Aims. We report a prospective cohort study of the midterm results of surgical dislocation of the hip (according to Ganz) to perform resection of osteochondromas involving the femoral neck in patients with multiple hereditary exostoses (MHE). . Methods. Hip range of movement (ROM) was assessed pre- and post-operatively. Patients’ judgment of post-operative reduction of pain, symptoms, the Rand 36-item Health Survey (RAND-36) and complications were analysed. . Results. Symptomatic osteochondromas of the femoral neck were removed in 20 hips (17 patients) between 2007 and 2012. There were nine men and eight women with a mean age at the time of surgery of 29 years (11 to 47). Mean follow-up was 46 months (26 to 73). At latest follow-up, mean ROM was significantly increased in all directions. Post-operatively the pain associated with the lesion was either significantly decreased or non-existent. There was a significant improvement in seven RAND-36 sub-domains. Encountered complications in four patients were pseudoarthrosis of the trochanteric osteotomy, traumatic separation of the trochanteric osteotomy, a pertrochanteric femoral fracture and avasvular necrosis. Histological analysis revealed osteochondromas in all hips. . Discussion. This study confirms the Ganz trochanteric flip osteotomy provided a reliable approach to osteochondromas of the femoral neck that are otherwise difficult to access for surgical resection. The procedure offered significant improvement in the quality of life, although one should be aware of the serious complications can arise despite the relatively safe procedure. Take home message: When daily function and activities are affected, resection of osteochondromas of the proximal femur according to Ganz is indicated to significantly improve quality of life. Cite this article: Bone Joint J 2016;98-B:260–5

Aims. The aim of this study was to report the outcomes of patients who underwent definitive surgery for secondary chondrosarcomas arising from osteochondromas. Patients and Methods. A total of 51 patients with secondary chondrosarcomas occurring from osteochondromas were reviewed. Median age was 36 years (interquartile range (IQR) 15 to 82). Median follow-up was 6.9 years (IQR 2.8 to 10.6). The pelvis was the most commonly affected site (59%). Histological grades were grade I in 35 (69%), grade II in 13 (25%), and grade III in three patients (6%). Results. Preoperative biopsy histology correctly predicted the final histological grade in 27% of patients. The ten-year disease-specific survival (DSS) for all patients was 89.4%. Local recurrence occurred in 15 patients (29%), more commonly in pelvic tumours (37%) compared with limb tumours (19%). Four patients with pelvic tumours died from progression of local recurrence. No patient with limb tumours died of disease. Wide/radical margin was associated with improved local recurrence-free survival (p = 0.032) and local recurrence was associated with worse DSS (p = 0.005). Conclusion. We recommend that a secondary chondrosarcoma arising from osteochondroma of the pelvis is resected with wide/radical resection margins. The balance between the morbidity of surgery and risk of local recurrence needs to be considered in patients with limb secondary chondrosarcomas. Cite this article: Bone Joint J 2019;101-B:1313–1320

Osteochondromas are benign chondrogenic lesions arising on the external surface of the bone with aberrant cartilage (exostosis) from the perichondral ring that may contain a marrow cavity also. In a few cases, depending on the anatomical site affected, different degrees of edema, redness, paresthesia, or paresis can take place due to simple contact or friction. Also, depending on their closeness to neurovascular structures, the procedure of excision becomes crucial to avoid recurrence. We report a unique case of recurrent osteochondroma of the proximal humerus enclosing the brachial artery which makes for an important case and procedure to ensure that no relapse occurs. We report a unique case of a 13-year-old female who had presented with a history of pain and recurrent swelling for 5 years. The swelling size was 4.4 cm x 3.7 cm x 4 cm with a previous history of swelling at the same site operated in 2018. CT reports were suggestive of a large well defined broad-based exophytic diaphyseal lesion in the medial side of the proximal humerus extending posteriorly. Another similar morphological lesion measuring approximately 9 mm x 7 mm was noted involving the posterior humeral shaft. The minimal distance between the lesion and the brachial artery was 2 mm just anterior to the posterio-medial growth. Two intervals were made, first between the tumor and the neurovascular bundle and the other between the anterior tumor and brachial artery followed by exostosis and cauterization of the base. Proper curettage and excision of the tumor was done after dissecting and removing the soft tissue, blood vessels, and nerves so that there were very less chances of relapse. Post-operative X-ray was done and post 6 months of follow-up, there were no changes, and no relapse was observed. Thus, when presented with a case of recurrent osteochondroma of the proximal humerus, osteochondroma could also be in proximity to important vasculature as in this case enclosing the brachial artery. Thus, proper curettage and excision should be done in such cases to avoid recurrence

Aim: A case report: Symptomatic Osteochondroma of the Coracoid. Introduction: An osteochondroma is a common developmental tumour of bone characterized by abnormal periphyseal ectopic endochondral ossification. This results in a cartilage-capped subperiosteal bony projection. A solitary osteochondroma is encountered more frequently than are multiple hereditary osteochondromas. They are usually appreciated in the first decades of life and are most commonly located in the long bones, especially the femur, humerus and the tibia. Clinical presentations generally relate to the mass effect of the lesion. These lesions are said to grow to skeletal maturity. Continuous slow growth of the osteochondroma in adults should alert the clinician to the possibility of secondary malignant transformation, usually to a chondroma. Method: We present an unusual case of shoulder pain in a 36-year-old man with a painful solitary osteochondroma of the coracoid process. Plain radiographs, computed tomographic and magnetic resonance imaging of the lesion showed a solitary osteochondroma with a visible cartilage cap eroding the under surface of the clavicle. The lesion was surgically explored and excised. Histological examination showed a benign osteochondroma. Removal of the tumour resulted in resolution of all signs and symptoms. Conclusion: We are aware of no reported cases in the literature of osteochondroma of the coracoid process. This case was unusual in terms of age at clinical presentation and location, suggesting a continuous growth of the tumour beyond skeletal maturity

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° to 75.0° (p = 0.049). Ulnar lengthening did not significantly affect the clinical outcome. The Sauvé-Kapandji technique improved the mean pronation from 33.6° to 55.0° (p = 0.047) and supination from 70.0° to 81.4° (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

Our aim was to investigate the outcome of excision of osteochondromas. 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

Osteochondroma is the most common benign bone tumour. The risk of sarcomatous change in an isolated lesion is approximately 1%. We report a case of an isolated osteochondroma which appeared benign on clinical and plain radiographic examination but routine histological analysis revealed non-Hodgkin’s lymphoma in the underlying bone. This association has not previously been reported and the case emphasises the importance of routine histological analysis, even if a lesion appears benign

Osteochondromas occur are most commonly in the distal femur, proximal tibia and fibula and the proximal humerus. There are no large studies focusing on the clinical presentation, management and outcome of treatment for patients with an osteochondroma involving the proximal fibula. The purpose of this study is to specifically understand the manifestation of the proximal fibular osteochondroma on the preoperative peroneal nerve function, and how surgical management of the osteochondroma affects function immediately postoperatively and at long-term followup. This is an IRB-approved retrospective review of a consecutive series of patients with a proximal fibular osteochondroma (PFO) treated operatively at a single institution from 1990 to 2013. The medical record was carefully reviewed to identify demographic data, clinical data and especially the status of the peroneal function at various time points. There were 25 patients with 31 affected extremities who underwent surgical excision of the PFO at an average age of 12.4 years (range 3.0–17.9 years). There were 16 males and 9 females. The underlying diagnosis was isolated PFO in 2(8%) patients and multiple hereditary exostosis (MHE) in 23(92%) patients. Preoperatively, 9 (29%) had a foot drop and 22 (71%) did not. Those with preoperative foot drop underwent surgery at a younger age (9.1 vs 13.8 years) (p<0.004). Five of the nine (55.5%) had complete resolution, three (33.3%) had improvement, and one (11.1%) persisted postoperatively and required AFO. Of the 22 who were normal preoperatively, 5 (22.7%) developed a postoperative foot drop-three (60%) completely resolved, 1 (20%) improved, and 1 (20%) persisted and was found to have a transected nerve at exploration. In total, 23 of the 25 (92%) patients who had a PFO excision, had a normal or near-normal peroneal nerve function including those who had poor function preoperatively. A proximal fibular osteochondroma can result in a high incidence of peroneal nerve dysfunction prior to any treatment, but responds the majority of the time to surgical intervention with removal of the osteochondroma. For those who have normal preoperative function, 1 in 4 will develop a postoperative foot drop but nearly all improve spontaneously unless iatrogenic injured

An osteochondroma is a benign tumour and multiple hereditary osteochondromatosis [MHO] is an auto-somal dominant skeletal disorder in which there are numerous cartilage-capped excrescences. The true incidence of malignant change of osteochondromas is not known, as many osteochondromas, especially solitary lesions, are asymptomatic and usually not reported. Between the years 1995 to 2002, 11 patients with a secondary chondrosarcoma developing in osteochon-droma were found, out of 300 cases of musculoskeletal tumours treated at our institution. All the patients were treated surgically, The mean follow up of the patients was approximately 2 years [range from 3 months to 4 years]. In radiographs, evidence of malignant change was seen in all the cases. In the cases where MRI was carried out [6 out of 11 cases], the average cartilage cap thickness was 5.0 cm [ranging from 2 to 12 cm]. It is important to recognize the features suggesting malignant change, namely pain, continued growth of the lesion after skeletal maturity, thick bulky cartilaginous cap, and soft tissue mass with or without calcifications. Six of our cases had Grade I chondrosarcoma. High-grade chondrosarcomas occur with greater frequency in patients of multiple hereditary osteochondromatosis. Grading of chondrosarcoma is considered to have prognostic significance. However, the rate of local recurrence is primarily dependent on the adequacy of the primary surgical therapy, rather than the histological grade. In our series we had 3 cases wih local recurrence. In 2 of these cases, intralesional debulking had been done and in 1 case of marginal excision was done. Therefore primary resection [with a cuff of normal tissue] or radical excision appears to be the treatment of choice for these lesions

The purpose of this study was to determine the surgical risks and recurrence rate associated with the excision of osteochondroma from the long bones most frequently operated on in our institution; the femur, tibia, humerus and fibula. Two hundred and twenty four osteochondromata were excised in total between July 1992 and January 2001. The medical records and radiographs of 126 patients who had 147 osteochondromata excised from the femur, tibia, humerus and fibula were reviewed. Of these, 30 patients presented with multiple osteochondromata, accounting for 48 of the 147. Fifty three involved the femur (2 proximal), 55 the tibia (16 distal), 12 the fibula (2 distal) and 27 the proximal humerus. The mean age at excision was 12.5 years (2–18 years) and the mean follow-up was five years (1 to 10 years). There were 15 surgical complications (10% of excisions) including one compartment syndrome, five superficial wound infections, two haematoma formations which required evacuation, one partial wound dehiscence, one deep infection with sinus formation which required excision, one sural nerve and one saphenous nerve neuropraxia, one cutaneous nerve entrapment and two hypertophic scar/keloid formations. The patient with the compartment syndrome had excision of a distal femoral, proximal tibial and fibular osteochondroma during the same procedure and was diagnosed to have won Willebrand disease after the surgery. There were eight recurrences involving five patients with multiple osteochondromata and three in whom the excision was incomplete due to the proximity to neurovascular structures. Surgical risks related to excision of osteochondroma are relatively frequent and must not be underestimated. Excision should therefore only be performed if strongly indicated. The recurrence rate (5.5%) seems to be higher than previously reported in the literature (2%) and generally affects patients with multiple osteochondromata. Incomplete excision resulted in recurrence in all our cases

Introduction and Objectives: Osteochondroma is the most common tumour of the bone. Treatment is necessary only in the case of pain, compression of adjacent structures, for aesthetic reasons, or in cases of suspected malignancy. Materials and Methods: This study reviews a series of 119 patients with solitary osteochondroma tracked in our centre since 1975. Location, gender, reason for consultation, tumour and treatment-related complications, type of treatment, recurrence and malignant transformation, and final status of patients were tracked for a minimum of one year. Results: Of the 119 patients in this study, 75 required surgical intervention, with tumor recurrence being the most common complication (15 cases). Seven patients suffered malignant transformation all of which resolved after surgical intervention. Discussion and Conclusions: In our experience, simple resection is a satisfactory treatment for osteochon-droma in most cases. Periodic follow-up is necessary in these cases as they have the potential to become malignant

Aim: This study describes the clinical features and treatment of 94 patients with skeletal osteochondroma during the last 20 years. Materials-methods: A retrospective review of various size solitary osteochondroma was evaluated. There were 51 males and 44 females with mean age 21 years. The mean follow-up was 8 years (1–12). There were 40 lesions in the distal femur, 6 in the greater trochanter, 19 in the proximal tibia, 1 in the proximal fibula, 1 in the calcaneus, 3 in the lateral malleolus, 1 in the medial malleolus, 3 in the talus, 2 in the tarsus, 3 in the metatarsals, 3 in the scapula, 4 in the humerus, 1 in the elbow,1 in the radius, 6 in the fingers. The lesions were diagnosed by history and plain radiographs. In two patients with large lesions around the knee an angiography was done. Results: Pain and local tenderness were the main symptoms. The treatment was en bloc excision of the tumor. There were no recurrence. Two patients had wound infection which was dealt with antibiotic. Conclusion: The site and the results of this study are similar with the literature. The radiologic image is pathognomic for the tumor. The treatment consisted of en bloc excision. There is high possibility of recurrence in case of insufficient excision

Intracapsular and para-articular osteochondromas are a rare subtype of soft tissue chondroma occurring in and around joints. We report a giant 5.5cm × 5.5cm × 3.0cm mass occurring in the knee of a 45 years old lady and examine previous cases to update our understanding of para-articular soft tissue osteochondromas. Clinicopathological data were obtained from medical records for the case report whilst a multi-database literature search was conduction for the literature review. 27 articles containing 39 cases were identified in the English literature under our strict inclusion criteria. Along with our data, 40 cases were collated and analysed to provide a set of reference characteristics. These included: age, male-female ratio, spatial location, time of onset, tumour size, clinical symptoms, mechanism of injury, investigations used, treatment received, histopathology features, follow-up and recurrence characteristics. Statistical analysis was performed on data to elicit any discernable pattern of tumour formation. Median age of patients was 50 years old with a male to female ratio of 1:1.11. Most commonly occurs in the 40s, 50s and 60s accounting for two-thirds of all cases. Majority of tumours were located within or adjacent to a fat pad structure. 33 were located in the infra-patellar region, 3 in the suprapatella/pre-femoral region and 4 in other para-articular locations. Average time of onset to diagnosis was 5.81 yrs with a mean volume of 87.5 cubic centimetres. No discernable correlation between time of onset to diagnosis and tumour size was found (spearman correlation co-efficient 0.534, p=0.007). The main symptom reported was pain in 29 cases, whilst 5 were pain free, 6 cases were unspecified. X-Rays, CT and MRI have become the core imaging modalities in investigation. En bloc excision is the choice of treatment, whilst arthroscopic techniques have also been used with similar success. Histologically, 35 cases had a typical description of a cartilage capped lesion with central trabecular bone and areas of endochondral ossification. 3 cases had a histological appearance of predominantly bone whilst 2 cases had predominantly cartilage. All tumours analysed were benign. No recurrences were reported with an average follow up period of 1.91 years. We have provided the latest set of data for the characterisation of para-articular and intracapsular soft tissue osteochondromas. These tumours are benign entity with an invariably good outcome following simple excision. Recognition of this entity is important to prevent over investigation and the performance unnecessarily invasive and radical procedures

1. Two cases are reported in which reappearance of an osteochondroma after excision was shown to represent a second independent lesion and not a true recurrence. 2. The significance of this observation is discussed in relation to the pathogenesis and prognosis of this lesion. 3. A plea is made for greater discrimination in using the ominous description "recurrence," because the rare true recurrence must strongly favour a diagnosis of malignancy

We report two cases of vertebral osteochondroma. In one patient a solitary cervical lesion presented as entrapment neuropathy of the ulnar nerve and in the other as a thoracic tumour associated with hereditary multiple exostoses producing paraplegia. We highlight the importance of an adequate preoperative evaluation in such patients

Eight children developed osteochondroma (OS) at a mean of 88 months, after hematopoietic stem cell transplantation (HSCT). The mean age at HSCT was 56 months (12-84). This represents a cumulative incidence of 20% among patients less than 18 years of age transplanted from 1981 to 1997. These eight patients underwent allogeneic (n=2) of autologous (n=6) transplantation for either acute leukemia (n=6) or neuroblastoma (n=2) after a conditioning regimen including total body irradiation (n=7) or a combination of Busulfan and Cyclophosphamide.Multiple OS were indentified in seven patients and a solitary OS in one. Locations included: clavicle (2), ribs (2), superior iliac epiphysis (1), metaphy-sis of the distal femur (2), distal (2) and proximal (1) tibia, proximal humerus (1), distal radii (3), scapula (3), proximal metaphysis of the proximal phalanges of the fingers (2) and parietal bone (1). OS were asymptomatic in four children. Eight lesions in five patients were resected and all were benign. No recurrence occured.Four children received growth hormone before diagnosis of OS, but there was no clinical, radiological or histological difference between those who did not. Univariate analysis showed an increased rate associated only with autolo-gous HSCT, with a 31,7% probability of a new OS et 12 years after HSCT.Ostoechondroma should be added to the other adverse effects of HSCT in children

Dysplasia Epiphysealis Hemimelica (DEH) also known as Trevor's Disease is a rare developmental disorder resulting in cartilaginous overgrowth of the epiphysis of long bones. DEH is usually diagnosed in children between two and eight years old and it is three times more often diagnosed in boys. The most reported complaints are pain, limitation in range of motion, and deformity or swelling of the affected joint. Treatment of symptomatic lesions consists of surgical resection of the lesion, resulting in good long-term results. Based on histological evaluation, DEH is often described as an osteochondroma or an osteochondroma-like lesion, although there are clinical, radiological and genetic differences between DEH and osteochondromas. To investigate the hypothesis that DEH and osteochondromas are histologically identical, two cases of DEH and two cases of osteochondromas in patients with Hereditary Multiple Osteochondroma (HMO) are compared at histological level. Tissue samples from patients with a histopathologically confirmed diagnosis of DEH were compared with two age and gender matched patients diagnosed with HMO. After tissue sampling and processing, (immuno)histological stainings were performed for Collagen type II, Collagen type X, Sox-9 and Safranin-O. Histologically, clumping of chondrocytes in a fibrillar matrix, a thick disorganized cartilage cap and ossification centres with small amounts of unresorbed cartilage were observed in DEH. In contrast, chondrocyte organisation in cartilage of osteochondromas displays characteristics of the normal growth plate. In addition, differences in expression of collagen type II, collagen type X and Sox9 were observed. Collagen type II was expressed in the extracellular matrix surrounding proliferative and hypertrophic chondrocytes in osteochondromas, while weak expression was observed in the entire cartilage cap in DEH. Collagen type X was not expressed in DEH, while expressed in the pericellular matrix surrounding hypertrophic chondrocytes in osteochondromas. Staining for Sox9 was positive in the hypertrophic chondrocytes in osteochondromas, while expressed in the nuclei of all chondrocyte clusters in DEH. Both morphological and immunohistological differences were observed in histological sections of DEH and osteochondromas. These findings reject our hypothesis, and supports the earlier observed clinical, radiological and genetic differences and implies a different aetiology between DEH and osteochondroma formation in HMO

Aim: The pelvis is a rare location for osteochondromas and differentiation from chondrosarcomas can be difficult. We aim to aid this differentiation using tends and demographics of treated cases. Methods and Results: Patients referred to a supra-regional bone tumour centre with pelvic tumours, consequently diagnosed as osteochondromas were studied to determine the clinico-pathological features that differentiate them from chondrosarcoma. Treatment outcome was also reviewed. 30 patients were studied with a mean follow-up of 32 months. The mean age at diagnosis was 34yrs (range 19–79). The male to female ratio was 1:1. The most common location was the ilium (19 patients), with the pubis and ischium accounting for a third of patients. Only 1 patient had an acetabular osteochondroma. Median duration of symptoms prior to referral was 6 months (1–79). Pain without a lump was the main presenting symptom (16 patients), followed by lump with pain (6), and lump alone (6). Two patients presented with obstructive labour requiring emergency procedures. The lesions were solitary in 24 and associated with hereditary multiple exostosis (HME) in 6 patients. 1 patient had a radiation induced lesion. The lesions showed increased uptake on bone scans and the cartilage cap was less than 10mm in all but 2 patients. Treatment was surgical excision in 21 patients and observation with serial radiographs in 9. Histological examination confirmed osteochondroma in all patients, however 1 patient with HME had areas of Grade I malignancy. Significant surgical complications occurred in 1 patient who developed pulmonary embolism. Conclusion: We conclude that symptoms from osteochondromas of the pelvis are similar to those with chondrosarcomas and increased uptake on bone scans is seen in both. However, a tumour with a cartilage cap larger than 10mm or arising from the acetabulum is unlikely to be an osteochondroma