Pedunculated Osteochondroma Research Articles

Osteochondroma of Dorsal Scapula: A Case Report and Review of Literature.

Osteochondroma of the scapula constitutes only 3-5% of all osteochondromas; osteochondroma on dorsal aspect of scapula is a rare entity. Diagnosis is almost always clinicoradiologically. Additional computed tomography scan and magnetic resonance imaging may be required for osteochondroma of flat bones such as scapula. Indications for surgery include pain, deformity, dysfunction, neural or vascular compromise, failure of conservative management, or in clinical settings with the high suspicion of malignant transformation and occasionally cosmesis. Outcome of a surgery should be assessed by Patient-Reported Outcome Measures (PROMs) which appraises what "matters to the patient." A 10-year-old boy presented to us with painless swelling over the right upper back since 3 years of age and discomfort over the area while sleeping on his back for 6 months. Diagnosis confirmed it to be a pedunculated osteochondroma arising from the dorsal scapula. Here, we report the diagnosis, treatment, and successful Patient-Reported Outcome using QuickDASH© score for an osteochondroma of dorsal scapula using CARE© case reporting guidelines. We report a rare site of osteochondroma, review the relevant literature, and also stress upon the necessity of analyzing PROMs after surgical treatment of benign tumors of bone which would enable us to evaluate the result of surgery on symptoms, functioning, and health-related quality of life from the patient's perspective.

Reperfusion Injury in the Cord—Rare Case of Pediatric White Cord Syndrome

Background: Postoperative neurological deficits following spinal decompression are often caused due to an expanding hematoma or other iatrogenic injuries. When a definitive etiology could not be identified, it may rarely be related to a reperfusion injury. Such unexplained neurological deficits are often associated with the presence of cord signal changes on imaging. It is assumed to result from ischemia-reperfusion injury and is often designated as “white cord syndrome” due to its imaging appearance. Such a diagnosis is made after excluding other differentials. Outcomes are variable based on the current literature. We report a patient with possible white cord syndrome following decompression and excision of cervicodorsal osteochondroma. Case Description: In this case report, we present a young patient who was admitted with slowly progressive paraplegia, and initial imaging showed C7-D1 pedunculated osteochondroma. He underwent an uneventful spinal laminectomy accompanied by tumor excision. In the immediate postoperative period, the patient became paraplegic and a follow-up magnetic resonance imaging was taken. It showed re-expansion of cord in the region of compression by the mass lesion at C7-D1 level with interval abnormal T2/IR hyper intensity extending from C6 to D1 levels. Conclusion: White cord syndrome is an extremely rare condition. It is postulated to be caused by reperfusion injury to the cord within areas of chronic ischemia due to compressive causes. We describe a child with white cord syndrome following decompression and excision of an osteochondroma.

Dysuria: An unusual complication of pubic exostosis in a child 10 years

Abstract Exostosis or osteochondromas are benign bone tumors frequently.These benign tumors may be symptomatic or be manifested on the occasion of a complication. We report the case of a child boy 1O years, admitted to our training multiple exostosis, with a location iliopubic left that proved by painful induration left of the base of the penis. Induration the increasing volume, it bothered the child during urination. Conventional radiography and CT were in favor of a pedunculated osteochondroma of the left iliac ramus compressing the urethra. The child underwent surgical tumor resection and pathological examination confirmed the diagnosis of osteochondroma. The evolution was good with disappearance of urinary symptoms down two years without recurrence.

Knee locked in flexion: incarcerated semitendinosus tendon around a proximal tibial osteochondroma

This case reports on a knee locked in flexion due to incarceration of the semitendinosus tendon around an osteochondroma in a patient with a history of multiple hereditary exostoses (MHE). An 18-year-old female with history of MHE presented with acute right medial knee pain and inability to extend her knee. Radiographs confirmed multiple lower extremity osteochondromas, notably a large, 3-cm pedunculated osteochondroma about her right medial proximal tibia. This was assessed as a locked knee secondary to incarcerated hamstring tendons around an osteochondroma. Excision of the osteochondroma restored normal flexion and extension of her knee. At the 3-month follow-up visit, she had returned to all activities with no recurrent medial knee pain or locking. The differential diagnosis for a locked knee joint can be broad, but tendon incarceration should be considered in appropriate patients with significant symptoms. In patients with a history of MHE, osteochondromas may be the cause of tendon entrapment.

Pedunculated Osteochondroma arising from the Medial Aspect of Proximal Femur: A Rare Presentation

ABSTRACT Osteochondroma is a benign bony tumor arising as a bony outgrowth covered by a cartilage cap and occurs most commonly in the metaphysis of long bones (proximal tibia, distal femur, proximal humerus) and pelvis. Osteochondroma grows eccentrically instead of centrifugally. This article reports a case of a 24-yearold female, who presented with a painless bony hard irregular swelling over medial aspect of right groin. There was no distal neurovascular deficit. Site, nature, and extent of the lesion were assessed by radiographs and magnetic resonance imaging. Tumor was completely excised and on histopathology, osteochondroma confirmed. No weight bearing was allowed for 1 week. Patient returned to her normal routine activities in 1 month. On regular follow-up, no evidence of recurrence of the lesion was seen. How to cite this article Hamid FB, Singh G, Somashekarappa T, Jauhari RP, Singh S, Agarwal D. Pedunculated Osteochondroma arising from the Medial Aspect of Proximal Femur: A Rare Presentation. Int J Adv Integ Med Sci 2017;2(1):44-46.

Type IV Popliteal Arterial Entrapment Associated With an Osteochondroma

A 27-year-old man complaining of a several-month history of right lower extremity coolness was seen by his primary care physician. He works as a farmer and tends his fields on the farm and commonly squats for milking cows. Ten days before presentation, he developed pain in his right foot with walking along with progressively increased coolness in his right leg. On physical examination, he was found to have a cool right lower extremity and no palpable dorsalis pedis or posterior tibial arterial pulses. Doppler examination produced a faint monophasic posterior tibial signal. No sensory deficits were noted. Computed tomography showed occlusion of the anterior tibial artery along with occlusion of the peroneal and posterior tibial arteries. Increased velocities were noted on the duplex ultrasound examination with provocative maneuvers in the tibial vessels. The patient underwent angiography, which demonstrated the occlusion of the anterior tibial, posterior tibial, and peroneal arteries. Catheters were then delivered to the anterior tibial and posterior tibial to allow infusion of tissue plasminogen activator. With repeated angiography, the posterior tibial artery remained occluded, and the anterior tibial artery opened with flow into the dorsalis pedis. The posterior tibial artery remaining occluded in spite of increased dose of tissue plasminogen activator. Further imaging was performed to look for a potential cause of thrombosis. The patient underwent magnetic resonance angiography with active dorsiflexion and plantar flexion to evaluate for potential popliteal entrapment as the patient’s pulse would diminish with plantar flexion. Magnetic resonance angiography demonstrated a pedunculated osteochondroma arising from the right proximal medial tibia. This lesion had significant mass effect on the adjacent medial gastrocnemius and popliteus muscles. With the active maneuvers performed, there was no evidence of compression; however, with the patient’s history, it was suspected that certain activities would cause compartment compression secondary to the osteochondroma. With this pedunculated osteochondroma, the patient was referred to orthopedics for resection. The patient underwent operative exploration with resection of the osteochondroma and release of his popliteus muscle to open the popliteal compartment. Postoperative duplex ultrasound examination demonstrated return of normal ankle-brachial index.

Complicated Fracture and Resorption of an Osteochondroma

Aims: To describe two unusual complications of a typical solitary pedunculated femoral osteochondroma that included a distal fracture of the exostosis and a missed fragment following surgical treatment as well as to evaluate the progress of the untreated free fragment at follow-up. Case Presentation: A 13-year-old boy consulted for a painful bruising of the medial side of the right knee following injury. Radiological survey indicated a pedunculated osteochondroma of the distal femoral metaphysis but there was no evidence of a fracture line. Surgical removal of the lesion was uncomplicated but the post-operative radiographs indicated an osteocartilaginous portion of the osteochondroma missed in the thigh musculature. No further surgical intervention was undertaken. Radiographic followup revealed gradual regression and complete resorption of the free fragment 3 years later. No complications have been recorded at the most recent follow-up, 10 years later. Discussion: Fracture through the base or stalk of a pedunculated osteochondroma is a rare complication but the diagnosis of a distally fractured exostosis has not been previously reported. Regression or resorption of a solitary pedunculated osteochondroma following a fracture is also very rare. Although recurrence of the lesion in the reported patient would be very likely, complete resorption was evident instead within 3 years. Conclusion: An obscure distal fracture of a penduculated osteochondroma may be suspected in cases that a clinical diagnosis of a fractured exostosis is not associated Original Research Article British Journal of Medicine & Medical Research, 4(8): 1719-1728, 2014 1720 with the radiographic detection of a fracture line through its stalk. Radiographic control during surgery is necessary to ensure complete removal in cases with a clinically, or even radiologically, diagnosed fractured exostosis. Surgical excision of a distally fractured osteochondroma may be avoided, since complete resorption of the distal fragment may be evident in a few years.

An unusual complication of pubic exostosis

We report the case of a left superior pubic ramus osteochondroma occurring in a 29-year-old man. The patient consulted for a multiple exostoses disease revealed by a painful induration at the base of his penis. This induration was increasing in volume and causing discomfort during sexual intercourse and when sitting for a prolonged period of time. CT-scan examination showed a pedunculated osteochondroma of the left superior pubic ramus compressing the urethra. Surgical resection of the tumor confirmed the diagnosis of osteochondroma. At a 2-year follow-up delay, all symptoms had regressed with no evidence of recurrence.

Giant cervical exostosis: a case report with review of literature

We report a rare case of an 8-year-old girl who presented with a giant cauliflower-like autofused pedunculated osteochondroma arising from spinous processes of the second to sixth cervical vertebrae. She was successfully treated by enbloc excision without any recurrence.

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.

Pes Anserinus Syndrome Due to Solitary Tibial Spurs and Osteochondromas

We studied 19 children with the pes anserinus syndrome due to proximal tibial exostoses. Nine children had a solitary sessile or pedunculated osteochondroma that produced a painful lump that was readily palpable. The symptoms resolved following removal of the osteochondroma. Ten children had a bone spur that was shaped like a rose thorn. It produced pain with snapping or a feeling of locking of the pes anserinus tendons. Careful palpation was required to detect the tender bone spur beneath the pes anserinus. In five children, the bone spurs were excised because of persistent symptoms, and each was shown to be an exostosis without a cartilage cap. The symptoms resolved. However, the bone spurs need not be excised if the symptoms improve with rest and do not recur following resumption of activities.

Fracture Through the Stalk of Pedunculated Osteochondromas

Although fracture through the base of an osteochondroma is a well-recognized clinical entity, the fate of such fractures has never been documented. Recommendations concerning the treatment of these fractures are contradictory. Of the three cases of fracture through the base of a pedunculated osteochondroma observed in the last 12 years, two healed without problem, one in a patient with a solitary osteochondroma, the other in a patient with multiple osteochondromas. The third patient remained symptomatic one year after injury, and histologic evaluation of the specimen after surgical excision confirmed the diagnosis of fibrous nonunion of the fracture. Experience with fractures through the base of a pedunculated osteochondroma suggests that the majority of these fractures will heal without complication, regardless of whether they involve solitary or multiple osteochondromas. However, symptomatic fibrous nonunion of such a fracture may occur particularly when an osteochondroma is located near large, mobile tendons.