Osteoid osteoma of calcar of femur in child: prophylactic fixation using PHILOS and excision

Successful en-bloc excision for recurrent femoral osteoid osteoma: The use in modern era

INTRODUCTION AND IMPORTANCE

Osteoid osteoma is a benign bone tumor that may resolve spontaneously and commonly affects adolescents in the proximal femur region and causes characteristic pain. Although benign, it can relapse and severely deteriorate function when juxta-articular. Its recurrence rate varies according to the treatment method used.

CASE PRESENTATION

This article presents a case of a 21-year-old male with a recurrent calcar osteoid osteoma that was successfully treated by surgical en bloc excision; Harris Hip Score of 97.00 %. The lesion was previously managed through an intralesional curettage and an autologous iliac crest bone graft.

CLINICAL DISCUSSION

The treatment of osteoid osteoma varies from medical therapy with NSAIDs or minimally invasive surgery to traditional open surgery. The surgical approach aims to excise the nidus, remove the pain, avoid growth disturbance in immature skeletons, and limit the side effects of long-term NSAID use.

CONCLUSION

Radiofrequency ablation is the standard therapy for osteoid osteoma nowadays; unfortunately, it is unavailable in some countries due to the high cost and lack of equipment and specialists. En bloc excision may be the ideal approach for recurrent cases after intralesional curettage.

Adult Proximal Humeral Locking Plate Is a Good Alternative Option in the Treatment of Adolescent Subtrochanteric Femur Fractures: A Case Series and Literature Review

Purpose

Management of pediatric subtrochanteric femur fractures (SFFs) is difficult. The aim of this study was to evaluate the outcomes of adolescent SFFs treated with adult proximal humeral locking plates (PHLPs).

Materials and Methods

A retrospective analysis of 18 adolescents (11 male, 7 female) with a diagnosis of SFF who underwent internal fixation with a PHLP was conducted. Data regarding injury mechanism, fracture pattern, and time to union were recorded for all patients. In addition, a clinical and functional evaluation of patients was performed using the Harris hip score (HHS), Iowa hip score (IHS), modified Merle d'Aubigne-Postel score (MMAPS), Flynn criteria, and hip range of motion (ROM).

Results

The mean age of the patients was 12.72±2.05 years (range, 10-16 years). Radiological observation was performed for evaluation of five different injury mechanisms and different fracture patterns in patients. The mean postoperative HHS was 92.27±5.61, the mean IHS was 90.88±6.46, and the mean MMAPS was 17.22±0.94. According to the Flynn criteria, excellent results were achieved in 14 cases and satisfactory results were obtained in four cases. Measurements of the patients' mean hip ROM values were as follows: 17.77±3.52° in extension, 115.27±6.74° in flexion, 43.05±3.48° in abduction, 27.50±4.28° in adduction, 42.22±4.60° in internal rotation, and 42.22±3.91° in external rotation.

Conclusion

Surgery performed on adolescent patients using an adult PHLP showed good, safe results. Therefore, it should be considered as an alternative option.

Osteoid Osteoma of the Proximal Femur: Pitfalls in Diagnosis and Performance of Open Surgical Resection

Aims

Proximal femoral osteoid osteoma (OO) is extremely easy to be misdiagnosed or missed. The purpose of this study was to retrospectively analyze the clinical data of patients with proximal femoral OO in order to determine the clinical manifestation and imaging characteristics of the disease, so as to provide help for the preoperative diagnosis and clinical treatment of proximal femoral OO.

Methods

This was a retrospective study involving 35 patients with proximal femoral OO admitted into our hospital from January 2015 to January 2021. The baseline characteristics of the participants included; 24 males and 11 females, aged between 13 and 25 (mean 16.2) years old, and the course of the disease was 1 to 14 (mean 6.3) months. We used previous medical experience records of the patients to analyze for the causes of misdiagnosis. Moreover, we compared the difference between preoperative and postoperative treatment practices in alleviating pain in OO patients and restoring hip function. Follow-ups were carried out regularly, and patients advised to avoid strenuous exercises for 3 months.

Results

We followed up 35 patients (25 intercortical, 4 sub-periosteal, and 6 medullary) for an average of 41.4 months. We found that 15 patients (42.9%) had been misdiagnosed of synovitis, perthes disease, osteomyelitis, intra-articular infection, joint tuberculosis and hip impingement syndrome, whose average time from symptoms to diagnosis were 6.3 months. Postoperative pain score and joint function score improved significantly compared with preoperative, and complications were rare.

Conclusion

Open surgical resection constitutes an effective treatment for proximal femoral OO by accurately and completely removing the nidus. Wrong choice of examination, and the complexity and diversity of clinical manifestations constitutes the main reasons for the misdiagnosis of proximal femoral OO.