Search

INTRODUCTION: Radial head dislocation in patients with multiple hereditary exostosis (MHE) can lead to functional deficit. We investigated whether the location of the exostosis and certain radiological criteria predict risk of radial head dislocation/subluxation. HYPOTHESIS: We hypothesized that the radiological criteria differentiate between patients who need closer follow-up of the forearm and others for whom multiple radiographs are superfluous. PATIENTS AND METHODS: We retrospectively reviewed the demographics of patients with MHE in our hospital, and radiographic measurements were made on forearm radiographs: radial length, ulnar length, ulnar variance, radial articular angle, and radial bowing. RESULTS: 49 forearms were analyzed in 30 patients. Mean age was 9.5 years at first evaluation and 11.8 years at last evaluation. Radial head dislocation or subluxation was found in 6 forearms (12%). Risk factors comprised isolated exostosis in the distal portion of the ulna or exostosis in the distal part of both the ulna and radius, radial or ulnar shortening > 4.6 cm, radial bowing > 8.1%, radial articular angle > 35°, and ≥ 3 exostoses in the forearm. DISCUSSION: In patients with MHE with risk factors for radial head dislocation, close follow- up with regular radiography is indicated and early surgery should be performed before the radial head dislocates. LEVEL OF EVIDENCE: IV; retrospective study.

Resection of malignant tumors in the posterior pelvis requires multidirectional approaches for the resection and the subsequent spine-pelvic fixation. The multifidus muscle can be scarified during the operation. This is a case report of a 44-year-old male with a secondary chondrosarcoma arising from an osteochondroma in the sacral ala. Recurrence occurred 11 months after the initial operation, and the resected tissue from the recurrence was diagnosed as a chondrosarcoma. In both operations, the multifidus muscle was elevated from its distal attachment to provide an adequate view of the tumor resection and insertion of spine-pelvic instrumentation. An adequate view by elevation of the multifidus muscle is useful for a safe operation. A preserved multifidus muscle covering the instrumentation may reduce the risk of infection. The elevation and preservation of the multifidus muscle is an easy and simple method that contributes to successful resection of a malignant tumor of the pelvis.

We successfully treated a case of facial asymmetry involved in unilateral mandibular condylar osteochondroma with ipsilateral mandibular condylectomy and contralateral ramus osteotomy. A female, 32-year 11-month of age, had a chief complaint of facial asymmetry which initiated about 10 years ago. A mirror image analysis using a non-contact 3D image scanner revealed that the soft tissue on the deviated side was protruded more than 5.50 mm compared with the non-deviated side. The patinet was diagnosed as facial asymmetry with a skeletal Class III jaw-base relationship caused by unilateral mandibular condylar osteochondroma. After 18 months of preoperative orthodontic treatment, ipsilateral condylectomy and contralateral sagittal split ramus osteotomy were performed. As the results of postoperative orthodontic treatment for 20 months, an ideal occlusion having a Class I molar relationship with an adequate interincisal relationship was achieved. Facial asymmetry and mandibular protrusion were dramatically improved, and the differences between the deviation and non-deviation sides were decreased to less than 1.11 mm. The acceptable occlusion and symmetric face were maintained throughout 1-year retention period. Conclusively, our results indicated the stability after condylectomy without condylar reconstruction in a patient with unilateral condylar osteochondroma.

Osteochondroma is the most common benign primary tumor of appendicular skeleton arising from the metaphyseal or metadiaphyseal region of long bones and are most commonly seen around the knee. A proximal fibular osteochondroma may distort the normal anatomical course of nerves and it may lead to vascular compression syndromes or peroneal nerve paralysis. We report a case of proximal fibular osteochondroma causing splitting of common peroneal nerve leading to neuropathy in an adult. Our article concludes that osteochondroma of proximal fibula could be responsible for common peroneal nerve palsy due to compression or entrapment and in such cases decompression of nerve should not be delayed. Moreover, we also report that osteochondroma causing splitting of midsubstance of common peroneal nerve which may surprise surgeon intraoperatively. Through this case report, we are hoping to alert surgeons that this problem may occur, and care should be taken to identify the entire common peroneal nerve prior to removal of the osteochondroma.

Osteochondroma is a benign cartilaginous neoplasm and the most common benign tumor of bone. Osteochondromas occur primarily in the axial skeleton with a predilection for the distal femur, and relatively few cases occur in the head and neck region. The majority of cases of osteochondromas in the head and neck region affect the mandibular condyle, with fewer cases reported in the skull base and the neck. To our knowledge, there is no reported case of osteochondroma of the hyoid bone documented in the English literature. We thus report the first case of a hyoid bone osteochondroma, presenting as an asymptomatic mass in a young woman.

OBJECT Clinical outcomes in patients with primary spinal osteochondromas are limited to small series and sporadic case reports. The authors present data on the first long-term investigation of spinal osteochondroma cases. METHODS An international, multicenter ambispective study on primary spinal osteochondroma was performed. Patients were included if they were diagnosed with an osteochondroma of the spine and received surgical treatment between October 1996 and June 2012 with at least 1 follow-up. Perioperative prognostic variables, including patient age, tumor size, spinal level, and resection, were analyzed in reference to long-term local recurrence and survival. Tumor resections were compared using Enneking appropriate (EA) or Enneking inappropriate surgical margins. RESULTS Osteochondromas were diagnosed in 27 patients at an average age of 37 years. Twenty-two lesions were found in the mobile spine (cervical, thoracic, or lumbar) and 5 in the fixed spine (sacrum). Twenty-three cases (88%) were benign tumors (Enneking tumor Stages 1-3), whereas 3 (12%) exhibited malignant changes (Enneking tumor Stages IA-IIB). Sixteen patients (62%) underwent en bloc treatment-that is, wide or marginal resection-and 10 (38%) underwent intralesional resection. Twenty-four operations (92%) followed EA margins. No one received adjuvant therapy. Two patients (8%) experienced recurrences: one in the fixed spine and one in the mobile spine. Both recurrences occurred in latent Stage 1 tumors following en bloc resection. No osteochondroma-related deaths were observed. CONCLUSIONS In the present study, most patients underwent en bloc resection and were treated as EA cases. Both recurrences occurred in the Stage 1 tumor cohort. Therefore, although benign in character, osteochondromas still require careful management and thorough follow-up.

The expression of bone morphogenetic proteins (BMPs) and their cognate receptors (BMPRs) in osteochondromas has not been investigated. We determined the immunohistochemical localization and distribution of BMP-2/4, -6 and -7; BMP receptors BMPR-1A, BMPR-1B and BMPR-2; signal transducing proteins phosphorylated Smad1/5/8; and BMP antagonist noggin in the cartilaginous cap of solitary (SO) and multiple (MO) human osteochondromas and compared these with bovine growth plate and articular cartilage. The distribution and localization patterns for BMP-6, BMP-7, BMPR-1A and BMPR-2 were similar between the cartilaginous cap and the growth plate. BMP-2/4 and BMPR-1B were present throughout the growth plate. However, BMP-2/4 and phosphorylated Smad1/5/8 were mainly detected in proliferating chondrocytes of the cartilaginous cap. Also, BMPR-1B was found in hypertrophic chondrocytes of SO and proliferating chondrocytes of MO. Noggin was observed in resting chondrocytes and, to a lesser extent, in clustered proliferating chondrocytes in SO. On the other hand, noggin in MO was observed in proliferating chondrocytes. Since BMPs can stimulate proliferation and hypertrophic differentiation of chondrocytes, these findings suggest that there is an imbalance of BMP-2/4 and noggin interactions that may lead to abnormal regulation of chondrocyte proliferation and differentiation in the cartilaginous cap of human osteochondromas.

The expression of bone morphogenetic proteins (BMPs) and their cognate receptors (BMPRs) in osteochondromas has not been investigated. We determined the immunohistochemical localization and distribution of BMP-2/4, -6 and -7; BMP receptors BMPR-1A, BMPR-1B and BMPR-2; signal transducing proteins phosphorylated Smad1/5/8; and BMP antagonist noggin in the cartilaginous cap of solitary (SO) and multiple (MO) human osteochondromas and compared these with bovine growth plate and articular cartilage. The distribution and localization patterns for BMP-6, BMP-7, BMPR-1A and BMPR-2 were similar between the cartilaginous cap and the growth plate. BMP-2/4 and BMPR-1B were present throughout the growth plate. However, BMP-2/4 and phosphorylated Smad1/5/8 were mainly detected in proliferating chondrocytes of the cartilaginous cap. Also, BMPR-1B was found in hypertrophic chondrocytes of SO and proliferating chondrocytes of MO. Noggin was observed in resting chondrocytes and, to a lesser extent, in clustered proliferating chondrocytes in SO. On the other hand, noggin in MO was observed in proliferating chondrocytes. Since BMPs can stimulate proliferation and hypertrophic differentiation of chondrocytes, these findings suggest that there is an imbalance of BMP-2/4 and noggin interactions that may lead to abnormal regulation of chondrocyte proliferation and differentiation in the cartilaginous cap of human osteochondromas.

Introduction: The benign bone tumors are most frequent in pediatric age; osteochondroma is the major of them. Objective: To determine the osteochondroma frequency and the most common anatomic location on patients aged less than 19 years. Materials and methods: It was made a five years study with a descriptive and longitudinal design. To select the cases with histopathological diagnosis of osteochondroma between January 1 of 2008 and December 31 of 2013, were reviewed the clinical records included in the biopsies book of the Department of anatomy pathology of Hospital Pediatrico Universitario “Eduardo Agramonte Piña” of Camaguey, Cuba. Results: Children between 10 and 14 years are the most frequent group with osteochondroma. The most common location of osteochondroma was metaphyseal, principally in the metaphysis of the distal femur and proximal humerus and tibia. All pathological findings about benign bone tumors in the medical records were comparable to literature consulted. Conclusion: Given that the anatomic location of osteochondroma is the metaphysis of long bones, and the injuries can be multiple or solitary, the study of associated comorbidity it is important for establishing the diagnosis and follow of disease as well as for the early identification of possible complications of this benign tumor., Introducción: Los tumores óseos benignos son los más frecuentes en la edad pediátrica, entre ellos, el osteocondroma es el principal. Objetivo: Determinar la frecuencia y la localización anatómica más habitual del osteocondroma en un grupo de pacientes menores de 19 años. Materiales y métodos: Se realizó un estudio de cinco años con un diseño descriptivo y longitudinal, en el cual se revisaron los informes médicos contenidos en el libro de biopsias del Departamento de anatomía patológica del Hospital Pediátrico Universitario “Eduardo Agramonte Piña” de Camagüey, Cuba, correspondientes a todos aquellos casos con diagnóstico histopatológico de osteocondroma, en el período de enero 1 de 2008 a diciembre 31 de 2013. Resultados: El grupo de edad en el cual se observó mayor frecuencia de osteocondroma fue en el de 10 a 14 años. La localización más frecuente fue la metafisaria, siendo la metáfisis distal del fémur la más encontrada, seguida de la proximal del húmero y la tibia. Los hallazgos anatomopatológicos reportados en los informes médicos estudiados son comparables con los ofrecidos por la literatura consultada en cuanto a los tumores óseos benignos se refiere. Conclusiones: Teniendo en cuenta que la localización anatómica del osteocondroma es a nivel de la metafisis de los huesos largos y, que las lesiones se pueden presentar de forma múltiple o solitaria, el estudio de la comorbilidad asociada a este tipo de tumor resulta de gran importancia tanto para el establecimiento del diagnóstico y la definición de la conducta a seguir, así como para la identificación precoz de las complicaciones que de esta enfermedad se puedan derivar.

Osteochondromas is one of the common bone tumour account for 35-46% of cases. These are most commonly seen on the metaphysis of a long bone, but they can arise from any bone which is preformed from cartilage and also involves flat bones like ilium and scapula. Scapular involvement is noted in 3 – 4.6 % of cases and patients usually are affected by winging of scapula. It is common in young patients, usually below 30 years of age, with a ratio of males to females of 2:1. We present a male patient diagnosed with solitary asymptomatic scapular osteochondroma with review of literature.

Paraarticular ostehochondroma is a rare osteocartilagenous tumor that arises in the soft tissue adjacent to a joint with no attachment to the bone. Although several case reports have been published on this tumor, spinal paraarticular osteochondroma has not been reported in the literature. We present a patient with a paraarticular osteochondroma arising in the spinal canal just medial to the facet joint that caused severe spinal cord compression. A 69-year-old man complained of paresthesia and muscle weakness in the lower extremities. Cervical magnetic resonance imaging and computed tomography revealed an intraspinal mass lesion at C7–Th1 with severe compression of the thecal sac, and concomitant spinal canal stenosis on C3–C7. Surgical en bloc resection of the calcified mass and C3–C6 laminoplasty were performed. The patient’s symptom improved dramatically. Histological analysis showed that the lesion comprised trabecular bone and bone marrow, and was capped by hyaline cartilage with no connection to the bone. This is the first report of spinal paraarticular osteochondroma.

Subungual exostosis is a benign bony tumor, uncommon in childhood, and it is clinically manifests as a subungual tumor thatassociates variable degree of nail plate or periungular soft tissues alteration. It generally consists of an isolated lesion thatmainly affects first toe terminal phalanx. Its exact etiology is still unknown. Clinical suspicion is confirmed by the radiographicfinding of a distinct trabecular bone growth arising from the dorsal aspect of the phalanx of the affected digit.Surgical excisionis the treatment of choice.We report a case of a 9 years old boy with subungual exostosis., La exostosis subungueal es un tumor óseo benigno, infrecuente en la infancia, que se manifiesta clínicamente comouna tumoración subungueal acompañada por diferentes grados de alteración de la lámina ungueal o de los tejidosadyacentes. Generalmente es una lesión única, localizada en la falange distal del primer dedo del pie. Su etiología noestá completamente aclarada. El diagnóstico es principalmente clínico y la radiografía lo confirma con el hallazgo deuna imagen excrecente redondeada radio-opaca, yuxtapuesta a la cara dorsal de la falange del dedo afectado, quecorresponde a hueso trabecular. La resección quirúrgica es el tratamiento de elección. Se describe el caso deexostosis subungueal en un niño de 9 años.

The role of hip arthroscopy in the management of femoroacetabular impingement (FAI) has been advancing rapidly. In this case report, we describe the use of hip arthroscopy to successfully treat a femoral neck osteochondroma that caused a symptomatic labral tear in a 37 year old woman. Hip arthroscopy offers several advantages to surgical dislocation of the hip in the management of intraarticular pathology and FAI. Hip arthroscopy is minimally invasive without the significant trauma to hip musculature, is useful in treatment of labral tears generated by FAI, and can be used to resect small lesions on the femoral head.

The role of hip arthroscopy in the management of femoroacetabular impingement (FAI) has been advancing rapidly. In this case report, we describe the use of hip arthroscopy to successfully treat a femoral neck osteochondroma that caused a symptomatic labral tear in a 37 year old woman. Hip arthroscopy offers several advantages to surgical dislocation of the hip in the management of intraarticular pathology and FAI. Hip arthroscopy is minimally invasive without the significant trauma to hip musculature, is useful in treatment of labral tears generated by FAI, and can be used to resect small lesions on the femoral head.

Osteochondroma are the most common benign bone tumors. They represent approximately 40% of benign and 10% of all primary skeletal tumors.

The coexistence of two different types of benign cartilaginous tumours of bone in the same patient has not been reported in literature. We report a case in which a sixteen-year-old male had a benign chondroblastoma of the proximal left humerus and an osteochondroma of the distal left femur. Both originated at the same time and had a progressive increase in size with growth.

Objetivo: Estudiar a largo plazo la evolución histológica de defectos osteocondrales de la rótula de conejos tratados con fibra de carbono. Material y Método: 18 conejos de raza gigante español, variedad parda, de ambos sexos, con un peso aproximado de 1.5 a 2 Kg y 18 discos Cleveland de fibra de carbono de 8 mm de diámetro (Medicarb®, fabricado por Leyland Medical International). Creación de un defecto de 6 mm. de diámetro en la superficie articular de la rótula, hasta alcanzar el tejido óseo subcondral sangrante, que fue rellenado con un disco de fibra de carbono previamente humedecido en solución salina y recortado para una adecuada adaptación al defecto. Resultados: A los seis meses de evolución postoperatoria el defecto fue rellenado por tejido fibroso, a los nueve meses se desarrolló tejido fibrocartilaginoso y a los 12 meses los defectos estaban cubiertos por tejido cartilaginoso hialino. Conclusiones: Demostramos la neoformación de cartílago hialino en defectos osteocondrales de rótula de conejo rellenados con fibra de carbono., Peer Reviewed

A very rare case of solitary osteochondroma of the knee is reported. The patient presented with a slowly growing retropatellar bony tumour of 4 years duration following a minor trauma. An excisional biopsy with a total patellectomy was performed as the patellar articular surface was unsalvageable. A 20 month follow up revealed no recurrence and a functional knee. A brief review of literature is also presented.

Ultrasonography (US) enables accurate assessment of the cartilage cap of exostoses. The cartilage cap appears as a hypoechoic layer covering the hyperechoic surface of the calcified part. Measurements of cap thickness with US were compared with measurements performed on pathological specimens in 22 resected exostoses and 2 exostotic chondrosarcomas. The US measurements proved to be very accurate, with a mean measurement error of less than 2 mm for cartilage caps less than 2 cm thick. The detection rate and measurement accuracy of US were higher than with computed tomography (CT) and comparable to magnetic resonance imaging (MRI), which were available in 14 and 10 cases, respectively. US appears to be a good procedure for evaluating the cartilage cap, which is usually thin for a benign exostosis and thick for a malignancy. In addition, other complications--such as bursa formation--are easily recognizable. The sole limitation is that US cannot visualize the cartilage cap when it is inwardly orientated or deeply located in soft tissues, which are both, however, relatively uncommon situations.

Osteochondromatosis is a condition in which multiple benign, cartilage-capped tumors arise from the surface of bones formed by endochondral ossification. The current report describes the presence of 4 prominent exophytic masses, measuring between 4 and 13 cm in diameter, arising from the surface of the ribs, and located within the thoracic cavity, in a 2-year-old female domestic pig (Sus scrofa domesticus). Histological studies revealed that masses were well-differentiated, cartilage-capped proliferations with an orderly pattern of endochondral mineralization toward deeper areas. The observed gross and microscopic findings are characteristic of osteochondromatosis.

Osteochondromatosis is a condition in which multiple benign, cartilage-capped tumors arise from the surface of bones formed by endochondral ossification. The current report describes the presence of 4 prominent exophytic masses, measuring between 4 and 13 cm in diameter, arising from the surface of the ribs, and located within the thoracic cavity, in a 2-year-old female domestic pig (Sus scrofa domesticus). Histological studies revealed that masses were well-differentiated, cartilage-capped proliferations with an orderly pattern of endochondral mineralization toward deeper areas. The observed gross and microscopic findings are characteristic of osteochondromatosis.

Osteochondromatosis is a condition in which multiple benign, cartilage-capped tumors arise from the surface of bones formed by endochondral ossification. The current report describes the presence of 4 prominent exophytic masses, measuring between 4 and 13 cm in diameter, arising from the surface of the ribs, and located within the thoracic cavity, in a 2-year-old female domestic pig (Sus scrofa domesticus). Histological studies revealed that masses were well-differentiated, cartilage-capped proliferations with an orderly pattern of endochondral mineralization toward deeper areas. The observed gross and microscopic findings are characteristic of osteochondromatosis.