm (range, 33.6-51.2). During the mean 43.1 months follow-up, four patients had mild pain and two patients had mild restriction of daily activities. The rotation of forearm and motion of wrist had increased except in Case 3. The RAA, CS, and radial bowing had been improved except in Case 6 and 7. In all patients, relative ulnar shortening had been corrected. According to the functional evaluation criteria recommended by Krimmer, there were ten excellent and four good. The combined use of ulna lengthening and excision of osteochondromas is a proper and effective treatment method to the type I Masada deformity with the relative ulnar shortening more than 15 mm.

Arthroscopic Tennis Elbow Release: Outcomes Correlated to Associated Lesions (SS-50)

Pain relief and strength, after arthroscopic tennis elbow release, continue to improve for the first 12 months, with little improvement thereafter. Description of and Prospective analysis of long-term outcomes of arthroscopic tennis elbow release. 100 patients (102 elbows) with lateral epicondylitis, recalcitrant to a minimum of 6 months of supervised conservative management, underwent arthroscopic lateral epicondylar release. Each patient was clinically evaluated pre-operatively and post-operatively and a quantitative assessment of the grip strength was collected on both sides with a dynamo meter, in full elbow extension and in 90 degrees flexion. Functional assessment with the Mayo Elbow Performance Score and dynamo meter grip strengths were collected for the first two years post-operation. Postoperative follow-up averaged 36 months (range 24-45months). The average MEPS increased from 57/100 to 89/100. 98 elbows were graded as excellent/good outcomes, and 4 elbows were noted to have fair outcomes. The latter 4 patients were assessed to have type 2 failure, with two subsequently requiring PIN releases, one requiring an osteochondroma excision from the distal lateral humerus, and one patient lost to follow-up. Dynamo meter strength returned to above pre-operative level at an average of 3 months and were and average of 35% greater than the pre-operative level at final review. Complications consisted of synovial fistulae (n=8) all of which spontaneously resolved within one month, 2 portal superficial infections, 1 mild anterior capsular contracture, and no neurovascular injuries. Concurrent intra-articular pathology that was noted included radio-capitellar chondrosis (n=42), lateral trochlear chondrosis (n=30), anterolateral synovial plicae (n=17), synovitis (n=23), radial head instability (n=6), and synovial osteochondromatosis (n=1). A trend of decreased subjective satisfaction was observed when correlated to the number of associated lesions. Arthroscopic tennis elbow release is a valid technique for the treatment of recalcitrant lateral epicondylitis. The results show that pain relief and strength improve significantly upto 3 months post-surgery, and continue to improve for the first 12 months, with little improvement beyond that time. Associated lesions may have a negative effect on subjective outcomes.

Fibular Rotational Osteotomy for the Treatment of Distal Tibial Osteochondroma: A Technical Modification for Deformity Correction and Improved Outcomes

The technique of choice for excision of osteochondromas located in the lateral aspect of the tibia is a transfibular approach to expose the lesion for resection. A drawback of this approach is that removal of the lesion leaves a void that may cause a visible deformity and adversely affect long-term function. Fibular rotational osteotomy followed by fibular graft may minimize the resultant deformity, producing a more satisfactory functional and cosmetic result. The authors report a retrospective case series consisting of 5 cases in which a fibular graft rotation was performed after rotational osteotomy via a transfibular approach. Retrograde intramedullary fixation by means of a Kirschner wire, in combination with the design of the fibular osteotomy, provided rotational graft and fibular stability until healing occurred.

Tumor Location Affects the Results of Simple Excision for Multiple Osteochondromas in the Forearm

The effectiveness of excision of osteochondromas in controlling the progression of forearm and wrist deformity remains an issue of controversy. The purpose of this study was to analyze the effectiveness of tumor excision in the correction of forearm and wrist deformity due to multiple osteochondromas in children, with an interpretation of the results based on different patterns of deformity. Fourteen forearms in thirteen children with a follow-up of more than twenty-four months (average, fifty-three months) were included in the study. The forearms were divided into two groups on the basis of the location of the tumor and the pattern of deformity. In Group 1 (six forearms), the osteochondroma was only in the distal aspect of the ulna and caused compression of the radius. In Group 2 (eight forearms), tumors were in both the distal aspect of the ulna and the ulnar side of the distal part of the radius and were in contact with each other. Radial length, ulnar shortening, radial bowing, the radial articular angle, and carpal slip were measured as radiographic parameters. Ulnar shortening and radial bowing were expressed as a percentage of the radial length to make it possible to compare data between the individuals. Each parameter was evaluated before surgery and at the time of final follow-up. In Group 1, the percentage of ulnar shortening and the percentage of radial bowing had improved at the time of final follow-up; however, in Group 2, both the radial articular angle and the percentage of radial bowing had deteriorated significantly after the tumor excision (p = 0.049 and p = 0.017, respectively), even though the percentage of ulnar shortening showed no change. The effectiveness of simple excision of osteochondromas of the distal aspect of the forearm is influenced by the tumor location and is related to the pattern of the deformity. Simple tumor excision can correct the forearm deformity in patients with an isolated tumor of the distal part of the ulna. Conversely, in patients with tumors involving the distal part of the ulna and the ulnar side of the distal end of the radius, tumor excision alone is a less promising procedure for the correction of the deformity. Prognostic Level IV.

Abnormal Scarring With Keloid Formation After Osteochondroma Excision in Children With Multiple Hereditary Exostoses

Multiple hereditary exostoses (MHE) is an autosomal dominant condition characterized by numerous cartilage-capped exostoses/osteochondromas in areas of actively growing bone. Abnormal scarring with keloid formation after osteochondroma excision in children with MHE has not been previously described. A retrospective double-cohort study was undertaken to determine if children with MHE have a higher rate of abnormal scarring with keloid formation after osteochondroma excision when compared with those with solitary osteochondroma. In the initial phase, all consecutive children with MHE that underwent excision of osteochondroma with a minimum 2-year postoperative follow-up were identified. A control group of age-matched cases of solitary osteochondroma was subsequently identified. All patients were interviewed for wound healing problems and noncosmetic scarring. All patients with unsatisfactory scars were asked to send pictures and/or were invited for follow-up. Data were statistically analyzed. Eighty-three surgeries were performed in 25 patients with MHE, whereas 25 surgeries were performed in 25 patients with solitary osteochondroma. Twelve keloid scars were noted in 7 patients with MHE, and no keloids were noted in any of the patients in the solitary group. Diagnosis of MHE was a statistically significant risk factor for formation of keloids after surgery (P < 0.05). Abnormal scarring with keloid formation after osteochondroma excision in MHE has not been previously reported. Although this study has limited numbers, the results demonstrate a statistically significant correlation between keloid formation and MHE. The risk for abnormal scarring and keloid formation should be discussed with all patients before surgery.

Correction and lengthening for deformities of the forearm in multiple cartilaginous exostoses

BackgroundMultiple cartilaginous exostoses cause various deformities of the epiphysis. In exostoses of the ulna, the ulna is shortened and the radius acquires varus deformity, which may lead to dislocation of the radial head. In this study, we present the results of exostoses resection, with correction and lengthening with external fixators for functional and cosmetic improvement, and prevention of radial head dislocation. MethodsWe retrospectively reviewed seven forearms of seven patients who had deformities of the forearm associated with multiple cartilaginous exostoses. One patient had dislocation of the radial head. Operative technique was excision of osteochondromas from the distal ulna, correction of the radius, and ulnar lengthening with external fixation up to 5mm plus variance. We evaluated radiographs and the range of pronation and supination. Furthermore, we conducted a follow-up of ulnar length after the operation. ResultsDislocation of the radial head of one patient was naturally reduced without any operative intervention. At the most recent follow-up, six of the seven patients showed full improvement in pronation–supination. Ulnar shortening recurred with skeletal growth of four skeletally immature patients; however, it did not recur in one skeletally mature patient. Overlength of 5 mm was negated by the recurrence of ulnar shortening about 1.5 years after the operation. ConclusionsWe treated seven forearms of seven patients by excision of osteochondromas, correction of radii, and gradual lengthening of ulnas with external fixators. The results of the procedure were satisfactory, especially for function of the elbow and wrist. However, we must consider the possible recurrence of ulnar shortening within about 1.5 years during skeletal growth periods in immature patients.

Treatment of multiple hereditary osteochondromas of the forearm in children

We have evaluated the clinical outcomes of simple excision, ulnar lengthening and the Sauvé-Kapandji procedure in the treatment of deformities of the forearm in patients with multiple hereditary osteochondromas. The medical records of 29 patients (33 forearms) were reviewed; 22 patients (22 forearms) underwent simple excision (four with ulnar lengthening) and seven the Sauvé-Kapandji procedure. Simple excision increased the mean supination of the forearm from 63.2 degrees to 75.0 degrees (p = 0.049). Ulnar lengthening did not significantly affect the clinical outcome. The Sauvé-Kapandji technique improved the mean pronation from 33.6 degrees to 55.0 degrees (p = 0.047) and supination from 70.0 degrees to 81.4 degrees (p = 0.045). Simple excision may improve the range of movement of the forearm but will not halt the progression of disease, particularly in younger patients. No discernable clinical or radiological improvement was noted with ulnar lengthening. The Sauvé-Kapandji procedure combined with simple excision of osteochondromas can improve stability of the wrist, movement of the forearm and the radiological appearance.

Progressive subluxation of the hip joint in a child with hereditary multiple exostosis

We describe the treatment and follow-up of a case of hereditary multiple exostosis in a 16-year-old girl, who had intraarticular and extraarticular osteochondromas in the right hip joint which caused hip subluxation. These osteochondromas were excised, the femoral head was located concentrically, and the patient was put in a spica cast for 6 weeks. Six months later, hip magnetic resonance imaging showed no evidence of avascular necrosis. Three years after the operation the patient walked freely, without pain, and there was satisfying coverage of the femoral head. The authors emphasize that careful attention should be given to the surgical technique prior to extraarticular and intraarticular acetabular osteochondroma excision in order to avoid the development of avascular necrosis.

Fractures of osteochondroma during physical exercise.

The mechanism responsible and the best form of treatment for fractures of osteochondromas remain unclear. We studied the incidence, cause, treatment, and outcome of fractures of osteochondroma over a 17-year period. Retrospective cohort study. We retrospectively reviewed all cases of osteochondroma at one institution over 17 years (1985 to 2002) to identify cases of fractures. These patients were then contacted for follow-up. Seven cases of fracture through the stalk of a pedunculated osteochondroma were identified. All fractures were sustained during physical exercise. One fracture was due to a direct blow, and the others to indirect muscle or tendon injury. Five patients were treated surgically with excision of the osteochondroma, and the other two received nonoperative treatment consisting of restriction of physical activity and observation. In all cases, patients were able to resume sporting activity within 4 to 8 weeks. The recovery period was shorter for patients who received surgical treatment. Surgical excision of the fractured osteochondroma may be preferable for patients engaging in sport.

Surgical treatment of symptomatic osteochondroma. A three- to eight-year follow-up study.

Our aim was to investigate the outcome of excision ofosteochondromas. Between 1994 and 1998, 92 symptomatic osteochondromas in 86 patients were excised. There were 40 women and 46 men with a mean age of 20 years (3 to 62). Of these, 56 had a solitary osteochondroma and 30 had multiple hereditary tumours. The presenting symptoms were pain (79.1%), swelling (23.3%), reduced range of movement (19.8%), cosmetic abnormalities (17.4%), and bursitis (12.8%). The most common site (37.6%) was around the knee. Four patients had major complications (4.7%) including one intra-operative fracture of the femoral neck and three nerve palsies which resolved after decompression. Six patients had minor complications. Overall, 93.4% of the preoperative symptoms resolved after excision of the tumours. Excision is a successful form of treatment for symptomatic osteochondromas with a low morbidity.

第３基節骨亜脱臼及び第３ＭＰ関節変形性関節症を併発した両側第３中手骨骨軟骨腫の１例

We present a case in which a osteochondroma on the distal ulnar end of the third metacarpal bone of both hands caused subluxation of the proximal phalanx and resulted in the osteoarthritis of both third metacarpophalangeal (MP) joints. The patient was a 49-year-old man who complained of pain of the third MP joint of both hands. On examination, he had a hard nonmobile mass on the dorso-ulnar side of the third metacarpal bone of both hands. There was a restriction of flexion and extension of the MP joint. Radiographs demonstrated exostosis based on the distal dorso-ulnar surface of the head of the metacarpal bone of both middle fingers. There was subluxation of the proximal phalanx and osteoarthritc change in the MP joint. He underwent excision of the osteocartilaginous mass and reattachment of the collateral ligament for each hand. Pathologic examination revealed a cartilaginous-cap with bony traveculae, consistent with an osteochondroma. Early excision of osteochondroma as well as correction of deformity are required to prevent deformity of the finger for such cases.

THE GRADUAL CORRECTION OF FOREARM DEFORMITIES IN MULTIPLE HEREDITARY EXOSTOSES

Careful preoperative planning, fixator selection and design, surgical technique, and sustained follow-up care are essential for successful gradual correction of pediatric forearm deformities. The sequence of planning gradual deformity correction can be created by establishing a problem list and using this as the basis for design of the gradual correction. Viewing limb length and deformity correction as a "process," rather than a procedure, is of value. Using a hybrid fixation formula that combines half pins with wires can minimize the potential for neurovascular injury. The combination of radial osteotomy, excision of osteochondromas, and gradual ulnar lengthening by distraction osteogenesis improves forearm appearance and function in most patients with multiple hereditary exostoses.

Hand Involvement in Multiple Hereditary Exostosis

In summary, patients with multiple hereditary exostosis often inherit hand involvement but rarely show hand deformity. The principal area of involvement appears to be around the MCP joint but the PIP joint is the most common area of deformity. Metacarpal shortening usually does not cause functional problems and need not be treated. Angular deformity, though rare, does cause problems and needs surgical treatment. Unfortunately, there is no evidence that prevention of deformity is possible by early excision of osteochondromas. Treatment, therefore, requires both osteochondroma excision and closing-wedge corrective osteotomy.

Operations for forearm deformity caused by multiple osteochondromas.

We reviewed 36 cases of forearm deformity caused by multiple osteochondromas in 30 patients and classified them into three types: Type I showed a combination of ulnar shortening and bowing of the radius secondary to osteochondromas of the distal ulna (22 forearms). Type II showed dislocation of the radial head, either with osteochondromas of the proximal radius (Type IIa, two forearms) or secondary to more distal involvement (Type IIb, five forearms). Type III had relative radial shortening due to osteochrondromas at the distal radius (seven forearms). Operations were performed on 16 forearms in 13 patients, with 92% of satisfactory results. For Type I deformity, excision of osteochondromas, immediate ulnar lengthening and corrective osteotomy of the radius are recommended. For Type IIa, excision of the radial head is necessary, and for Type IIb, we advise gradual lengthening of the ulna using an external fixator. Excision of osteochondromas alone gave good results in Type III deformity. Our classification gives a reliable indication of the prognosis and is a guide to the choice of surgical treatment.