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Vita F, Tuzzato G, Pederiva D, Bianchi G, Marcuzzi A, Adani R, Spinnato P, Miceli M, Donati D, Manzetti M, Pilla F, Faldini C. Osteoid Osteoma of the Hand: Surgical Treatment versus CT-Guided Percutaneous Radiofrequency Thermal Ablation. Life (Basel) 2023; 13:1351. [PMID: 37374133 DOI: 10.3390/life13061351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: Osteoid osteoma (OO) is one of the most common benign bone tumors. This type of osteogenic tumor is generally characterized by a well-defined lytic area with a vascularized central nidus surrounded by sclerosis and bone thickening. The wrist and hand bones are infrequent sites for osteoid osteoma: only 10% of the cases arise in these areas. Standard treatments are surgical excision and radio-frequency ablation (RFA), both with advantages and disadvantages. This study aimed to compare the two techniques to prove if RFA could be a potential alternative to surgery in the treatment of OO of the hand. (2) Methods: Patients treated for OO of the hand between January 2011 and December 2020 were evaluated and data was collected regarding the lesions' characteristics and the treatment outcome. Each patient was followed up for 24 months and VAS pain (Visual Analogue Scale), DASH (Disability of the Arm, Shoulder and Hand), and PRWE (Patient-Related Wrist Evaluation) scores were collected. (3) Results: A total of 27 patients were included in the study: 19 surgical and 8 RFA. Both treatments showed a significant improvement in pain and functionality. Surgery was associated with a higher complication rate (stiffness and pain), while RFA was associated with a higher recurrence rate (2/8 patients). RFA allowed for a speedier return to work. (4) Conclusions: We believe that osteoid osteoma treatment with RFA in the hand should be an available alternative to surgery as it allows rapid pain relief and a swift return to work. Surgery should be reserved for cases of diagnostic uncertainty or periosteal localization.
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Affiliation(s)
- Fabio Vita
- IRCCS-Rizzoli Orthopedic Institute, University of Bologna, 40136 Bologna, Italy
| | - Gianmarco Tuzzato
- IRCCS-Rizzoli Orthopedic Institute, University of Bologna, 40136 Bologna, Italy
| | - Davide Pederiva
- IRCCS-Rizzoli Orthopedic Institute, University of Bologna, 40136 Bologna, Italy
| | - Giuseppe Bianchi
- IRCCS-Rizzoli Orthopedic Institute, University of Bologna, 40136 Bologna, Italy
| | - Augusto Marcuzzi
- Department of Hand Surgery and Microsurgery, University Hospital of Modena, 41124 Modena, Italy
| | - Roberto Adani
- Department of Hand Surgery and Microsurgery, University Hospital of Modena, 41124 Modena, Italy
| | - Paolo Spinnato
- IRCCS-Rizzoli Orthopedic Institute, University of Bologna, 40136 Bologna, Italy
| | - Marco Miceli
- IRCCS-Rizzoli Orthopedic Institute, University of Bologna, 40136 Bologna, Italy
| | - Danilo Donati
- Department of Hand Surgery and Microsurgery, University Hospital of Modena, 41124 Modena, Italy
| | - Marco Manzetti
- IRCCS-Rizzoli Orthopedic Institute, University of Bologna, 40136 Bologna, Italy
| | - Federico Pilla
- IRCCS-Rizzoli Orthopedic Institute, University of Bologna, 40136 Bologna, Italy
| | - Cesare Faldini
- IRCCS-Rizzoli Orthopedic Institute, University of Bologna, 40136 Bologna, Italy
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Meyer J, Priemel M, Rolvien T, Frosch KH, Schlickewei C, Yarar-Schlickewei S. The Diagnostic Challenge of Osteoid Osteoma in the Bones of the Hand—A Case Series. Diagnostics (Basel) 2023; 13:diagnostics13071279. [PMID: 37046495 PMCID: PMC10093072 DOI: 10.3390/diagnostics13071279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/04/2023] [Accepted: 03/10/2023] [Indexed: 03/31/2023] Open
Abstract
Osteoid osteoma (OO) is a benign bone tumor that rarely occurs in the bones of the hand. Due to the comparatively non-specific symptoms when occurring in the hand, OO is often misdiagnosed at first presentation, posing a diagnostic challenge. In the present case study, six cases of phalangeal and carpal OO, treated surgically at our department between 2006 and 2020, were retrospectively reviewed. We compared all cases regarding demographic data, clinical presentation, imaging findings, time to diagnosis, surgical treatment, and clinical outcome in follow-up examinations. When OO occurs in the bones of the hand, it can lead to swelling and deformities, such as enlargement of the affected bone and nail hypertrophy. Initial misdiagnoses such as primary bone tumors other than OO, tendinitis, osteomyelitis, or arthritis are common. Most of the presented cases showed a prolonged time until diagnosis, whereby the primarily performed imaging modality was often not sensitive. CT proved to be the most sensitive sectional imaging modality for diagnosing OO. With adequate surgical treatment, complications and recurrence are rare.
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Osteoid osteoma in the bones of the hand: a systematic literature review. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04839-5. [PMID: 36939892 PMCID: PMC10374483 DOI: 10.1007/s00402-023-04839-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 12/17/2022] [Indexed: 03/21/2023]
Abstract
INTRODUCTION Osteoid osteoma (OO) is a common benign bone tumor. OO is observed most frequently in the long bones, especially in the tibia and femur. When occurring in the bones of the hand, OO can be a diagnostic and therapeutic challenge. The aim of this study was to provide a systematic review of occurrence, symptoms, diagnosis and treatment options regarding OO in hand bones. MATERIALS AND METHODS We performed a systematic review of the literature. All studies from the online databases PubMed and SpringerLink, which reported cases of osteoid osteomas in the bones of the hand, were included. By summarizing the literature, we evaluated the localization within the hand as well as diagnostic and therapeutic options. RESULTS We included 133 studies reporting 401 cases. OO was mostly common in the phalanges. The diagnosis was mostly made by CT (computed tomography) scan. Most of the OO were treated surgically by open curettage or en bloc resection. CONCLUSIONS Osteoid osteomas in the bones of the hand are rare and a delayed diagnosis is common. In cases of pain combined with particular symptoms such as nail hypertrophy and swelling OO should be considered. Of the most used imaging methods, CT scans have the highest sensitivity.
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Cerny J, Soukup J, Cerna S, Novotny T. Current Approaches to Osteoid Osteoma and Minimally Invasive Surgery-A Minireview and a Case Report. J Clin Med 2022; 11:jcm11195806. [PMID: 36233673 PMCID: PMC9572602 DOI: 10.3390/jcm11195806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/09/2022] [Accepted: 09/27/2022] [Indexed: 11/21/2022] Open
Abstract
Osteoid osteoma is a benign bone tumor typically affecting the long bones of the lower limbs in young male patients. The lesion can be asymptomatic but, in most cases, patients present with characteristic nocturnal pain that is very responsive to the administration of non-steroidal anti-inflammatory drugs. Although osteoid osteomas can regress spontaneously over time, surgical therapy is often indicated in cases of long-lasting resistant pain. Apart from a traditional open resection, the modalities of minimally invasive surgery, such as radiofrequency ablation or cryoablation, have gradually become the option of choice in most cases. The first part of this manuscript is a minireview of the contemporary literature on the pathogenesis, diagnosis, and current trends in the treatment of osteoid osteoma. The second part is a case report of our own experience with a conventional C-arm-guided radiofrequency ablation of an osteoid osteoma located in the femoral neck in an adolescent patient. The aim was to prove that, even when more sophisticated guiding devices (CT, O-arm, etc.) are not available, the safe and reliable ablation of the lesion using a C-arm is still possible even in hard-to-reach areas. The case was a success, with no perioperative or postoperative complications.
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Affiliation(s)
- Jan Cerny
- Department of Orthopaedics, University J.E. Purkinje and Masaryk Hospital, 401 13 Usti nad Labem, Czech Republic
| | - Jan Soukup
- Department of Orthopaedics, University J.E. Purkinje and Masaryk Hospital, 401 13 Usti nad Labem, Czech Republic
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, 150 06 Prague, Czech Republic
| | - Sarka Cerna
- Department of Genetics, University J.E. Purkinje and Masaryk Hospital, 401 13 Usti nad Labem, Czech Republic
| | - Tomas Novotny
- Department of Orthopaedics, University J.E. Purkinje and Masaryk Hospital, 401 13 Usti nad Labem, Czech Republic
- Correspondence: ; Tel.: +420-4-7711-3050
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Light J, Retrouvey M, Conran RM. Educational Case: Osteoid Osteoma. Acad Pathol 2021; 8:23742895211060536. [PMID: 34926796 PMCID: PMC8679056 DOI: 10.1177/23742895211060536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/19/2021] [Accepted: 10/15/2021] [Indexed: 11/16/2022] Open
Abstract
The following fictional case is intended as a learning tool within the
Pathology Competencies for Medical Education (PCME), a set of national
standards for teaching pathology. These are divided into three basic
competencies: Disease Mechanisms and Processes, Organ System Pathology, and
Diagnostic Medicine and Therapeutic Pathology. For additional information,
and a full list of learning objectives for all three competencies,
seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.1
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Affiliation(s)
- Jonathan Light
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Michele Retrouvey
- Department of Radiology, Eastern Virginia Medical School/Medical Center Radiologists, Norfolk, VA, USA
| | - Richard M. Conran
- Department of Pathology & Anatomy, Eastern Virginia Medical School, Norfolk, VA, USA
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Sferopoulos NK. Clinical and Radiographic Features of Phalangeal Osteoid Osteoma. Open Orthop J 2021. [DOI: 10.2174/1874325002115010071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
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Effectiveness and reliability of traditional open surgery in atypical localizations of osteoid osteoma. Jt Dis Relat Surg 2021; 31:541-547. [PMID: 32962587 PMCID: PMC7607951 DOI: 10.5606/ehc.2020.74333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives
This study aims to evaluate traditional open surgery results of osteoid osteomas (OOs) in atypical localizations and explore whether open surgery can be a safe alternative in localizations where radiofrequency ablation (RFA) may not be suitable. Patients and methods
A total of 26 patients (20 males, 6 females; mean age 23.3±14.2 years; range, 4 to 65 years) having OO in atypical localizations between January 2008 and January 2017 were retrospectively evaluated. All patients underwent traditional open surgery under anesthesia. All patients were followed-up, and their clinical success and complications were evaluated. The pain intensity was assessed using the visual analog scale (VAS). Results
The postoperative first year VAS score was 0.2±0.5 (range, 0-2) (p<0.005). None of the patients showed any complications. No recurrences were reported at the end of the first year. All patients were relieved from pain due to OO in atypical localizations. Conclusion Although RFA has been accepted as the preferred treatment for OO, traditional open surgery may still be used for OO in atypical localizations yielding perfect clinical results with fewer complications. It is a safe alternative for localizations such as carpal bones, distal ulna, hand and foot where RFA complications can be seen more frequently. In these localizations, traditional open surgery can be recommended as the first treatment choice.
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Resection of a Rare Metacarpal Distal Condyle Osteoid Osteoma. Case Rep Orthop 2019; 2019:4542862. [PMID: 31263611 PMCID: PMC6556241 DOI: 10.1155/2019/4542862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/29/2019] [Accepted: 05/09/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Osteoid osteoma is a benign bone-forming tumor with young male predilection. It occurs predominantly in the long bones. In the hand, osteoid osteoma is more commonly located in the phalanges and carpal bones. The metacarpals are the least common site for osteoid osteoma. Pain is the most common symptom. It usually increases at night and responds to nonsteroidal anti-inflammatory drugs. Case Presentation The authors report the excision of an osteoid osteoma lying at the distal condyle of a metacarpal bone of the left hand. The clinical and radiological findings are exposed as well as the surgical management of the lesion. Pain and swelling disappeared after surgery, and there was no evidence of recurrence at follow-up. Discussion They discuss this rare location and further radiological examination that was used leading to the diagnosis. The imputation of the traumatic factor has been discussed, along with the different therapeutic possibilities and the advantages of a total excision while preserving the integrity of the adjacent ligament and joint space. Conclusion The surgical alternative appears to be a satisfying treatment for osteoid osteoma in this particular superficial location. Both the exact pathogenesis and the contribution of the traumatic factor remain unclear.
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Shubinets V, Ben-Amotz O, Steinberg DR. A Subperiosteal Proximal Phalanx Osteoid Osteoma: A Challenging Diagnosis. J Hand Surg Asian Pac Vol 2019; 24:233-237. [PMID: 31035881 DOI: 10.1142/s2424835519720111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A relatively rare tumor, osteoid osteoma most commonly affects the lower extremity. In 10% of the cases, it can affect the hand and wrist. We present a case of osteoid osteoma in the proximal phalanx of ring finger that was initially misdiagnosed as a soft tissue lesion. The soft tissue lesion was resected, but the symptoms recurred shortly thereafter, leading to repeat diagnostic workup. Despite X-rays, magnetic resonance imaging, and tissue biopsy, the diagnosis remained elusive until surgical re-exploration. Based on the lessons learned from this case and the experience reported in literature, we discuss the intricate nature of osteoid osteoma diagnosis in the hand, the obstacles often encountered, and how to approach these challenging patients in a stepwise and critical fashion.
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Affiliation(s)
- Valeriy Shubinets
- * Department of Surgery, Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Oded Ben-Amotz
- † Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - David R Steinberg
- † Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Noordin S, Allana S, Hilal K, Nadeem N, Lakdawala R, Sadruddin A, Uddin N. Osteoid osteoma: Contemporary management. Orthop Rev (Pavia) 2018; 10:7496. [PMID: 30370032 PMCID: PMC6187004 DOI: 10.4081/or.2018.7496] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 03/06/2018] [Accepted: 03/18/2018] [Indexed: 11/23/2022] Open
Abstract
Osteoid osteoma is a benign bone-forming tumor with hallmark of tumor cells directly forming mature bone. Osteoid osteoma accounts for around 5% of all bone tumors and 11% of benign bone tumors with a male predilection. It occurs predominantly in long bones of the appendicular skeleton. According to Musculoskeletal Tumor Society staging system for benign tumors, osteoid osteoma is a stage-2 lesion. It is classified based on location as cortical, cancellous, or subperiosteal. Nocturnal pain is the most common symptom that usually responds to salicyclates and non-steroidal anti-inflammatory medications. CT is the modality of choice not only for diagnosis but also for specifying location of the lesion, i.e. cortical vs sub periosteal or medullary. Non-operative treatment can be considered as an option since the natural history of osteoid osteoma is that of spontaneous healing. Surgical treatment is an option for patients with severe pain and those not responding to NSAIDs. Available surgical procedures include radiofrequency (RF) ablation, CT-guided percutaneous excision and en bloc resection.
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Affiliation(s)
| | - Salim Allana
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kiran Hilal
- Department of Radiology, Aga Khan University, Karachi, Pakistan
| | - Naila Nadeem
- Department of Radiology, Aga Khan University, Karachi, Pakistan
| | - Riaz Lakdawala
- Orthopaedic Surgery, Aga Khan University, Karachi, Pakistan
| | - Anum Sadruddin
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Nasir Uddin
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
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Kuyumcu G, Sundaram M, Schils JP, Ilaslan H. Osteoid osteoma of the hand and foot in children successfully treated with radiofrequency neurotomy probes. Skeletal Radiol 2017; 46:1561-1565. [PMID: 28689337 DOI: 10.1007/s00256-017-2702-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/05/2017] [Accepted: 06/12/2017] [Indexed: 02/02/2023]
Abstract
Osteoid osteoma is a common benign tumor that is typically found in young adults and children, usually in the long bones of the lower extremity. Radiofrequency ablation (RFA) under computed tomography guidance is the standard of care for symptomatic osteoid osteomas. However, patients with osteoid osteoma of the hand or foot are often treated with open surgery because of the risk of injury to vascular and neural structures from RFA. This risk is more pronounced in pediatric patients because of the small lesion size and proximity of lesions to important neurovascular structures. Here, we present 2 pediatric patients, one with an osteoid osteoma in the hand and the other with an osteoid osteoma in the foot. In both patients, a 22-gauge, 2.5-mm active tip ablation probe was used. The smaller ablation volume achieved with this probe protected neighboring neurovascular structures while effectively ablating the osteoid osteoma nidus. Based on our success in these cases, we recommend the application of this method for cases in which neurovascular proximity to the osteoid osteoma lesion makes ablation challenging.
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Affiliation(s)
- Gokhan Kuyumcu
- Cleveland Clinic Imaging Institute, 9500 Euclid Avenue, Cleveland, OH, 44106, USA.
| | - Murali Sundaram
- Cleveland Clinic Imaging Institute, 9500 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Jean P Schils
- Cleveland Clinic Imaging Institute, 9500 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Hakan Ilaslan
- Cleveland Clinic Imaging Institute, 9500 Euclid Avenue, Cleveland, OH, 44106, USA
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Proximal Phalanx Osteoid Osteoma: A Case Report and Literature Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1332. [PMID: 28607858 PMCID: PMC5459641 DOI: 10.1097/gox.0000000000001332] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/21/2017] [Indexed: 11/25/2022]
Abstract
Osteoid osteoma is a rare clinical entity often mistaken for osteomyelitis, enchondroma, osteochondroma and other bony pathologies. Cardinal features include localized swelling and nocturnal pain often relieved by nonsteroidal antiinflammatory drugs. Definitive treatment requires surgical removal of the lesion by curettage or en bloc excision. The following case report details the diagnosis and management of a recurrent case of osteoid osteoma in a long finger proximal phalanx. Included with this case report is a literature review of osteoid osteomas on the hand and the anatomic distribution of 289 cases published in the last 30 years.
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Alemdar C, Çaçan MA, Dusak A, Özkul E, Atiç R, Kapukaya A. A comparison of percutaneous trephine excision and open surgery in the treatment of osteoid osteoma. INTERNATIONAL ORTHOPAEDICS 2015; 40:1481-7. [PMID: 26572883 DOI: 10.1007/s00264-015-3044-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 11/02/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE The aim of this study was to compare CT-assisted percutaneous excision, which is a closed, economic method and a more cosmetic approach, and open surgery in the treatment of osteoid osteoma. MATERIALS AND METHODS Fifty-three patients (12 female and 41 male patients) who had percutaneous excision (n = 24) and open surgery (n = 29) were evaluated retrospectively. The mean age was 16.6 years and the mean duration of follow-up was 53.5 months. During percutaneous excision, a trephine was advanced through the labeling wire and the site, including the nidus, was excised en-bloc and the incision walls were curetted. During the open surgery, the localization of the nidus was marked using c-arm X-ray and the nidus was accessed by lifting the cortical bone, layer-by-layer, using burr. The nidus was excised and its cavity curetted. RESULTS The result was successful in 22 and a failure in three patients who had closed excision. The result was successful in 20 and a failure in nine patients who had open surgery. The mean duration of operation was 44.37 minutes in the percutaneous excision group and 80.6 minutes in the open surgery group. There was no difference in the pre-operative VAS values between the two groups, whereas the post-operative VAS values were statistically significantly different. There was also a statistically significant difference in the duration of the operation and the length of the hospital stay between the groups. CONCLUSION Percutaneous excision with trephine is a more successful, effective, minimally invasive, safe and a better cosmetic approach in the treatment of osteoid osteoma. This method is also a cheap method that does not require expensive equipment.
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Affiliation(s)
- Celil Alemdar
- Department of Orthopaedics and Traumatology, Dicle University Medical Faculty, 21280, Diyarbakir, Turkey.
| | - Mehmet Akif Çaçan
- Department of Orthopaedics and Traumatology, Dicle University Medical Faculty, 21280, Diyarbakir, Turkey
| | - Abdurrahim Dusak
- Department of Radiology, Dicle University Medical Faculty, Diyarbakir, Turkey
| | - Emin Özkul
- Department of Orthopaedics and Traumatology, Dicle University Medical Faculty, 21280, Diyarbakir, Turkey
| | - Ramazan Atiç
- Department of Orthopaedics and Traumatology, Dicle University Medical Faculty, 21280, Diyarbakir, Turkey
| | - Ahmet Kapukaya
- Department of Orthopaedics and Traumatology, Dicle University Medical Faculty, 21280, Diyarbakir, Turkey
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