Osteochondroma

Bony swelling for

evaluation DR GIRIDHAR BOYAPATI

P.G.

DEPT. OF ORTHOPAEDICS

A 19 year old male presented with chief complaints of

swelling over the right shoulder since 5 years.

Swelling is insidious in onset and gradually progressive in

nature and attained the present size . No sudden

increase in size.

Not associated with pain or discharging sinuses .

No history of trauma or fever.

No history of any other swellings in the body.

No history of chronic cough , significant weight loss.

No other co-morbid conditions, otherwise a healthy

individual.

No past history of similar swellings.

No relevant family history.

On General examination

No significant pallor, cyanosis, icterus , oedema,

regional lymphadenopathy noted.

No signs of infection or any chronic disease.

CVS : S1 S2 +

CNS : No focal neurological deficit

RS : NVBS, no added sounds

P/A : soft, no organomegaly .

ON Local Examination .

ON INSPECTION

A 4 X 4 cm size swelling over the antero- lateral

aspect of Left proximal arm.

Surface is Smooth , ovoid in shape,

Skin over the swelling is normal .

No significant muscle wasting.

No scars, dilated veins, discharging sinuses

ON PALPATION

No local raise of temperature.

No bony tenderness.

Well defined margins.

Swelling is hard in consistency and fixed to the

humerus.

Not reducible or compressible .

No fixity to the overlying skin.

No pulsations.

No bruit on auscultation.

Movements of the shoulder joint normal .

No distal neurovascular deficit.

DEFFERENTIAL Diagnosis

Exostosis / Osteochondroma

Periosteal Chondroma

Parosteal Osteosarcoma

Myosistis ossificans

INVESTIGATIONS

HB 13.7 gm%

T.C 55OO CELLS /CUMM

P.C 2.3 LAKHS

ESR 10mm /1st hr

BT 2:30

CT 4:30

RBS 87mg%

Na 142 meq/l

K 4.3 meq/l

B.UREA 31mg%

S.CREATININE 0.7mg%

X-rays

X-ray report

Exophytic lesion noted in lateral cortex of left

humerus at meta-diaphysial junction away from the

shoulder joint.

Cortex and medulla of the lesion is continuous with

that of the host bone.

Asymmetric widening of meta-diaphysial juntion.

Evidence of cartilage cap noted.

Impression: Osteochondroma of left

proximal humerus.

MRI

MRI

MRI report

Focal bony projection in metaphysical region of left proximal

humerus laterally and anteriorly.

Irregular cartilaginous cap covering the lesion. Maximum

thickness of the cartilage cap is 5mm.

No obvious bursal formation or vascular compression noted.

IMPRESSION : Osteochondroma of left proximal humerus.

Cartilage cap thickness is within normal limits.

Patient was advised

EXCISION of the lesion

1. To rule out malignancy.

2. To prevent complications.

3. To confirm the diagnosis.

SURGICAL APPROACH

1.Using Delto-pectoral

approach a curved incision is

made over the left proximal

arm and plane is created

between Deltoid and

Pectoralis major muscles.

2. Lesion is exposed on

anterolateral aspect of

humerus.

EXCISION

1.Multiple drill holes are

made at the base of

stalk of the lesion.

2. Drill holes are

connected using

osteotome and lesion is

excised en-bloc.

Excised material sent

for histopathology.

POST OPERATIVE

PERIOD

No wound related

complications.

Movements of the shoulder

joint normal .

POST

OPERATIVE

XRAY

Histopathology

Histopathology

MICROSCOPY:

Sections show cartilage with mature bone trabecule

having bone marrow elements.

IMPRESSION: Histological features are

consistent with Osteochondroma.

CENSUS Total of 15 cases of exostosis were operated in the

past 3 years.

All cases are solitary exostosis.

Male 10/ Female 5.

Age group ranging from 8 – 21 years.

Exostosis of

Distal Femur: 8 cases

Proximal Humerus : 6 cases

Distal Tibia : 1 case.

Post operative period is un-eventfull .

No recurrence .

No neurovascular complications .

Range of movements of adjacent joints is

normal.

Exostosis

Is a developmental anomaly of bone that result in formation of an exophytic outgrowth.

Most common bone tumor .

30-50% of benign bone tumors .

10-15 % of all bone tumors.

AGE : First two decades of life.

Sex : male : female 1.5 to 1.

location

Metaphysis of long bones.

Most common sites

Distal femur

Proximal tibia

Proximal Humerus

Also seen in flat bones like ilium, scapula, clavicle.

Pathogenesis

Herniation of a fragment of epiphyseal growth plate

through the periosteal bone cuff.

Misdirected growth of portion of physical plate.

Development of eccentric cartilage capped bony

prominence.

Clinical features

Mostly asymptomatic presenting as painless lump.

Pain may be due to

-pressure on surrounding structures.

-bursitis

-fracture of bony stalk

-malignant change.

mechanical block to joint movements.

Radiographic features.

Occur in metaphysis or in the diaphysis. Never found

in the epiphysis.

Directed away from the growing end of long bones.

Cortex and medulla of the tumor is continuous with

that of the host bone.

Exostosis is either pedunculated or sessile.

Ultrasound

- to determine thickness of cartilage cap

-extent of the bursa

MRI

STRUCTURE AND THICKNESS OF CARTILAGE CAP

MALIGNENT CHANGE

CORD COMPRESSION IN SPINAL LESIONS

TREATMENT

INDICATIONS FOR EXCISION OF THE LESION

Pressure symptoms

Mechanical block

Fracture of the pedicle

Bursitis

Malignancy

Cosmetic ( commonest reason for excision)

Sarcomatous change

Chondrosarcoma

Malignant transformation in

solitary exostosis < 1%

multiple exostosis 5%

flat bones 10%

Malignant change:

rapid increase in size

pain

local raise of temperature.