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Bram JT, Li DT, Tracey OC, Lijesen E, Chipman DE, Widmann RF, Dodwell ER, Blanco JS, Green DW. Hemiepiphysiodesis for Genu Valgum in Patients With Multiple Hereditary Exostoses. J Pediatr Orthop 2024; 44:e406-e410. [PMID: 38450657 DOI: 10.1097/bpo.0000000000002654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
BACKGROUND Genu valgum is a well-known feature of multiple hereditary exostoses (MHE). Though prior reports have demonstrated successful treatment with hemiepiphysiodesis, details regarding the correction rate and comparison to an idiopathic population are lacking. This study aimed to detail our institution's experience with guided growth of the knee in patients with MHE and compare this to an idiopathic population. METHODS All pediatric patients (age 18 and younger) with MHE who underwent lower extremity hemiepiphysiodesis at a tertiary care medical center between January 2016 and December 2022 were retrospectively reviewed. Preoperative and postoperative mechanical lateral distal femoral angle (mLDFA) and medial proximal tibial angle (MPTA, the primary outcomes) were measured in addition to mechanical axis deviation (MAD) and hip-knee-ankle angle (HKA). Patients were 1:2 matched based on age, sex, and physes instrumented to a cohort with idiopathic genu valgum. RESULTS A total of 21 extremities in 16 patients with MHE underwent hemiepiphysiodesis of the distal femur, proximal tibia, and/or distal tibia. The mean age at surgery was 11.7±2.2 years. Mean MAD corrected from zone 1.9±0.7 to -0.3±1.5, while mLDFA corrected from 83.4±2.9 to 91.7±5.2 degrees and MPTA corrected from 95.3±3.6 to 90.5±4.0 degrees in distal femurs and proximal tibias undergoing guided growth, respectively. Three extremities (14.3%) experienced overcorrection ≥5 degrees managed with observation. There were no differences in correction rates per month for mLDFA (0.54±0.34 vs. 0.51±0.29 degrees, P =0.738) or MPTA (0.31±0.26 vs. 0.50±0.59 degrees, P =0.453) between MHE and idiopathic groups. For 11 extremities in the MHE group with open physes at hardware removal, they experienced a mean recurrence of HKA of 4.0±3.4 degrees at 19-month follow-up. CONCLUSION Hemiepiphysiodesis corrects lower extremity malalignment in patients with MHE at a similar rate compared with an idiopathic coronal plane deformity population. Rebound deformity of 4 degrees at 19 months after hardware removal in patients with remaining open growth plates should make surgeons conscious of the remaining growth potential when planning deformity correction. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Joshua T Bram
- Department of Pediatric Orthopedics, Hospital for Special Surgery, New York, NY
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Labott JR, Heidenreich MJ, Mills GL, Lewallen DG, Houdek MT, Couch CG. Long-term outcome of total hip arthroplasty in patients with multiple hereditary exostosis. Eur J Orthop Surg Traumatol 2024; 34:1141-1145. [PMID: 37978058 DOI: 10.1007/s00590-023-03780-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Multiple hereditary exostosis (MHE) is a rare autosomal dominant disorder characterized by multiple osteochondromas. There is a paucity of literature concerning total hip arthroplasty (THA) in patients with MHE. The aim of this study is to report long-term outcomes of THA in patients with MHE. METHODS Fourteen patients undergoing 15 THA's for the treatment of osteoarthritis in the presence of osteochondromas and proximal femoral deformity secondary to MHE were reviewed. Mean age at the time of surgery and follow-up was 56 and 12 years. Seven (47%) had uncemented femoral components. Eleven hips had coxa valga on preoperative imaging. Clinical outcomes were assessed with both Harris hip scores (HHS) and Musculoskeletal Tumor Society Scores (MSTS). RESULTS Following surgery, there was an improvement in the HHS (48-82, p < 0.01) and MSTS scores (41-70%, p < 0.01). Complications occurred in 5 patients leading to reoperation in 3 patients, of which 2 patients underwent a revision procedure at 19 and 20-years postoperative. The 10-year revision free survival was 100%. CONCLUSIONS THA in the setting of MHE reliably improves patient function. One in three patients will have a postoperative complication; however, the long-term incidence of revision is low.
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Affiliation(s)
- Joshua R Labott
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Mark J Heidenreich
- Department of Orthopedics and Sports Medicine Sanford Health, 1210 W. 18Th St., Suite G01, Sioux Falls, SD, 57104, USA
| | - Gavin L Mills
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - David G Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| | - Cory G Couch
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
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Lixa J, Pinho A, Vieira P, Vieira da Silva N, Silva MR, Marques A, Veludo V. Medullary Compression by a Cervical Osteochondroma in a Patient with Multiple Hereditary Exostoses: A Case Report. JBJS Case Connect 2024; 14:01709767-202403000-00006. [PMID: 38207085 DOI: 10.2106/jbjs.cc.23.00429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
CASE A 19-year-old man with Multiple Hereditary Exostoses presented with cervical pain without neurological symptoms and/or signs. Magnetic resonance revealed a large C2 osteochondroma, occupying a part of the medullary canal. He was submitted to an en bloc resection with hemilaminectomy without fusion. At the 1-year follow-up, he presented resolution of pain and no neurological symptoms or signs, without cervical instability or radiological signs of disease recurrence. CONCLUSION Cervical osteochondroma is usually asymptomatic. Neurological compression and differentiation to chondrosarcoma are the main concerns. Surgical excision allows the local cure of the disease and is usually performed without fusion.
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Affiliation(s)
- João Lixa
- Department of Orthopedics and Traumatology, São João University Hospital Centre, Porto, Portugal
| | - André Pinho
- Department of Orthopedics and Traumatology, São João University Hospital Centre, Porto, Portugal
| | - Paula Vieira
- Department of Orthopedics and Traumatology, São João University Hospital Centre, Porto, Portugal
| | - Nuno Vieira da Silva
- Department of Orthopedics and Traumatology, Tâmega e Sousa Hospital Centre, Penafiel, Portugal
| | - Miguel Relvas Silva
- Department of Orthopedics and Traumatology, São João University Hospital Centre, Porto, Portugal
| | - Ana Marques
- Department of Anatomical Pathology, São João University Hospital Centre, Porto, Portugal
| | - Vitorino Veludo
- Department of Orthopedics and Traumatology, São João University Hospital Centre, Porto, Portugal
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Massard-Combe P, Debs A, De Tienda M, Pejin Z, Gaume M, Pannier S. Radiographic evaluation of ulnar deformity in patients with hereditary multiple osteochondroma and its relationship with radial head dislocation. Orthop Traumatol Surg Res 2023; 109:103591. [PMID: 36905956 DOI: 10.1016/j.otsr.2023.103591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 12/20/2022] [Accepted: 01/02/2023] [Indexed: 03/11/2023]
Abstract
INTRODUCTION In patients who have hereditary multiple osteochondroma (HMO), progressive deformity of the forearm skeleton may lead to radial head dislocation. The latter is permanent, painful and causes weakness. HYPOTHESIS There is a relationship between the amount of ulnar deformity and the presence of radial head dislocation in patients with HMO. MATERIALS AND METHODS This was a cross-sectional radiographic study comprising an analysis of anterior-posterior (AP) and lateral x-rays of 110 forearms in children having a mean age of 8 years and 4 months who were followed for HMO between 1961 and 2014. Four factors reflecting on the ulnar deformity in the coronal plane were investigated on the AP view and three factors in the sagittal plane were investigated on the lateral view to identify any relationship between ulnar deformity and radial head dislocation. The forearms were separated into two groups: with radial head dislocation (26 cases) and without radial head dislocation (84 cases). RESULTS Ulnar bowing, intramedullary angle of ulnar bowing, tangent ulnar angle and overall ulnar angle were significantly higher in the group of children who had a radial head dislocation (0.05 vs 0.03, p<.001; 161 vs 167, p<001; 156 vs 162, p<001; 50 vs 30, p<.001) in univariate and multivariate analyses. DISCUSSION Ulnar deformity, evaluated using the method described here, is more often associated with radial head dislocation than other previously published radiological parameters. This provides new insight on this phenomenon and may help to determine which factors are associated with radial head dislocation and how to prevent it. CONCLUSION Ulnar bowing in the context of HMO, especially when evaluated on AP radiographs, is significantly associated with radial head dislocation. LEVEL OF EVIDENCE III; case-control study.
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Affiliation(s)
- Philippe Massard-Combe
- Service chirurgie orthopédique, Hôpital Necker - Université Paris Cité, 149 Rue de Sèvres, 75015 Paris, France.
| | - Alexandre Debs
- Service de santé publique du Pr. Carrat, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - Marine De Tienda
- Service chirurgie orthopédique, Hôpital Necker - Université Paris Cité, 149 Rue de Sèvres, 75015 Paris, France
| | - Zagorka Pejin
- Service chirurgie orthopédique, Hôpital Necker - Université Paris Cité, 149 Rue de Sèvres, 75015 Paris, France
| | - Mathilde Gaume
- Service chirurgie orthopédique, Hôpital Necker - Université Paris Cité, 149 Rue de Sèvres, 75015 Paris, France
| | - Stéphanie Pannier
- Service chirurgie orthopédique, Hôpital Necker - Université Paris Cité, 149 Rue de Sèvres, 75015 Paris, France
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Bom F, Barbier O, Libouton X, Docquier PL. Forearm deformity in multiple hereditary exostosis. Radiologic predictors of radial head dislocation. Orthop Traumatol Surg Res 2023; 109:103445. [PMID: 36270444 DOI: 10.1016/j.otsr.2022.103445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 02/03/2023]
Abstract
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 Forty-nine 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>4.6cm, 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.
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Affiliation(s)
- Frank Bom
- Cliniques universitaires Saint-Luc, service d'orthopédie et de traumatologie de l'appareil locomoteur, avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Olivier Barbier
- Cliniques universitaires Saint-Luc, service d'orthopédie et de traumatologie de l'appareil locomoteur, avenue Hippocrate 10, 1200 Brussels, Belgium; Université catholique de Louvain, secteur des sciences de la santé, institut de recherche expérimentale et clinique, Neuro-Musculoskeletal Lab (NMSK), avenue Mounier 53, 1200 Brussels, Belgium.
| | - Xavier Libouton
- Cliniques universitaires Saint-Luc, service d'orthopédie et de traumatologie de l'appareil locomoteur, avenue Hippocrate 10, 1200 Brussels, Belgium; Université catholique de Louvain, secteur des sciences de la santé, institut de recherche expérimentale et clinique, Neuro-Musculoskeletal Lab (NMSK), avenue Mounier 53, 1200 Brussels, Belgium
| | - Pierre-Louis Docquier
- Cliniques universitaires Saint-Luc, service d'orthopédie et de traumatologie de l'appareil locomoteur, avenue Hippocrate 10, 1200 Brussels, Belgium; Université catholique de Louvain, secteur des sciences de la santé, institut de recherche expérimentale et clinique, Neuro-Musculoskeletal Lab (NMSK), avenue Mounier 53, 1200 Brussels, Belgium
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Cao S, Zeng JF, Xiao S, Dong ZG, Xu ZL, Liu H, Li X, Fang K, Wen J, Zeng M, Tang ZW, Li B, Gong HL, Li FL. Modified ulnar lengthening for correction of the Masada type 2 forearm deformity in hereditary multiple exostosis. Sci Rep 2023; 13:10554. [PMID: 37386285 PMCID: PMC10310833 DOI: 10.1038/s41598-023-37532-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 06/23/2023] [Indexed: 07/01/2023] Open
Abstract
Few articles have reported on the treatment of Masada type 2 forearm deformities in hereditary multiple exostosis, possibly because of the high redislocation rate and other complications. This study precisely declares the use of modified ulnar lengthening by an Ilizarov external fixation with tumour excision for the treatment of Masada type 2 forearm deformities. 20 children with Masada type 2 forearm deformities were admitted for surgical treatment at our hospital from February 2014 to February 2021. There were 13 girls and 7 boys, ranging in age from 3.5 to 15 years (mean: 9 years) at the time of operation. We removed the prominent osteochondromas of the distal ulna and the proximal radius, positioned a classic Ilizarov external fixator on the forearm and then performed ulnar transverse one-third proximal diaphyseal subperiosteal osteotomy. We adopted modified ulnar lengthening postoperatively. The effects of surgical correction of deformity and functional improvement of the limb were assessed via regular follow-up and X-ray. The patients were followed up for 36 months, and the ulna was lengthened 26.99 mm on average; all radial heads remained relocated. The radiographic evaluations, including relative ulnar shortening, radial articular angle, and carpal slip, were improved. The functions of the elbow and forearm were all improved after surgery. Modified ulnar lengthening by an Ilizarov external fixation with tumour excision for the treatment of Masada type 2 forearm deformities in hereditary multiple exostoses has been proven to be an effective and reliable technique in the early stage.
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Affiliation(s)
- Shu Cao
- Department of Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, People's Republic of China
| | - Jian-Fa Zeng
- Department of Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, People's Republic of China
| | - Sheng Xiao
- Department of Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, People's Republic of China.
| | - Zhong-Gen Dong
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, No. 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Zi-Li Xu
- Department of Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, People's Republic of China
| | - Hong Liu
- Department of Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, People's Republic of China
| | - Xin Li
- Department of Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, People's Republic of China
| | - Ke Fang
- Department of Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, People's Republic of China
| | - Jie Wen
- Department of Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, People's Republic of China
| | - Ming Zeng
- Department of Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, People's Republic of China
| | - Zhong-Wen Tang
- Department of Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, People's Republic of China
| | - Bo Li
- Department of Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, People's Republic of China
| | - Hao-Li Gong
- Department of Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, People's Republic of China
| | - Fan-Ling Li
- Department of Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, People's Republic of China
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Lu Y, Canavese F, Lin R, Huang Y, Wu X, Lin B, Chen S. Distraction osteogenesis at the proximal third of the ulna for the treatment of Masada type I/IIb deformities in children with hereditary multiple exostoses: a retrospective review of twenty cases. Int Orthop 2022; 46:2877-2885. [PMID: 36087118 DOI: 10.1007/s00264-022-05551-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/11/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Ulna distraction by monolateral external fixator (MEFix) is a good option for the treatment of Masada type I and IIb deformities in children with hereditary multiple exostoses (HMEs). However, there is no consensus regarding where to perform ulnar osteotomy. Our hypothesis is that osteotomy at the proximal third of the ulna and progressive distraction with MEFix can simultaneously correct elbow and wrist deformities in patients with HME. METHODS We retrospectively reviewed patients with HME who underwent ulna distraction osteogenesis from June 2014 to March 2019. The carrying angle (CA), radial articular angle (RAA), ulnar variance (UV), radial variance (RV) and range of motion (ROM) of the affected forearm and elbow were clinically assessed before lengthening and at the last follow-up visit. The total ulna lengthening distance (LD) and radiographic outcome were also recorded. RESULTS Nineteen patients (20 forearms) with HME aged 9.1 ± 2.4 years at the time of surgery were retrospectively reviewed. The mean follow-up period was 26.1 ± 5.6 months. There were 11 patients (12 forearms) with Masada type I deformities and eight patients (8 forearms) with Masada type IIb deformities. Patients with type IIb deformity had higher RV, lower CA values, less elbow flexion and forearm pronosupination than those with type I deformity (p < 0.05); RV was an independent risk factor for radial head dislocation, with the cut off at RV > 15.5 mm. The mean LDs in patients with type I and type IIb deformities were 33.6 ± 6.6 mm and 41.4 ± 5.4 mm, respectively. The mean CA, UV, RV, forearm pronation and ulna deviation at the wrist improved significantly following surgery in all patients. In particular, five of eight patients (62.5%) with type IIb deformities had concentric reduction of the radiocapitellar joint, while no radial head subluxation was detected in patients with type I deformities at the last follow-up. Three complications were recorded: two pin-track infections and one delayed union. CONCLUSIONS Distraction osteogenesis at the proximal third of the ulna provides satisfactory clinical and radiological outcomes in patients with Masada type I and IIb deformities. Early treatment of Masada type I deformities is indicated before progression to more complex type IIb deformities.
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Affiliation(s)
- Yunan Lu
- Department of Paediatric Orthopaedics, Fuzhou Second Hospital, The Third Clinical Medical College, Fujian Medical University, Fuzhou Second Hospital of Xiamen University, School of Medicine, Xiamen University, 47th Shangteng Road of Cangshan District, Fuzhou, 350007, Fujian Province, China
| | - Federico Canavese
- Department of Paediatric Orthopaedic Surgery, Lille University Centre, Jeanne de Flandre Hospital, Rue Eugène Avinée, 59000, Lille, France
| | - Ran Lin
- Department of Paediatric Orthopaedics, Fuzhou Second Hospital, The Third Clinical Medical College, Fujian Medical University, Fuzhou Second Hospital of Xiamen University, School of Medicine, Xiamen University, 47th Shangteng Road of Cangshan District, Fuzhou, 350007, Fujian Province, China
| | - Yuling Huang
- Department of Paediatric Orthopaedics, Fuzhou Second Hospital, The Third Clinical Medical College, Fujian Medical University, Fuzhou Second Hospital of Xiamen University, School of Medicine, Xiamen University, 47th Shangteng Road of Cangshan District, Fuzhou, 350007, Fujian Province, China
| | - Xinwu Wu
- Department of Paediatric Orthopaedics, Fuzhou Second Hospital, The Third Clinical Medical College, Fujian Medical University, Fuzhou Second Hospital of Xiamen University, School of Medicine, Xiamen University, 47th Shangteng Road of Cangshan District, Fuzhou, 350007, Fujian Province, China
| | - Binbin Lin
- Department of Paediatric Orthopaedics, Fuzhou Second Hospital, The Third Clinical Medical College, Fujian Medical University, Fuzhou Second Hospital of Xiamen University, School of Medicine, Xiamen University, 47th Shangteng Road of Cangshan District, Fuzhou, 350007, Fujian Province, China
| | - Shunyou Chen
- Department of Paediatric Orthopaedics, Fuzhou Second Hospital, The Third Clinical Medical College, Fujian Medical University, Fuzhou Second Hospital of Xiamen University, School of Medicine, Xiamen University, 47th Shangteng Road of Cangshan District, Fuzhou, 350007, Fujian Province, China.
- Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma (2020Y2014), Fuzhou, 350007, China.
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Zhang R, Wang X, Liu S, Ruan H, Xu J, Kang Q. Hinge positioning method of Ilizarov apparatus in correcting radial head luxation caused by multiple hereditary exostoses. Jt Dis Relat Surg 2022; 33:40-50. [PMID: 35361079 PMCID: PMC9057536 DOI: 10.52312/jdrs.2022.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 02/21/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives
In this study, we present a specified hinge positioning method to achieve satisfying and steerable lengthening and angulation to correct forearm multiple hereditary exostoses (MHE) combined with severe radiocapitellar joint dislocation using Ilizarov ring fixators. Patients and methods
Between January 2014 and December 2018, a total of 30 forearms of 23 patients (11 males, 12 females; mean age: 18.3±6.8 years; range, 8 to 35 years) who suffered from type IIa (n=2) or IIb (n=28) MHE with severe radiocapitellar joint luxation were retrospectively analyzed. All patients were treated with Ilizarov external fixators with our specified hinge positioning method. Range of motion of the elbow, forearm and wrist and Visual Analog Scale (VAS), as well as Disabilities of Arm, Shoulder, and Hand (DASH) score, and radiological parameters, including radial articular angle (RAA), ulnar variance (UV) and carpi slip (CS), were recorded preoperatively and at final follow-up and were compared. Results
Clinical and radiological outcomes were evaluated. Range of motion of the elbow, forearm and wrist, VAS, DASH and radiological features, including RAA, CS, and UV were significantly improved, except for range of motion of the forearm supination. Temporary nail track infection was seen in two of the forearms and was controlled with oral antibiotics. None of the patients developed radial head dislocation again. Conclusion
Clinical and radiological outcomes of this novel hinge positioning method are satisfactory in treating MHE with severe radial head dislocation, and this method can be an alternative treatment for MHE by setting a milestone for accurate radiocapitellar joint reduction.
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Affiliation(s)
| | | | | | | | | | - Qinglin Kang
- Department of Orthopedics, Shanghai Sixth People's Hospital, 200233 Shanghai, China.
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Usui D, Komura S, Hirakawa A, Ichikawa K, Matsumoto K, Akiyama H. Corrective Surgery for a Forearm Deformity in a Middle-Aged Patient with Multiple Hereditary Exostoses: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00095. [PMID: 34101654 DOI: 10.2106/jbjs.cc.20.00875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 48-year-old man underwent corrective surgery for a deformity of the left forearm because of multiple hereditary exostoses (MHE). The patient had no complaint of pain, the appearance of his forearm improved, and acceptable range of motion of the wrist and forearm were maintained at 14-month follow-up. CONCLUSION The esthetic forearm deformity in the middle-aged patient with MHE was successfully improved without sacrificing function. Although there is little evidence of forearm corrective surgeries for adult patients with MHE, this report could expand surgical indications for them.
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Affiliation(s)
- Daiki Usui
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
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Kim WJ, Park JS, Won SH, Lee HS, Lee DW, Jang BW, Lee JJ, Hong YC, Kang JK, Wibowo R, Kim CH. Total hip arthroplasty in hereditary multiple exostoses with secondary osteoarthritis: A case report. Medicine (Baltimore) 2019; 98:e18175. [PMID: 31770268 PMCID: PMC6890341 DOI: 10.1097/md.0000000000018175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Hereditary multiple exostoses (HME) is an autosomal dominant disease that causes multiple exostoses throughout the body. It usually occurs around the metaphysis of the long bones, and when it involves the hip, symptoms arise due to deformity and the mass effect. If the lesion does not involve the joint or is not associated with arthritis, symptoms can be relieved by surgical excision of the osteochondroma. However, if secondary osteoarthritis (OA) or subluxation of the joint has progressed, joint replacement arthroplasty should be considered. PATIENT CONCERNS A 57-year-old woman with HME visited our outpatient department with severe right hip pain. She complained of difficulty walking and severe discomfort during activities of daily living. She was short in stature and had a family history of HME. DIAGNOSIS A physical examination revealed limited motion in the hip joint and a limb length discrepancy. Plain radiography and a computed tomography scan revealed huge osteochondromas on bilateral proximal femurs and advanced OA with subluxation of the right hip joint. INTERVENTIONS Cementless total hip arthroplasty of the right hip joint via the modified posterolateral approach was done. OUTCOMES The patient showed good clinical scores and functional improvement at the 2-year follow-up. LESSONS Total hip arthroplasty for an anatomically deformed joint is technically difficult, and there are many factors to consider that can make surgeons reluctant to use this modality. However, with careful preparation, arthroplasty is a good surgical option for symptomatic and functional recovery in HME patients with hip joint involvement.
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Affiliation(s)
- Woo Jong Kim
- Department of Orthopedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan
| | - Jong Seok Park
- Department of Orthopedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan
| | - Sung Hun Won
- Department of Orthopedic Surgery, Soonchunhyang University Hospital Seoul
| | - Hong Seop Lee
- Department of Foot and Ankle Surgery, Nowon Eulji Medical Center, Eulji Uiversity
| | - Dhong Won Lee
- Department of Orthopedic Surgery, Konkuk University Medical Center, Seoul
| | - Byung-Woong Jang
- Department of Orthopedic Surgery, Soonchunhyang University Hospital Seoul
| | - Jae Jun Lee
- Department of Orthopedic Surgery, Soonchunhyang University Hospital Seoul
| | - Yong Cheol Hong
- Department of Orthopedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan
| | - Jin Ku Kang
- Department of Anesthesia, Soonchunhyang University Hospital Cheonan, Cheonan, South Korea
| | - Ricky Wibowo
- Department of Orthopedics and Traumatology Faculty of Medicine Universitas Padjadjaran Bandung, West Java, Indonesia
| | - Chang Hyun Kim
- Department of Orthopedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan
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Li Y, Han B, Tang J, Chen M, Wang Z. Identification of risk factors affecting bone formation in gradual ulnar lengthening in children with hereditary multiple exostoses: A retrospective study. Medicine (Baltimore) 2019; 98:e14280. [PMID: 30702592 PMCID: PMC6380801 DOI: 10.1097/md.0000000000014280] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The forearm deformity classified by Masada is a characteristic trait of patients with hereditary multiple exostoses (HME). Ulnar gradual lengthening, which was considered to be a safe and reliable procedure, was popular in treating these difficult deformities, however, delayed consolidation of the callus is uncommon but not rare in literature review. The purpose of this study was to try to identify the risk factors influencing bone healing in gradual ulnar lengthening in HME.We retrospectively reviewed patients with HME-induced forearm deformity who underwent gradual ulnar lengthening at our hospital from 2010 to 2016. Patients' demographic data, forearm deformity of Masada type, surgical procedure, ulnar diameter of osteotomy site, and external fixator type were recorded. We also reviewed radiographical data included gained length, axis deviation, callus form. Clinical outcome was assessed by the bone healing index (HI). Multiple linear regression was used to analyze the relationships between diffident parameters and the HI, the level of significance was set P <.05.Thirty-three patients were included in this study. The mean follow-up period was 1.5 (range 0.5-8) years. Circular external fixators were used in 5 patients and monolateral external fixators were used in 28 patients. The mean achieved length was 4.24 cm. The mean HI was 50.3 (range 26.6-99.3) days/cm. In patient with monolateral external fixator, patient's age was positively correlated with the bone HI (P = .001), while diameter and body mass index (BMI) were negatively correlated with the HI (P = .040, .018, respectively). Patient's sex, removal of distal ulnar exostoses, lengthening percentage, and axis deviation were non-significant in the regression model.When using monolateral external fixator for ulnar lengthening, patient's age, diameter of osteotomy site, and BMI are the most important risk factors related to bone formation. Pediatric orthopedic surgeons should consider these variables in order to avoid delayed union.
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Affiliation(s)
| | | | - Jingyan Tang
- Department of Hematology and Oncology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Mu Chen
- Department of Pediatric Orthopedics
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Agashe M, Shah A, Parikh SN. A Rare Presentation and Management of Forearm Deformity in a Patient with Hereditary Multiple Exostoses: A Case Report. JBJS Case Connect 2018; 8:e53. [PMID: 30045076 DOI: 10.2106/jbjs.cc.17.00295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
CASE We report the case of a patient with a long-standing and progressive forearm deformity, secondary to underlying hereditary multiple exostoses (HME). A salvage surgery was performed with excision of the pathologic parts of the radius and the ulna, followed by the creation of a 1-bone forearm. CONCLUSION One of the common manifestations of HME is forearm deformity due to abnormal ossification and osteochondromas that affect the radius and/or the ulna. Progressive deformity can lead to increasing pain, joint instability, limited motion, and functional decline. Neglected or recalcitrant deformities pose a treatment challenge. At 1.5 years after surgery, the patient had a satisfactory outcome with a fully functional, pain-free forearm in a fixed, neutral position.
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Affiliation(s)
| | - Avi Shah
- Cincinnati Children's Hospital, Cincinnati, Ohio
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13
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Abstract
RATIONALE Metachondromatosis (MC) is a very rare genetic disease, which is infrequently reported worldwide, which leads to osteochondroma and enchondromatosis. The disease has been shown to be associated with loss of function of the tumor suppressor gene "protein tyrosine phosphatase, non-receptor type 11" (PTPN11). PATIENT CONCERNS A 12-year-old female was admitted to the hospital with pain due to an enlarged mass in her left fifth finger. DIAGNOSIS Examination of the left hand by computed tomography (CT) revealed an expanding type of round and low-density lesion in the fifth proximal phalanx. The patient then underwent technetium-99m methylene diphosphonate single-photon emission CT/CT (Tc-MDP SPECT/CT) to assess the nature of the lesion. The SPECT/CT image revealed dilated osteopathy and increased activity of the fifth proximal phalanx on the left hand. Unexpectedly, the examination of the right hand revealed slight expanded lesions and increased activities of the third metacarpal and proximal phalange, as well as the fourth proximal phalange and the middle phalanx. On the basis of the patient's symptoms and the results of the above-mentioned examinations, we diagnosed the patient as having MC in her hands. INTERVENTION Considering the pain of the fifth finger of the left hand, the patient underwent debridement of the fifth proximal phalanx of the left hand and internal fixation with bone graft taken from the body. OUTCOMES The patient was discharged after a week of observation. One year later, she was admitted to the hospital again for removal of the bone healing internal fixation after osteoma surgery. Preoperative Tc-MDP SPECT/CT revealed that the left-handed lesions displayed postoperative changes, while the multiple lesions in the right hand increased in volume but remained unchanged in number. LESSONS This case revealed the CT and Tc-MDP SPECT/CT imaging features of MC. Specifically, SPECT/CT imaging contributed to the diagnosis of clinically asymptomatic bone lesions, and the 3D SPECT/CT fusion allowed a more comprehensive and intuitive view of the lesion by combining anatomy and function.
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Affiliation(s)
- Zi Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University
| | - Yuting Zou
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University
| | - Yu Chen
- Department of Radiology, The Affiliated TCM Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Yue Chen
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University
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Abstract
Background: The trigger finger is characterized by the painful blocking of finger flexor tendons of the hand, while crossing the A1 pulley. It is a rare disease in children and, when present, is usually located in the thumb, and does not have any defined cause. Methods: We report 2 pediatric trigger finger cases affecting the long digits of the hand that were caused by an osteochondroma located at the proximal phalanx. Both children held the diagnosis of juvenile multiple osteochondromatosis. They had presented at the initial visit with a painful finger blocking. Surgical approach was decided with wide regional exposure, as compared with the trigger finger traditional surgical techniques, with the opening of the A1 pulley and the initial portion of the A2 pulley, along with bone tumor resection. Results: Patients evolved uneventfully, and recovered the affected finger motion. Conclusion: It is important to highlight that pediatric trigger finger is a distinct ailment from the adult trigger finger, and also in children is important to differentiate whenever the disease either affects the thumb or the long fingers. A secondary cause shall be sought whenever the long fingers are affected by a trigger finger.
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Affiliation(s)
| | - Pedro J. Delgado
- Hospital Universitario HM Montepríncipe, Boadilla del Monte, Madrid, Spain
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15
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Chu A, Ong C, Henderson ER, Van Bosse HJP, Feldman DS. Distraction Osteogenesis of the Fibula to Correct Ankle Valgus in Multiple Hereditary Exostoses. Bull Hosp Jt Dis (2013) 2016; 74:249-253. [PMID: 27815946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Gradual distal fibula lengthening (DFL), in conjunction with other procedures, was used to correct ankle valgus and short fibulae in three pediatric patients with multiple hereditary exostoses (MHE). The average amount of DFL was 15 mm with a mean follow-up of 2.9 years. Final radiographs showed that all three patients had a stable ankle mortise without evidence of talar tilt or widening. In conclusion, gradual DFL has the advantage of restoring anatomy in cases of ankle valgus due to short fibulae and MHE, and may be performed in conjunction with other procedures.
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Krstačić A, Župetić I, Krstačić G, Čavor LL, Soldo SB. Hereditary multiple exostoses: an unusual cause of spinal cord compression. Acta Neurol Belg 2016; 116:357-8. [PMID: 26424540 DOI: 10.1007/s13760-015-0549-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 09/22/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Antonija Krstačić
- Clinical Hospital of Traumatology, "Sestre milosrdnice" University Hospital Center, Draškovićeva 19, 10000, Zagreb, Croatia.
- The Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.
| | - Ivana Župetić
- Clinical Hospital of Traumatology, "Sestre milosrdnice" University Hospital Center, Draškovićeva 19, 10000, Zagreb, Croatia
| | - Goran Krstačić
- The Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Institute for Cardiovascular Disease and Rehabilitation, Zagreb, Croatia
| | - Ljubica Luetić Čavor
- Clinical Hospital of Traumatology, "Sestre milosrdnice" University Hospital Center, Draškovićeva 19, 10000, Zagreb, Croatia
| | - Silva Butković Soldo
- Clinic of Neurology, University Hospital Center Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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17
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Beutel BG, Klifto CS, Chu A. Timing of forearm deformity correction in a child with multiple hereditary exostosis. Am J Orthop (Belle Mead NJ) 2014; 43:422-425. [PMID: 25251529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Multiple hereditary exostosis (MHE) can cause progressive skeletal deformities (eg, ulnar shortening, bowing, radial head dislocation) in the upper extremity. Various procedures have been used to correct forearm deformity in children with MHE. The timing of these procedures, however, is controversial. An 11-year-old boy with known MHE presented 7 months after onset of left elbow pain and loss of flexion-extension to 40° to 120°. Radiographs showed a distal ulna osteochondroma, ulnar shortening, bowing, and radial head dislocation. Eighteen months after ulnar osteotomy, radial head reduction, and external fixation, he had motion from 0° to 135°. This case demonstrates that later stage MHE-induced forearm deformities can be successfully surgically corrected. Given possible recurrence during growth, there may be an indication for waiting until the patient is closer to skeletal maturity before proceeding with corrective forearm procedures.
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Affiliation(s)
| | | | - Alice Chu
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY.
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18
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Abstract
General orthopedic surgeons frequently encounter patients with conditions affecting multiple bones. It is important to recognize common polyostotic diseases. This article describes five polyostotic conditions: Multipe Enchondromatosis (Ollier Disease and Maffucci syndrome), Multiple Hereditary Exostosis (Diaphyseal Aclasis), Fibrous Dysplasia (McCune-Albright syndrome and Mazabraud syndrome), Paget's Disease of bone (Osteitis Deformans), and Skeletal Metastases. This is a survey of the clinical, pathologic and radiographic features that assist in diagnosing these conditions. Also, an overview of the laboratory findings, treatment, follow-up, and prognosis is presented. Recognizing these diseases will aid in prompt and accurate diagnosis and appropriate referral and therapy.
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Affiliation(s)
- Saravanaraja Muthusamy
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, 1400 NW 12th Avenue, Suite 4036, Miami, FL 33136, USA
| | - Sheila A Conway
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, 1400 NW 12th Avenue, Suite 4036, Miami, FL 33136, USA
| | - H Thomas Temple
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, 1400 NW 12th Avenue, Suite 4036, Miami, FL 33136, USA.
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Fitzgerald CWR, Rowan FE, O'Neill SC, Mulhall KJ. A mountain among molehills: removing an impinging large femoral neck osteochondroma in a man with hereditary multiple exostoses. BMJ Case Rep 2014; 2014:bcr2013202317. [PMID: 24408944 PMCID: PMC3902964 DOI: 10.1136/bcr-2013-202317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 31-year-old man with a history of hereditary multiple exostoses (HME) presented with persistent right groin pain and reduced hip range of movement. Examination demonstrated a positive FADIR (flexion, adduction and internal rotation) test suggesting femoroacetabular impingement (FAI). Investigations showed multiple sessile osteochondromata of the right femur with a dominant anterolateral femoral neck osteochondroma causing flexion block. The patient underwent an uncomplicated proximal femoral exostectomy. Six-week postoperative pain, range of movement and daily activity had greatly improved. This case highlights that even in the setting of multiple osteochondromata, excellent impingement relief can be achieved following selective proximal femoral exostectomy.
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Affiliation(s)
- Conall W R Fitzgerald
- Department of Trauma and Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
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20
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Abstract
PURPOSE Multiple hereditary exostoses of the forearm typically form in the distal ulna, causing disturbances in the growth of the ulna and functional disability. Multiple hereditary exostoses inhibit the growth of the ulna, leading to an acquisition of a varus deformity in the radius, which sometimes leads to dislocation of the radial head, the development of limitations in the pronation-supination of the forearm, and cosmetic problems. MATERIALS AND METHODS We retrospectively reviewed the cases of four patients who had deformities of the forearm with radial head dislocation associated with multiple hereditary exostoses, and evaluated the radiologic and clinical results of excision of the osteochondromas from the distal ulna and gradual ulnar lengthening with an Ilizarov external fixator. RESULTS Good clinical and radiological results were obtained after a mean follow-up of 25 months. At the most recent follow-up, radial bowing, ulnar shortening, carpal slip, and the pronation/supination arch of the forearm had improved. There was little change in terms of preoperative radial articular angle and the flexion/extension arch of the elbow by the most recent follow-up. CONCLUSION Treatment of four forearms from four patients by excision of osteochondromas and gradual lengthening of the ulna with an Ilizarov external fixator spontaneously reduced dislocations of the radial heads without the need for any additional operative intervention. All patients were satisfied with the final results.
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Affiliation(s)
- Yong Jin Cho
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea.
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Abstract
Though osteochondromas are the most common benign bone tumour, their spinal involvement is less frequent. We report a case of osteochondroma in a 5-year-old female child with multiple hereditary exostoses that originated from posterior elements of C2 vertebra, not involving spinal canal and caused restriction of neck movement. It was excised from its base without disturbing the continuity of lamina. Two years later she had normal neck movements without any recurrence. The rarity of this tumour at this location, with such a large size at an early age, makes this article unique.
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Affiliation(s)
- Naveen Tahasildar
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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22
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Tompkins M, Eberson C, Ehrlich M. Hemiepiphyseal stapling for ankle valgus in multiple hereditary exostoses. Am J Orthop (Belle Mead NJ) 2012; 41:E23-E26. [PMID: 22482098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
If left uncorrected, valgus ankle deformity in multiple hereditary exostoses can cause significant disability in skeletally immature children and in adults. Various management methods have been described, including hemiepiphyseal stapling, transphyseal screw placement, fibular-Achilles tenodesis, distal tibial osteotomy, and ablative epiphyseodesis. In this article, we report the cases of 3 skeletally immature children who had undergone hemiepiphyseal stapling of the medial distal tibial epiphysis for correction of valgus ankle deformity in multiple hereditary exostoses. Correction of the tibiotalar axis, in relation to chronological and bone age, was evaluated. Hemiepiphyseal stapling of the medial distal tibial epiphysis provides ipsilateral corrective potential while allowing staple removal for reversal of growth retardation. This procedure is useful in the management of ankle valgus in multiple hereditary exostoses.
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Affiliation(s)
- Marc Tompkins
- Alpert Brown Medical School, Providence, Rhode Island, USA.
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23
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Yinusa W, Owoola AM, Esin IA. Hereditary multiple exostoses: case report. Niger J Clin Pract 2010; 13:218-222. [PMID: 20499760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Hereditary Multiple Exostoses (HME) is a genetically transmitted bone dysplasia that is inherited in an autosomal dominant manner. It usually presents after the age of two years as multiple bony growths on the appendicular skeleton. As a rare condition (incidence of 0.9-2/100,000), it is not commonly seen in our environment. This paper presents the clinical and radiological features of two patients seen in our hospital within a period of six months. METHOD The case records of two patients with hereditary multiple exostoses are presented to highlight the clinical presentation and management options of the condition. RESULTS A boy and a girl who respectively manifested the features of hereditary multiple exostoses at the age of two and six years are presented. The main presenting features were painless progressively increasing bony swellings in both upper and lower limbs, with forearm deformity and ulnar deviation of the wrist. One of them had pressure symptoms which necessitated surgical excision of the symptomatic exostosis. Fine needle aspiration cytology confirmed the diagnosis ofosteochondroma. CONCLUSION Hereditary multiple exostoses though rare, do occur in our environment and the management is essentially by masterly inactivity except when the bony swellings exhibit any complications or there is concomitant deformity.
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Affiliation(s)
- W Yinusa
- Department of Orthopaedic and Trauma Surgery, National Orthopaedic Hospital, Igbobi, Lagos
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24
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Zheng L, Zhang HZ, Huang J, Tang J, Liu L, Jiang ZM. [Clinicopathologic features of osteochondroma with malignant transformation]. Zhonghua Bing Li Xue Za Zhi 2009; 38:609-613. [PMID: 20079189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To investigate the clinicopathologic, radiological and immunohistochemical characteristics of osteochondroma with malignant transformation. METHODS The clinical data, radiological imagings and hematoxylineosin stained histologic sections were reviewed in 463 cases of osteochondroma diagnosed in Shanghai 6th Hospital from 1991 to 2008, including 11 cases with malignant transformation. Immunohistochemical two-step staining was used to detect CK, vimentin, S-100 protein, p53 and c-myc expression in seven cases of osteochondroma with malignant transformation and 10 cases without malignant transformation. The relevant literature was reviewed. RESULTS Among the 11 cases with malignant transformation, five were single osteochondroma (5/408, 1.2%), and six were multiple osteochondromas (6/55, 10.9%). The male to female ratio was 10:1. These 11 cases were derived from femur (4 cases), tibia (3 cases), ilium (3 cases), shoulder bone (1 case) and pubis (1 case). There was one case that showed malignant transformation in both the femur and ilium. The mean ages for the malignant and non-malignant cases were 39.8 years and 20.4 years respectively. All the malignant cases showed large sized lesions with prominent calcification in the thick cartilage caps. The malignant component was low grade, peripheral chondrosarcoma (grade I-II). In some areas the tumor cells infiltrated the peripheral soft tissue and bone marrow. Of the seven cases with malignant transformation that had immunohistochemical staining, all were positive for vimentin and S-100 protein; p53 protein was positive in 2 of 7 cases. CONCLUSIONS Malignant transformation of osteochondroma was usually encountered in multiple lesions. Most patients were more than 30 years old with a long clinical history and with a male predominance. These tumors showed thick cartilage caps with prominent calcification. The lobulated nature of the tumors was evident and they infiltrated the surrounding soft tissue. The sarcomatoid component was peripheral type, well differentiated chondrosarcoma. p53 mutation may explain part of the molecular mechanism in the malignant transformation.
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Affiliation(s)
- Li Zheng
- Department of Pathology, Shanghai 6th People's Hospital, Shanghai Jiaotong University, Shanghai 200233, China
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Chadha M, Singh AP. Secondary chondrosarcoma of the cuboid bone in a patient with multiple exostoses. Can J Surg 2008; 51:E5-E6. [PMID: 18248720 PMCID: PMC2386303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Affiliation(s)
- Manish Chadha
- Department of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India.
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26
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Tzeng CY, Lee TS, Tan TS. Pseudomallet finger caused by an exostosis of the proximal phalanx. J Hand Surg Eur Vol 2007; 32:591-2. [PMID: 17482730 DOI: 10.1016/j.jhsb.2007.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2006] [Revised: 02/13/2007] [Accepted: 02/16/2007] [Indexed: 02/03/2023]
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Abstract
The pathogenesis of multiple exostosis has been controversial with many theories put forward including the structural/mechanical theory, which emphasizes that the osteochondroma arises in the displaced growth plate cartilage penetrating a defective periosteum. Recently, molecular genetics has offered the neoplastic model with tumor suppressor genes implicated in the development and pathogenesis of exostosis. In this study, we demonstrated the spectrum of histological abnormalities in the developing exostosis present on the surface of the bone at the physis. Seven skeletally immature patients with multiple exostoses were used in this study. The patients' families were advised of and consented to the proposed study. Coincident with removal of symptomatic exostoses that was adjacent to the physis, a thin strip of bone with overlying periosteum was removed to include the edge of the physis. This was followed by formalin fixation and routine paraffin embedding. We demonstrated the earliest lesion as a microchondroma within the periosteum adjacent to the normal physis (also called the 'groove of Ranvier'). More mature progressively larger lesions showing enchondral ossification were seen distally. The periosteum and the perichondrium were intact with normal physis. Our observations give support to the fact that precursor cells in the periosteum adjacent to the physis (also called the 'groove of Ranvier') gives rise to the chondrocytes that clonally expands and develops into exostosis.
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Affiliation(s)
- Atiya Mansoor
- Department of Pathology, Oregon Health and Science University, Portland, Oregon 97239, USA
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28
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Akita S, Murase T, Yonenobu K, Shimada K, Masada K, Yoshikawa H. Long-term results of surgery for forearm deformities in patients with multiple cartilaginous exostoses. J Bone Joint Surg Am 2007; 89:1993-9. [PMID: 17768197 DOI: 10.2106/jbjs.f.01336] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Surgical treatment of forearm deformities in patients with multiple cartilaginous exostoses remains controversial. The purpose of the present study was to determine the reasonable indications for operative treatment and to evaluate long-term results of forearm surgery in these patients. METHODS We retrospectively reviewed twenty-three patients (thirty-one forearms) after a mean duration of follow-up of nearly thirteen years. The mean age at the time of the initial procedure was eleven years. The patients underwent a variety of surgical procedures, including excision of exostoses; corrective procedures (lengthening of the radius or ulna and/or corrective osteotomy of the radius and/or ulna) and open reduction or excision of a dislocated radial head. Clinical evaluation involved the assessment of pain, activities of daily living, the cosmetic outcome, and the ranges of motion of the wrist, forearm, and elbow. The radiographic parameters that were assessed were ulnar variance, the radial articular angle, and carpal slip. RESULTS Four patients had mild pain, and five patients had mild restriction of daily activities at the time of follow-up. Eight patients stated that the appearance of the forearm was unsatisfactory. Radiographic parameters (ulnar variance, radial articular angle, carpal slip) were initially improved; however, at the time of the final follow-up visit, the deformities had again progressed and showed no significant improvement. The only procedure that was associated with complications was ulnar lengthening. Complications included nonunion (three forearms), fracture of callus at the site of lengthening (two forearms), and temporary radial nerve paresis following an ulnar distraction osteotomy (one forearm). Excision of exostoses significantly improved the range of pronation (p = 0.036). CONCLUSIONS In our patients with multiple cartilaginous exostoses, corrective osteotomy and/or lengthening of forearm bones was not beneficial. The most beneficial procedure was excision of exostoses. Reasonable indications for forearm surgery in these patients are (1) to improve forearm rotation and (2) to improve the appearance.
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Affiliation(s)
- Shosuke Akita
- Department of Orthopaedic Surgery, National Hospital Organization Osaka Minami Medical Center, 2-1 Kidohigashi, Kawachinagano, Osaka 586-8521, Japan.
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Hosalkar H, Greenberg J, Gaugler RL, Garg S, Dormans JP. Abnormal scarring with keloid formation after osteochondroma excision in children with multiple hereditary exostoses. J Pediatr Orthop 2007; 27:333-7. [PMID: 17414021 DOI: 10.1097/bpo.0b013e3180326732] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Multiple hereditary exostoses (MHE) is an autosomal dominant condition characterized by numerous cartilage-capped exostoses/osteochondromas in areas of actively growing bone. Abnormal scarring with keloid formation after osteochondroma excision in children with MHE has not been previously described. METHODS A retrospective double-cohort study was undertaken to determine if children with MHE have a higher rate of abnormal scarring with keloid formation after osteochondroma excision when compared with those with solitary osteochondroma. In the initial phase, all consecutive children with MHE that underwent excision of osteochondroma with a minimum 2-year postoperative follow-up were identified. A control group of age-matched cases of solitary osteochondroma was subsequently identified. All patients were interviewed for wound healing problems and noncosmetic scarring. All patients with unsatisfactory scars were asked to send pictures and/or were invited for follow-up. Data were statistically analyzed. RESULTS Eighty-three surgeries were performed in 25 patients with MHE, whereas 25 surgeries were performed in 25 patients with solitary osteochondroma. Twelve keloid scars were noted in 7 patients with MHE, and no keloids were noted in any of the patients in the solitary group. Diagnosis of MHE was a statistically significant risk factor for formation of keloids after surgery (P < 0.05). DISCUSSION Abnormal scarring with keloid formation after osteochondroma excision in MHE has not been previously reported. Although this study has limited numbers, the results demonstrate a statistically significant correlation between keloid formation and MHE. The risk for abnormal scarring and keloid formation should be discussed with all patients before surgery.
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Affiliation(s)
- Harish Hosalkar
- Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Pennsylvania, PA 19104, USA
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Ishikawa JI, Kato H, Fujioka F, Iwasaki N, Suenaga N, Minami A. Tumor location affects the results of simple excision for multiple osteochondromas in the forearm. J Bone Joint Surg Am 2007; 89:1238-47. [PMID: 17545427 DOI: 10.2106/jbjs.f.00298] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The effectiveness of excision of osteochondromas in controlling the progression of forearm and wrist deformity remains an issue of controversy. The purpose of this study was to analyze the effectiveness of tumor excision in the correction of forearm and wrist deformity due to multiple osteochondromas in children, with an interpretation of the results based on different patterns of deformity. METHODS Fourteen forearms in thirteen children with a follow-up of more than twenty-four months (average, fifty-three months) were included in the study. The forearms were divided into two groups on the basis of the location of the tumor and the pattern of deformity. In Group 1 (six forearms), the osteochondroma was only in the distal aspect of the ulna and caused compression of the radius. In Group 2 (eight forearms), tumors were in both the distal aspect of the ulna and the ulnar side of the distal part of the radius and were in contact with each other. Radial length, ulnar shortening, radial bowing, the radial articular angle, and carpal slip were measured as radiographic parameters. Ulnar shortening and radial bowing were expressed as a percentage of the radial length to make it possible to compare data between the individuals. Each parameter was evaluated before surgery and at the time of final follow-up. RESULTS In Group 1, the percentage of ulnar shortening and the percentage of radial bowing had improved at the time of final follow-up; however, in Group 2, both the radial articular angle and the percentage of radial bowing had deteriorated significantly after the tumor excision (p = 0.049 and p = 0.017, respectively), even though the percentage of ulnar shortening showed no change. CONCLUSIONS The effectiveness of simple excision of osteochondromas of the distal aspect of the forearm is influenced by the tumor location and is related to the pattern of the deformity. Simple tumor excision can correct the forearm deformity in patients with an isolated tumor of the distal part of the ulna. Conversely, in patients with tumors involving the distal part of the ulna and the ulnar side of the distal end of the radius, tumor excision alone is a less promising procedure for the correction of the deformity. LEVEL OF EVIDENCE Prognostic Level IV.
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Affiliation(s)
- Jun-Ichi Ishikawa
- Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan.
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Skinner R, Beall DP, Webb HR, Ly JQ, Fish JR. Calcaneal osteochondroma. J Okla State Med Assoc 2007; 100:120-4. [PMID: 17476996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Osteochondromas are essentially the most common primary bone tumors. These benign cartilage producing neoplasms are generally asymptomatic and have a relatively small potential for adverse effects. HME, the familial form of this tumor, is associated with a greater incidence of complications, the most significant of which is sarcomatous degeneration to secondary chondrosarcomas. Various imaging techniques can be used to characterize these lesions, but in the absence of symptoms or signs of complications, plain-film radiography is usually sufficient for diagnosis as this tumor has a characteristic radiographic appearance. Once this benign tumor is identified and more serious forms of tumor are ruled out, treatment is generally not needed. If a malignancy is suspected, however, complete surgical excision is the preferred treatment as this usually ensures long term survival.
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Affiliation(s)
- Ryan Skinner
- University of Oklahoma College of Medicine. Department of Radiological Sciences, 1200 N. Everett Dr., ET1606, OKC. OK 73104, USA
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Bansal U, Duttaroy D, Jagtap J, Patel G. A huge abdominal lump with multiple bony bumps. N Z Med J 2007; 120:U2423. [PMID: 17308560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
- Ujjwal Bansal
- Department of Surgery, Government Medical College and Sir Sayajirao General Hospital, Baroda, Gujarat, India
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Abstract
A 16-year-old male patient with hereditary multiple exostoses (HME) was found to have a pseudoaneurysm of the left popliteal artery caused by osteochondroma in the lower femur. The diagnosis was confirmed by ultrasound, magnetic resonance imaging and magnetic resonance angiography without the need to perform an angiogram. The osteochondroma was excised and the popliteal artery was repaired with a saphenous graft. Vascular complications are extremely rare in HME, pseudoaneurysm being the most common and mostly located in the popliteal artery. This complication should be considered in young HME patients with a mass at the knee region. The radiological spectrum of investigations allows the diagnosis of this complication with proper and less invasive management procedures for the patient.
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Affiliation(s)
- Azmy M Al-Hadidy
- Department of Diagnostic Radiology, Jordan University Hospital, University of Jordan, Amman 11942, Jordan.
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Saglik Y, Altay M, Unal VS, Basarir K, Yildiz Y. Manifestations and management of osteochondromas: a retrospective analysis of 382 patients. Acta Orthop Belg 2006; 72:748-55. [PMID: 17260614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Osteochondromas represent the most common primary bone tumours; they reportedly represent 20-50% of all benign bone tumours and 10-15% of all bone tumours. Malignant transformation is their most severe complication. However, deformities and interference with major joint function are the most frequent complaints in patients with hereditary multiple osteochondroma. Treatment should therefore aim not only at surgical resection of the masses but also at prevention of deformities. This article reports observations made on 69 patients with hereditary multiple osteochondroma and 313 patients with solitary osteochondroma, with a mean follow-up of 13.4 years.
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Affiliation(s)
- Yener Saglik
- Department of Orthopaedics and Traumatology, Ankara University Hospital, Turkey
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Pandya NK, Auerbach JD, Baldwin K, Lackman RD, Chin KR. Spinal cord compression in a patient with multiple hereditary exostoses caused by breast adenocarcinoma metastatic to osteochondromas of the spine: case report. Spine (Phila Pa 1976) 2006; 31:E920-4. [PMID: 17108823 DOI: 10.1097/01.brs.0000245926.30594.bf] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report. OBJECTIVE To report on thoracic spinal cord compression caused by a mass in a 66-year-old female with new onset of myelopathic symptoms and a history of multiple hereditary exostoses. SUMMARY OF BACKGROUND DATA To our knowledge, there have been no previous reports of spinal cord compression in a patient with multiple hereditary exostoses caused by breast adenocarcinoma metastatic to osteochondromas of the spine. METHODS.: Chart, pathologic, and radiographic documentation of the preoperative and postoperative clinical course of the patient was used. RESULTS The patient had resolution of her neurologic symptoms following wide surgical excision, decompression, and stabilization from T2 to T10. The patient's mass was found to be breast adenocarcinoma metastatic to osteochondromas of the spine. CONCLUSIONS When faced with a patient with a history of multiple hereditary exostoses with new onset of myelopathic symptoms and a mass compressing the spinal cord, the clinician's differential should be broad and always initially include a metastatic lesion, osteochondroma, or chondrosarcoma.
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MESH Headings
- Adenocarcinoma/complications
- Adenocarcinoma/diagnostic imaging
- Adenocarcinoma/secondary
- Adenocarcinoma/surgery
- Aged
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal, Humanized
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Breast Neoplasms/diagnosis
- Breast Neoplasms/drug therapy
- Carboplatin/administration & dosage
- Chondrosarcoma/diagnosis
- Combined Modality Therapy
- Decompression, Surgical
- Diagnosis, Differential
- Exostoses, Multiple Hereditary/complications
- Exostoses, Multiple Hereditary/surgery
- Female
- Humans
- Laminectomy
- Liver Neoplasms/diagnosis
- Liver Neoplasms/drug therapy
- Liver Neoplasms/secondary
- Lung Neoplasms/secondary
- Lung Neoplasms/surgery
- Neoplasms, Unknown Primary/diagnosis
- Neoplasms, Unknown Primary/drug therapy
- Paclitaxel/administration & dosage
- Spinal Cord Compression/etiology
- Spinal Cord Compression/surgery
- Spinal Fusion
- Spinal Neoplasms/complications
- Spinal Neoplasms/diagnostic imaging
- Spinal Neoplasms/secondary
- Spinal Neoplasms/surgery
- Thoracic Vertebrae/pathology
- Thoracic Vertebrae/surgery
- Tomography, X-Ray Computed
- Trastuzumab
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Affiliation(s)
- Nirav K Pandya
- Spine Surgery and Orthopaedic Oncology Services, Department of Orthopaedics, University of Pennsylvania Medical School, Philadelphia, PA 19104, USA
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Matsubara H, Tsuchiya H, Sakurakichi K, Yamashiro T, Watanabe K, Tomita K. Correction and lengthening for deformities of the forearm in multiple cartilaginous exostoses. J Orthop Sci 2006; 11:459-66. [PMID: 17013733 DOI: 10.1007/s00776-006-1047-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2005] [Accepted: 06/12/2006] [Indexed: 12/01/2022]
Abstract
BACKGROUND Multiple cartilaginous exostoses cause various deformities of the epiphysis. In exostoses of the ulna, the ulna is shortened and the radius acquires varus deformity, which may lead to dislocation of the radial head. In this study, we present the results of exostoses resection, with correction and lengthening with external fixators for functional and cosmetic improvement, and prevention of radial head dislocation. METHODS We retrospectively reviewed seven forearms of seven patients who had deformities of the forearm associated with multiple cartilaginous exostoses. One patient had dislocation of the radial head. Operative technique was excision of osteochondromas from the distal ulna, correction of the radius, and ulnar lengthening with external fixation up to 5 mm plus variance. We evaluated radiographs and the range of pronation and supination. Furthermore, we conducted a follow-up of ulnar length after the operation. RESULTS Dislocation of the radial head of one patient was naturally reduced without any operative intervention. At the most recent follow-up, six of the seven patients showed full improvement in pronation-supination. Ulnar shortening recurred with skeletal growth of four skeletally immature patients; however, it did not recur in one skeletally mature patient. Overlength of 5 mm was negated by the recurrence of ulnar shortening about 1.5 years after the operation. CONCLUSIONS We treated seven forearms of seven patients by excision of osteochondromas, correction of radii, and gradual lengthening of ulnas with external fixators. The results of the procedure were satisfactory, especially for function of the elbow and wrist. However, we must consider the possible recurrence of ulnar shortening within about 1.5 years during skeletal growth periods in immature patients.
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Affiliation(s)
- Hidenori Matsubara
- Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
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Hattori H, Asagai Y, Yamamoto K. Sudden onset of saphenous neuropathy associated with hereditary multiple exostoses. J Orthop Sci 2006; 11:405-8. [PMID: 16897208 DOI: 10.1007/s00776-006-1029-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2005] [Accepted: 03/22/2006] [Indexed: 11/25/2022]
Affiliation(s)
- Hiroyuki Hattori
- Department of Orthopedic Surgery, Shinano Handicapped Children's Hospital, Nagano, Japan
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Abstract
INTRODUCTION Intra-acetabular localisation of an osteochondroma causing subluxation of the hip joint is a rare entity in children suffering from multiple hereditary exostoses. In literature only 6 operatively treated cases have been reported. CASE We add the case of an 8-year-old boy with an intraarticular exostosis of the left acetabulum causing subluxation of the hip. Using an anterolateral approach to the hip joint this exostosis was removed surgically together with some extraarticular exostoses of the proximal femur. The hip could be re-centered in combination with an additional varus derotation osteotomy of the proximal femur. Intraoperatively the femoral head was only subluxated to minimise the risk of avascular necrosis. After a follow-up of two years the patient has complete remission of symptoms and there is no evidence of avascular necrosis radiologically with good remodelling of the left hip. CONCLUSION The operative treatment of an intraarticular exostosis of the hip joint is a difficult and risky surgical procedure. The reported open surgical procedure allowed resection of the intraarticular exostosis in combination with therapy of additional pathologies of the proximal femur.
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Affiliation(s)
- V Ettl
- Orthopädische Klinik, König-Ludwig-Haus, Lehrstuhl für Orthopädie, Würzburg
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Abstract
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.
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Affiliation(s)
- E K Shin
- Department of Orthopaedic Surgery UCLA, Centre for Health Sciences, 10833 LeConte Avenue, Los Angeles 90095, California, USA.
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Abstract
A review of the results of medial distal tibial surface epiphysiodesis to correct valgus deformity in the growing child indicates that the bone age can be used to predict correction. When performed at the appropriate bone age, it may have some advantage over the use of staples or screws.
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Affiliation(s)
- Rodney K Beals
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, Oregon 97239, USA.
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Faik A, Mahfoud Filali S, Lazrak N, El Hassani S, Hajjaj-Hassouni N. Spinal cord compression due to vertebral osteochondroma: report of two cases. Joint Bone Spine 2005; 72:177-9. [PMID: 15797501 DOI: 10.1016/j.jbspin.2004.02.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2003] [Accepted: 02/12/2004] [Indexed: 11/17/2022]
Abstract
Osteochondroma, or exostosis, is the most common of all benign bone tumors. Spinal osteochondromas are uncommon but may cause neurological compromise. We report two cases of spinal cord compression by osteochondromas. One patient was a 17-year-old man with hereditary multiple exostoses who was presented with spastic paraparesis, a sensory level at T3-T4, and a pyramidal syndrome. Vertebral exostosis was suspected by magnetic resonance imaging and confirmed by histological examination. Surgical decompression was followed by complete resolution of the neurological impairments. The other patient was a 19-year-old man with spastic paralysis of the right lower limb and a pyramidal syndrome. Whereas magnetic resonance imaging suggested a neurofibroma, histological features were those of osteochondroma. Nine months elapsed from symptom onset to surgery. This delay led to residual neurological impairments, which resolved almost completely after rehabilitation therapy. Vertebral osteochondromas contribute only 1.3-4.1% of all osteochondromas. The lesion may be solitary or a manifestation of hereditary multiple exostosis. Magnetic resonance imaging shows the exact location of the lesion, most notably with relation to neighboring neurological structures. Spinal cord compression is uncommon and usually has a favorable outcome provided surgical decompression is performed before major neurological damage develops.
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Affiliation(s)
- Afaf Faik
- Rheumatology Department B, El Ayachi Hospital, Rabat-Salé Teaching Hospital, Morocco.
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Abstract
A 6-year-old girl with hereditary multiple exostoses presented with spontaneous hemothorax and pericardial effusion. Chest computed tomographic scan showed left-sided costal exostoses protruding into the left side of the chest. She underwent successful thoracoscopic resection of 3 left rib exostoses and made a full recovery. This report illustrates this rare clinical scenario and reviews the previously published reports of this complication of costal exostoses.
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Affiliation(s)
- Robert A Cowles
- Division of Pediatric Surgery, The Children's Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
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Abstract
We report a case of vertebral osteochondroma of C1 causing cord compression and myelopathy in a patient with hereditary multiple exostosis. We highlight the importance of early diagnosis and the appropriate surgery in order to obtain a satisfactory outcome.
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Affiliation(s)
- Y S Chooi
- University Malaya Medical Centre, Kuala Lumpur, Malaysia.
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Miyamoto K, Sakaguchi Y, Hosoe H, Mori A, Yamazaki S, Hattori S, Shimizu K. Tetraparesis due to exostotic osteochondroma at upper cervical cord in a patient with multiple exostoses–mental retardation syndrome (Langer–Giedion syndrome). Spinal Cord 2004; 43:190-4. [PMID: 15583707 DOI: 10.1038/sj.sc.3101690] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Case report of a severe upper cervical cord compression and tetraparesis by a massive cervical exostotic osteochondroma in a patient with multiple exostoses-mental retardation syndrome (Langer-Giedion syndrome; LGS). OBJECTIVE To describe this very rare pathological condition and the results of surgical intervention. SETTING Gifu, Japan. METHODS A 23-year-old man was referred to our clinic because of progressing tetraparesis. He had previously been diagnosed with hereditary multiple exostoses and mental retardation. As he had not complained of any symptoms, his family only noticed the tetraparesis after advanced deterioration. His face possessed the pathognomic features of LGS. A postmyelogram CT scan demonstrated an exostotic mass arising from the left-side C2 pedicle with associated severe spinal cord compression. He was diagnosed with LGS. Hemilaminectomy on the left side and resection of the osteochondroma were performed. RESULTS At 5 years postoperatively, a neurological examination showed the full return of all motor functions. The CT scan revealed no intracanalar recurrence of the tumor. CONCLUSION In this case of severe tetraparesis due to cervical osteochondroma, decompression by hemilaminectomy provided excellent results. In patients with LGS and intracanalar osteochondroma, the neurological deficit may be masked by mental retardation. Hence, awareness of this pathological condition will help clinicians diagnose it at an early stage.
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Affiliation(s)
- K Miyamoto
- Department of Orthopaedic Surgery, Gifu University School of Medicine, Yanagido, Gifu-City, Gifu-Prefecture, Japan
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Abstract
We describe the treatment and follow-up of a case of hereditary multiple exostosis in a 16-year-old girl, who had intraarticular and extraarticular osteochondromas in the right hip joint which caused hip subluxation. These osteochondromas were excised, the femoral head was located concentrically, and the patient was put in a spica cast for 6 weeks. Six months later, hip magnetic resonance imaging showed no evidence of avascular necrosis. Three years after the operation the patient walked freely, without pain, and there was satisfying coverage of the femoral head. The authors emphasize that careful attention should be given to the surgical technique prior to extraarticular and intraarticular acetabular osteochondroma excision in order to avoid the development of avascular necrosis.
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Affiliation(s)
- Elisha Ofiram
- Orthopedic Surgery Department, The Hadassah-Hebrew University Medical School, Jerusalem, Israel
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Ham SJ, Heeg M, van Horn JR. [Three patients with hereditary multiple exostoses and malignant degeneration of an osteochondroma located in the pelvis]. Ned Tijdschr Geneeskd 2004; 148:1732-8. [PMID: 15468904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
In three male patients with hereditary multiple exostoses (HME), aged 50, 29 and 31 years, peripheral low-grade chondrosarcoma in the pelvic region led to swelling or pain. In the first patient, curative resection was not feasible because of the size and extension of the tumour. However, rapid tumour growth and unbearable pain necessitated a debulking procedure 16 months later. Histopathologic examination revealed a highly malignant dedifferentiated chondrosarcoma. The patient died two years after initial presentation as a result of local tumour growth. In the second patient, treatment consisted of wide resection of the tumour. Five years after the surgery the patient was free of disease. The third patient was initially treated by intralesional resection, followed by partial hemipelvectomy because of residual tumour. Thirteen months later, a local recurrence occurred that was treated by wide excision. Four years after the partial hemipelvectomy the patient was both pain-free and disease-free. Patients with HME are at increased risk for malignant degeneration of pelvic osteochondroma to chondrosarcoma. Periodic control of patients with pelvic osteochondromas is advised, preferably once every two years.
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Affiliation(s)
- S J Ham
- Onze Lieve Vrouwe Gasthuis, afd. Orthopedie, Postbus 95.500, 1090 HM Amsterdam.
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Abstract
Multiple exostoses is an autosomal dominant disease in which bony protuberances arise from the metaphyseal periphery. Most are asymptomatic but occasionally the tumors become troublesome, causing irritation to the surrounding tissues. While nerve compression by an adjacent osteochondroma has been reported, to our knowledge there are no reports of the tumor growing through the mid-substance of a nerve. This article reports two occurrences of an osteochondroma of the proximal fibula that was noted at surgery to grow through the common peroneal nerve, splitting it into two limbs. By reporting these cases, it is our hope to alert surgeons that this problem may occur, and care should be taken to identify the entire nerve prior to removal of the osteochondroma.
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Takahashi M, Nishihara A, Ohishi T, Shiga K, Yamamoto K, Nagano A. Arthroscopic resection of an intra-articular osteochondroma of the knee in the patient with multiple osteochondromatosis. Arthroscopy 2004; 20 Suppl 2:28-31. [PMID: 15243421 DOI: 10.1016/j.arthro.2004.04.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Osteochondroma is usually located outside of the joint and is asymptomatic. We have witnessed the symptoms of intra-articular osteochondroma of the knee joint and resected it arthroscopically. A 54-year-old woman with multiple osteochondromatosis presented with pain and a click on the right knee. Click was palpable and audible at the lateral aspect of the patellofemoral joint. Arthroscopy revealed that osteochondroma in the anterolateral site of the distal femur impinged the lateral edge of the lateral facets of the patella and the inflammatory change of the lateral capsule of the patellofemoral joint. Arthroscopic resection of this osteochondroma completely eliminated the symptoms. To our knowledge, this is the first report of arthroscopic resection of an osteochondroma in the intra-articular joint.
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Affiliation(s)
- Masaaki Takahashi
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
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Rohde V, Reinacher P, Patz E, Sellhaus B, Gilsbach JM. Rückenmarkskompression durch eine zervikale osteokartilaginäre Exostose: Operationsstrategische Aspekte. ACTA ACUST UNITED AC 2004; 142:179-83. [PMID: 15106063 DOI: 10.1055/s-2004-818785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIM The authors present the therapeutic management of a 12-year-old boy with known hereditary multiple exostosis syndrome (HME), who developed spinal cord compression symptoms caused by an exostosis of the C2 lamina. A perinatal brain lesion with tetraparesis delayed the recognition of the spinal cord compression substantially, which resulted in an extensive spur-like growth of the exostosis. METHOD In comparison with already published cases, this growth pattern was rather unique and required consideration on the best surgical management. We decided to monitor the spinal cord function from positioning of the patient to skin closure and to modify the surgical steps of the laminectomy with initial lateral cutting of both hemilaminae. RESULTS Electrophysiological monitoring helped to avoid spinal cord compression by inadequate head anteflexion during positioning. Lateral cutting of the hemilaminae C2 resulted in spontaneous extrusion of the exostosis with immediate improvement of the electrophysiological findings. The boy experienced a prompt improvement of his neurological deficits. CONCLUSION The good surgical and clinical result confirm the value of the applied management concept.
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Affiliation(s)
- V Rohde
- Neurochirurgische Klinik und Institut für Neuropathologie (BS), Universitätsklinik Aachen.
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Affiliation(s)
- Marcus C Korinth
- Department of Neurosurgery, University Hospital of the Technical University of Aachen, Germany.
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