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The British Journal of Radiology May 2021Atraumatic fractures of femur, although not as common as traumatic fractures, are frequently encountered in the clinical practice. They present with non-specific... (Review)
Review
Atraumatic fractures of femur, although not as common as traumatic fractures, are frequently encountered in the clinical practice. They present with non-specific symptoms and can be occult on initial imaging making their diagnosis difficult, sometimes resulting in complications. Overlapping terminologies used to describe these fractures may hamper effective communication between the radiologist and the clinician. In this article, we review various atraumatic fractures of femur, terminologies used to describe them, their imaging findings and differential diagnosis. The article also describes the aetiology, pathophysiology and relevant biomechanics behind these fractures. An approach to atraumatic femoral fractures has been outlined.
Topics: Adult; Aged; Diagnosis, Differential; Female; Femoral Fractures; Femoral Neck Fractures; Fractures, Spontaneous; Fractures, Stress; Humans; Middle Aged; Osteoma, Osteoid; Osteomalacia; Osteomyelitis; Terminology as Topic
PubMed: 33684312
DOI: 10.1259/bjr.20201457 -
Pediatric Radiology Apr 2019Image-guided percutaneous microwave ablation has been used to treat adult osteoid osteomas but has not been thoroughly evaluated in the pediatric population.
BACKGROUND
Image-guided percutaneous microwave ablation has been used to treat adult osteoid osteomas but has not been thoroughly evaluated in the pediatric population.
OBJECTIVE
To evaluate the technical feasibility and clinical efficacy of microwave ablation to treat osteoid osteomas in pediatric patients.
MATERIALS AND METHODS
The electronic medical record and imaging archive were reviewed for 24 consecutive patients who had undergone microwave ablation of osteoid osteomas between January 1, 2015, and May 31, 2018, at a single tertiary care pediatric hospital. All patients were diagnosed by clinical and imaging criteria, and referred by a pediatric orthopedic surgeon after failing conservative management with pain medication. The average age of the patients was 13.3 years (range: 3-18 years), and the average size of the osteoid osteoma nidus was 8.8 mm (range: 5-22 mm). Technical success was defined as placement of the microwave antenna at the distal margin of the lesion nidus and achievement of the target ablation temperature. Clinical findings were assessed pre- and post-ablation and clinical success was defined as complete relief of pain without pain medication at 1-month follow-up. The number and severity of complications were also documented.
RESULTS
Clinical success was achieved in 100% of patients (24/24), with all reporting complete cessation of pain medication use 1 week after treatment and 0/10 pain at 1 month. There were 4 minor complications (17%) including access site numbness and a minor soft-tissue infection. There were no major complications.
CONCLUSION
Microwave ablation is a technically feasible and clinically effective treatment for pediatric osteoid osteomas.
Topics: Adolescent; Bone Neoplasms; Catheter Ablation; Child; Child, Preschool; Cone-Beam Computed Tomography; Female; Humans; Male; Microwaves; Osteoma, Osteoid; Radiography, Interventional; Retrospective Studies
PubMed: 30617514
DOI: 10.1007/s00247-018-4327-1 -
Journal of Pediatric Orthopedics. Part B Jul 2017Intraoperative radiographic guidance has traditionally been utilized in orthopedic surgery through 2-D navigation with the C-arm and recently with 3-D navigation with...
UNLABELLED
Intraoperative radiographic guidance has traditionally been utilized in orthopedic surgery through 2-D navigation with the C-arm and recently with 3-D navigation with the O-arm. The aim of this study was to describe the outcome of surgical treatment of spinal osteoblastoma and osteoid osteoma with the utilization of the O-arm and conventional C-arm guidance. This is a retrospective cohort study of patients with spinal osteoid osteoma and or osteoblastoma who were treated at our institution between 2002 and 2011. Seventeen patients were examined in this study including seven with spinal osteoblastoma and 10 with spinal osteoid osteoma. The mean age of the patients at surgery was 11.5±3.9 years. The O-arm was used in seven patients and the C-arm in 10 patients. The C-arm failed to identify the tumor in one case and needed transport to perform a computed tomographic-scan. The length of surgery was shorter when the O-arm was used, especially in the osteoblastoma group. Thirteen patients were pain free at the last follow-up visit and two patients developed recurrence. Radiographs at the last follow-up did not show signs of vertebral instability following tumor resection. Safe and effective localization of spine tumors and confirmation of tumor removal during surgery was achieved by intraoperative radiographic guidance specifically with the O-arm 3-D navigation system.
LEVEL OF EVIDENCE
III.
Topics: Adolescent; Child; Female; Humans; Male; Osteoblastoma; Osteoma, Osteoid; Radiography; Retrospective Studies; Spinal Neoplasms; Surgery, Computer-Assisted; Tomography, X-Ray Computed
PubMed: 27832013
DOI: 10.1097/BPB.0000000000000406 -
European Journal of Nuclear Medicine... Apr 2019Osteoid osteoma is a painful, benign, osteoblastic lesion that occurs in younger patients and affects the extremities or the axial skeleton. While plain film findings... (Review)
Review
Osteoid osteoma is a painful, benign, osteoblastic lesion that occurs in younger patients and affects the extremities or the axial skeleton. While plain film findings may suggest the diagnosis, in complex anatomical regions such as the spine, pelvis, wrist and foot advanced imaging modalities are often required. A typical nidus surrounded by sclerosis or cortical thickening characterizes osteoid osteoma on plain radiography and CT. MR is the cross-sectional imaging modality of choice for most musculoskeletal disorders. Unfortunately, extensive accompanying bone marrow oedema, soft-tissue alterations, difficulty detecting the nidus, and lesion locations close to a joint (with reactive arthritis) may make a confident diagnosis of osteoid osteoma by MR imaging difficult. Hybrid imaging with bone-seeking tracers such as SPECT/CT with Tc-labelled bisphosphonates or PET/CT with F-labelled sodium fluoride (F-NaF) combines high radionuclide uptake with morphological details and provides accurate diagnosis of osteoid osteoma and additional information for treatment planning. FDG is not the recommended PET tracer because osteoid osteoma is normally FDG-negative, although some osteoid osteomas may show increased FDG uptake. Osteoblastoma, Brodie's abscess and stress fractures may mimic osteoid osteoma on imaging and clinical presentation. Once identified as the pain generator, destruction of the osteoid osteoma nidus by ablation or resection techniques usually leads to complete healing. Image-guided drill excision and radiofrequency ablation are widely used interventions. We review the presentation of osteoid osteoma across all imaging modalities, with special focus on hybrid imaging techniques.
Topics: Bone Neoplasms; Humans; Multimodal Imaging; Osteoma, Osteoid
PubMed: 30341641
DOI: 10.1007/s00259-018-4181-2 -
FP Essentials Jun 2020Primary benign bone tumors are uncommon and most often affect children and young adults. They typically are detected incidentally on imaging, though some patients...
Primary benign bone tumors are uncommon and most often affect children and young adults. They typically are detected incidentally on imaging, though some patients present with pain, swelling, or other symptoms. The four main categories of benign bone tumor are: bone-forming (eg, osteoid osteoma, osteoblastoma, fibrous dysplasia, enostosis), cartilage-forming (eg, osteochondroma, enchondroma), connective tissue, and vascular; the latter two are rare. A fifth category is idiopathic (eg, giant cell tumor, aneurysmal bone cyst, simple bone cyst). Osteochondromas are the most common, accounting for 30% to 35% of benign bone tumors. Giant cell tumors account for 20%, osteoblastomas for 14%, and osteoid osteomas for 12%. All others are less common. Diagnosis mainly is via imaging; biopsy rarely is required. Management varies with tumor type, location, symptoms, and risk of recurrence. Some (eg, enchondroma, osteochondroma, fibrous dysplasia, enostosis) typically are asymptomatic, and generally require no intervention. Others (eg, osteoid osteoma, aneurysmal bone cyst, simple bone cyst) can cause symptoms and require percutaneous ablation or surgery. Still others (eg, giant cell tumor, osteoblastoma) can be aggressive and require surgery and other therapies. Malignant transformation is rare for all benign bone tumors, but patients with these tumors should be monitored with serial imaging.
Topics: Biopsy; Bone Neoplasms; Child; Diagnosis, Differential; Humans; Osteoblastoma; Osteoma, Osteoid; Young Adult
PubMed: 32573182
DOI: No ID Found -
Radiology Feb 2022Background Cryoablation is playing an increasing role in the percutaneous treatment of bone tumors. However, despite its potential advantages over heat-based ablation...
Background Cryoablation is playing an increasing role in the percutaneous treatment of bone tumors. However, despite its potential advantages over heat-based ablation techniques, the clinical safety and efficacy of cryoablation have not been established for osteoid osteoma treatment. Purpose To evaluate percutaneous CT-guided cryoablation for the treatment of osteoid osteoma in young patients and adults. Materials and Methods This retrospective study reviewed data from 50 consecutive patients who underwent percutaneous CT-guided cryoablation for the treatment of osteoid osteoma between January 2013 and June 2019 in a single institution. In 30 of 50 patients (60%), the procedure was carried out with the patient under local anesthesia and conscious sedation, with the cryoprobe covering the lesion from an extraosseous position, avoiding direct penetration of the nidus. Clinical and radiologic features, procedure-related data, visual analog scale (VAS) pain scores, complications, and overall success rate were evaluated. Statistical analyses were performed by using the nonparametric Friedman test and Wilcoxon signed rank test for repeated measures. Results Fifty patients (median age, 24 years; interquartile range [IQR], 19-38 years; 31 men) underwent CT-guided cryoablation for the treatment of osteoid osteoma, with a 96% (48 of 50 patients) overall clinical success rate. Of the two patients without clinical success, one patient had incomplete pain relief and the other experienced a recurrence of osteoid osteoma at 11 months, which was successfully treated with a second cryoablation procedure. The median VAS pain score was 8 (IQR, 7-8) before the procedure and 0 (IQR, 0-1; < .001) after the procedure at both primary (6 weeks) and secondary (18-90 months) follow-up. Three of the 50 patients had minor complications (6%); no major complications were reported. Conclusion Osteoid osteoma was safely, effectively, and durably treated with CT-guided percutaneous cryoablation. In the majority of patients, treatment could be performed without general anesthesia, with the cryosphere covering the nidus from an extraosseous position. © RSNA, 2021.
Topics: Adult; Cryosurgery; Female; Humans; Male; Osteoma, Osteoid; Pain Measurement; Postoperative Complications; Radiography, Interventional; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 34812672
DOI: 10.1148/radiol.2021211100 -
The Journal of Foot and Ankle Surgery :... 2018Foot and ankle osteoid osteomas (OOs) are often cancellous or subperiosteal and rarely present with a periosteal reaction. Additionally, the large number of disorders...
Foot and ankle osteoid osteomas (OOs) are often cancellous or subperiosteal and rarely present with a periosteal reaction. Additionally, the large number of disorders included in the differential diagnosis and the nonspecific findings on radiographs complicate the diagnosis. We performed a manual search of the senior surgeon's hospitals' operating room records for the terms "benign bone tumor," "foot," "ankle," and "osteoid osteoma" from January 2003 until December 2014. Of 87 surgically treated patients with lower extremity OOs, 9 patients (11%) with foot or ankle OOs were included. The mean age at presentation was 21 (range 6 to 30) years; all 9 (11%) patients were male. The patients were evaluated for swelling, pain, trauma history, night pain, response to pain relievers, duration of complaints, and interval to diagnosis. The mean follow-up period was 48 ± 24 months, and no recurrences had developed. The mean American Orthopaedic Foot and Ankle Society scale score was 59.04 ± 11 before surgery and 91.56 ± 6 after surgery. The difference was statistically significant at p ≤ .0003. Most previous studies have been limited to case reports. The need for findings from a case series was an essential determinant of our decision to report our results. Patients usually have been treated conservatively, often for a long period. However, delays in treatment cause social, economic, and psychological damage. In conclusion, the presence of atypical findings on radiographs has resulted in a preference for magnetic resonance imaging instead of computed tomography; however, the diffuse soft tissue edema observed on MRI can lead to the use of long-term immobilization and a delay in the diagnosis.
Topics: Adolescent; Adult; Bone Neoplasms; Child; Cohort Studies; Fibula; Foot Bones; Humans; Magnetic Resonance Imaging; Male; Osteoma, Osteoid; Radiography; Young Adult
PubMed: 29503136
DOI: 10.1053/j.jfas.2017.11.019 -
Journal of Clinical Orthopaedics and... May 2022Targeted cannulation of the nidus and subsequent thermal ablation is the basis of CT-guided radiofrequency ablation (RFA) of osteoid osteoma, which is considered... (Review)
Review
Targeted cannulation of the nidus and subsequent thermal ablation is the basis of CT-guided radiofrequency ablation (RFA) of osteoid osteoma, which is considered nowadays as the treatment of choice. The majority of complications during this procedure are due to thermal injury of adjacent structures. Specific measures as per the anatomical location of osteoid osteoma can avoid the majority of complications. This article enlists the possible complications and their necessary precautions and remedies to avoid these complications during CT-guided radiofrequency ablation of osteoid osteoma.
PubMed: 35494487
DOI: 10.1016/j.jcot.2022.101869 -
European Journal of Orthopaedic Surgery... Dec 2021Osteoid osteoma is the third most common benign bone tumor, with well-known clinical presentation and radiological features. Although surgical excision has been the only... (Review)
Review
Osteoid osteoma is the third most common benign bone tumor, with well-known clinical presentation and radiological features. Although surgical excision has been the only therapeutic option for a long time, to date it has been replaced by minimally invasive techniques, which proved satisfactory success rates and low complication occurrence. Therefore, the purpose of this literature review was to describe the main updates of these recent procedures in the field of interventional radiology, with particular attention paid to the results of the leading studies relating to the efficacy, complications, and recurrence rate. Nevertheless, this study aimed to analyze the peculiarities of each reported technique, with specific focus on the possible improvements and pitfalls. Results proved that all mininvasive procedures boast a high success rate with slight number of complications and a low recurrence rate. Radiofrequency ablation is still considered the gold standard procedure for percutaneous treatment of osteoid osteoma, and it has the possibility to combine treatment with a biopsy. Interstitial laser ablation's advantages are the simplicity of use and a lower cost of the electrodes, while cryoablation allows real-time visualization of the ablated zone, increasing the treatment safety. Magnetic resonance-guided focused ultrasound surgery is the most innovative non-invasive procedure, with the unquestionable advantage to be radiation free.
Topics: Bone Neoplasms; Catheter Ablation; High-Intensity Focused Ultrasound Ablation; Humans; Neoplasm Recurrence, Local; Osteoma, Osteoid; Radiology, Interventional; Treatment Outcome
PubMed: 33839926
DOI: 10.1007/s00590-021-02946-w -
Techniques in Hand & Upper Extremity... Sep 2022Osteoid osteoma is considered the most common benign bone forming tumor accounting for 12% of all benign bone tumors. The carpus is a rare site for this tumor but quite...
Osteoid osteoma is considered the most common benign bone forming tumor accounting for 12% of all benign bone tumors. The carpus is a rare site for this tumor but quite a few cases were reported before. The lesion can be subperiosteal, cortical or medullary. Computed tomography scan is the gold standard diagnostic study, whereas magnetic resonance imaging can result in delaying the diagnosis as reported in the literature. Open excision with or without grafting was the technique of choice in most reviewed cases in the literature. In this paper we will illustrate a minimally invasive technique using wrist arthroscopy for an osteoid osteoma of hamate proximal pole. This minimally invasive arthroscopic technique provides a rapid recovery for patients with lesions that are accessible to wrist arthroscopy.
Topics: Arthroscopy; Bone Neoplasms; Hamate Bone; Humans; Osteoma, Osteoid; Tomography, X-Ray Computed
PubMed: 34923561
DOI: 10.1097/BTH.0000000000000377