DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20203738

Surgical excision of a solitary osteochondroma arising from the lesser trochanter in an adult: a case report

Swapnil Keny, Aditya Dahapute, Swapneel Shah, Nandan Marathe

Abstract


The occurrence of osteochondroma around the proximal femur is rarely reported as most cases are asymptomatic. We report a rare case of symptomatic solitary osteochondroma arising from the lesser trochanter in a skeletally mature patient causing significant impairment of hip function managed by surgical excision. A 32-year-old male labourer presented with pain and swelling over right hip region for nine months. Radiographic examination (X-ray, MRI, CT) revealed the pathognomonic continuity of the cortex and medulla of the lesion with the parent bone. Cartilage cap cover (measuring 15 mm) on MRI helped to clinch the diagnosis. CT guided biopsy was also suggestive of osteochondroma. The tumour was excised en bloc by posterior approach without the need for hip dislocation. The base of the lesser trochanter was osteotomised and the entire mass with the cartilage cap was removed. A two year follow up has shown no evidence of local recurrence. Surgical excision of a symptomatic osteochondroma is a successful form of treatment with low mortality. Adequate pre-operative radiographic examination is helpful to know the location and local spread of the tumour. Measurement of cartilage cap thickness on MRI is an essential tool to diagnose malignant changes. A safe and adequate resection should be carried out in an effective manner with attention to femoral head vascularity and prevention of local recurrences. Patients with solitary osteochondroma around the proximal femur should be kept under observation to help early detection of malignant changes.


Keywords


Osteochondroma, Exostosis, Proximal femur, Lesser trochanter

Full Text:

PDF

References


Dahlin DC, Unni KK. Osteochondroma (osteocartilaginous exostosis). In: Bone tumors. Springfield IL: Charles C Thomas, 1986:18-32.

Khurana J, Abdul-Karim F, Bovée JVM. Osteochondroma In: Fletcher CD, Unni KK, Mertens F. Pathology and genetics of tumours of the soft tissues and bones. Lyon: IARC Press. 2002;234-36.

De Souza AMG, Bispo Júnior RZ. Osteocondroma: ignore or investigate? Rev Bras Ortop. 2014;49:555-64.

Dorfman HD, Czerniak B. Osteochondroma. Bone tumors. St. Louis: Mosby.1998;331-46.

Saglik A. Manifestations and management of osteochondromas: a retrospective analysis of 382 patients. Acta orthop Belg. 2006;72:748-55.

Vivek J, Santosh M, Anil G, Sanjay M, Dharvin L, Hemlata K. Solitary osteochondroma: rare occurrence a report of two cases. Ann Int med and Dental Res. 2016;3(1).

Unni KK. Osteochondroma. Dahlin’s bone tumors: general aspects and data on 11,087 cases. Springfield Thomas. 1996;11-23.5.

Murphey MD, Choi JJ, Kransdorf MJ, Flemming DJ, Gannon FH. Imaging of osteochondroma: variants and complications with radiologic pathologic correlation. Radiographics. 2000;20(5):1407-34.

Inoue S, Noguchi Y, Mae T, Rikimaru S, Hotokezaka S. An external snapping hip caused by osteochondroma of the proximal femur. Modern Rheumatology. 2005;15(6):432-34.

Makhdom AM, Jiang F, Hamdy RC, Benaroch TE, Lavigne M, Saran N. Hip Joint Osteochondroma: Systematic Review of the Literature and Report of Three Further Cases. Advances in Orthopedics. 2014;239.

Weiner DS, Hoyt WA Jr. The development of the upper end of the femur in multiple hereditary exostosis. Clin Orthop1978;137:187-90.

Ahmed AR, Tan TS, Unni KK, Collins MS, Wenger DE, Sim FH. Secondary chondrosarcoma in osteochondroma: report of 107 patients. Clin Orthop. 2003;411:193-206.

Bottner F, Rodl R, Kordish I, Winklemann W, Gosheger G, Lindner N. Surgical treatment of symptomatic osteochondroma a three- to eight-year follow-up study. J Bone Joint Surg (Br). 2003;85-B:1161-5.

Siebenrock KA, Ganz R. Osteochondroma of the femoral neck. Clin Orthop and rel res. 2002;394:211-8.

Tschokanow K. 2 cases of osteochondroma of the femur neck, Beitrage zur Orthopadie und Traumatologie. 1969;6(12):751-2.

Ramos-Pascua L, S´anchez-Herr´aez S, Alonso-Barrio J, Alonso-Le´on A. Solitary proximal end of femur osteochondroma. An indication and result of the en bloc resection without hip luxation. RevistaEspa˜nola de Cirug´ıaOrtop´edica y Traumatolog´ıa. 2012;56(1):24-3.

Feeley B, Kelly B. Arthroscopic management of an intraarticular osteochondroma of the hip. Orthop reviews. 2009;1(1):e2.