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Arthroscopy Techniques Jul 2023Synovial osteochondromatosis is a benign process that most commonly affects the knee joint (70%). It is characterized by proliferative metaplasia of synovial membrane...
Synovial osteochondromatosis is a benign process that most commonly affects the knee joint (70%). It is characterized by proliferative metaplasia of synovial membrane into chondrocytes, resulting in the formation of multiple cartilaginous nodules, which can detach from the synovium to become multiple intra-articular loose bodies. It usually involves the anterior compartment, including infrapatellar fat pad, suprapatellar pouch, and anterior interval, and rarely involves the posterior compartment of the knee. Treatment for synovial osteochondromatosis usually involves surgery, especially in the presence of locking symptoms or decreased range of motion. Arthroscopy has gradually replaced a traditional open approach, resulting in low morbidity, low postoperative pain, better cosmetic results, early recovery of range of motion, short rehabilitation course, and an early return to previous function. In case of involvement of the posterior compartment of the knee joint, arthroscopic access may be difficult. In this Technical Note, the technical details of arthroscopic synovectomy and removal of loose bodies in synovial osteochondromatosis of the knee is described. This arthroscopic technique can deal with the disease, involving both the anterior and posterior compartments of the knee joint.
PubMed: 37533918
DOI: 10.1016/j.eats.2023.02.023 -
BMJ Case Reports Sep 2021Ischiofemoral impingement (IFI) has been described in the medical literature as a cause of hip pain. IFI occurs due to an abnormal contact or reduced space between the...
Ischiofemoral impingement (IFI) has been described in the medical literature as a cause of hip pain. IFI occurs due to an abnormal contact or reduced space between the lesser trochanter and the lateral border of the ischium and is an often unrecognised cause of pain and snapping in the hip. Association of multiple exostoses and a skeletal dysplasia characterised by an abnormal modelling of bone metaphysis and osseous deformities is highly characteristic of this disease. Consequently, multiple exostoses may narrow the ischiofemoral space and cause impingement and pain, even in the absence of malignant transformation. Surgical excision of exostosis of the lesser trochanter is a safe and effective method of treatment for patients with IFI. We present a case of left hip pain with incidental finding of hereditary multiple osteochondroma causing IFI and discuss the predisposing factors and review of literature.
Topics: Adult; Bone Neoplasms; Exostoses, Multiple Hereditary; Femoracetabular Impingement; Hip Joint; Humans; Incidental Findings; Ischium
PubMed: 34518173
DOI: 10.1136/bcr-2021-241840 -
Boletin Medico Del Hospital Infantil de... 2016Multiple hereditary osteochondromatosis is characterized by the growing of benign cartilaginous tumors in form of exostosis, predominately in the metaphysis of long...
BACKGROUND
Multiple hereditary osteochondromatosis is characterized by the growing of benign cartilaginous tumors in form of exostosis, predominately in the metaphysis of long bones. It is described with a prevalence of 1/50,000 individuals.
CASE REPORTS
This article presents the clinical information and its autosomal dominant inheritance pattern where exotoxin genes (EXT gene family) were affected in a three-member family with multiple hereditary osteochondromatosis. The three patients showed altered arcs of movement of wrists, shoulders and ankles. Clinical diagnosis was confirmed with radiology and malignancy was ruled out in all patients.
CONCLUSIONS
This disease requires frequent medical evaluation, surgical bone correction when the normal function is involved, surveillance for malignant transformation, and genetic counseling.
PubMed: 29421192
DOI: 10.1016/j.bmhimx.2015.11.008 -
Journal of Orthopaedic Surgery (Hong... Jan 2017Surgical dislocation of the hip remains an important alternative in hip preservation surgery, especially when a dynamic access to the hip is needed and arthroscopy is...
BACKGROUND
Surgical dislocation of the hip remains an important alternative in hip preservation surgery, especially when a dynamic access to the hip is needed and arthroscopy is not a suitable option. We describe a novel technique for operative dislocation of the hip without trochanteric osteotomy and the clinical results of our patients.
METHODS
Surgical dislocation of the hip without trochanteric osteotomy was done through a modified lateral approach in all of the cases. A review of demographic, clinical, and radiological data was done in all of the patients operated with this technique between 2010 and 2015. Complications, walking aids, weight-bearing status, and modified Harris Hip Score (mHHS) were also recorded.
RESULTS
Six surgical dislocations of the hip were carried out. Indications were tumor resection in five and bulletectomy in one hip. There were two women (four hips) and two men. Mean age was 19 ± 3.8 years. Median follow-up was 2.5 years (range 2-4.5 years). Median mHHS was 92 (90-96). There were no intraoperative nor postoperative complications.
CONCLUSIONS
Surgical dislocation of the hip without trochanteric osteotomy through a modified lateral approach appears to be a safe, simpler, and effective alternative.
Topics: Adolescent; Adult; Arthroplasty; Bone Neoplasms; Cohort Studies; Exostoses, Multiple Hereditary; Female; Femur Head; Giant Cell Tumor of Bone; Hip Dislocation; Hip Fractures; Humans; Male; Middle Aged; Osteotomy; Treatment Outcome; Young Adult
PubMed: 29185379
DOI: 10.1177/2309499016684414 -
Clinics in Orthopedic Surgery Mar 2020Synovial chondromatosis occurs rarely in the shoulder, and its details remain unclear. The purpose of this study was to clarify the clinical results of surgical... (Review)
Review
BACKGROUND
Synovial chondromatosis occurs rarely in the shoulder, and its details remain unclear. The purpose of this study was to clarify the clinical results of surgical resection and the histopathological findings of synovial chondromatosis in the shoulder.
METHODS
Ten shoulders with synovial chondromatosis that had been operatively resected were reviewed retrospectively. Osteochondral lesions were present in the glenohumeral joint in six shoulders and in the subacromial space in four shoulders. Two patients had a history of trauma with glenohumeral dislocation without recurrent instability, and the other seven patients (eight shoulders) did not have any traumatic episodes or past illness involving the ipsilateral shoulder girdle. The occurrences of osteochondral lesions, inferior humeral osteophytes, and acromial spurs were assessed on radiographs before resection, just after resection, and at final follow-up. The Constant scores were compared before resection and at final follow-up with Wilcoxon signed-rank tests. Resected lesions were histopathologically differentiated between primary and secondary synovial chondromatosis.
RESULTS
Inferior humeral osteophytes were found in five shoulders with synovial chondromatosis in the glenohumeral joint, and all four shoulders with synovial chondromatosis in the subacromial space had acromial spur formation. Osteochondral lesions appeared to have been successfully removed in all shoulders on postoperative radiographs. At the final follow-up, however, one shoulder with secondary synovial chondromatosis in the subacromial space showed recurrence of osteochondral lesions and acromial spur formation. The mean Constant score improved significantly from 53.0 points before resection to 76.0 points at a mean follow-up of 6.0 years ( = 0.002). On histopathological evaluation, one shoulder was diagnosed as having primary synovial chondromatosis, while nine shoulders had secondary synovial chondromatosis.
CONCLUSIONS
The present study showed that resection of shoulder osteochondral lesions successfully relieved the clinical symptoms and that primary synovial chondromatosis is less common than secondary synovial chondromatosis in the shoulder. Although most of the present osteochondral lesions were clinically determined to be primary chondromatosis, only one case was histopathologically categorized as primary synovial chondromatosis. These results suggest that histopathological identification is needed to differentiate between primary and secondary synovial chondromatosis.
Topics: Adolescent; Adult; Aged; Child; Chondromatosis, Synovial; Female; Humans; Male; Middle Aged; Pain Measurement; Range of Motion, Articular; Retrospective Studies; Shoulder; Young Adult
PubMed: 32117541
DOI: 10.4055/cios.2020.12.1.68 -
Orthopaedics & Traumatology, Surgery &... Oct 2022Spinal osteochondroma (or exostosis) is a rare benign tumour whose clinical manifestations are delayed due to their slow growth and location. Few studies have addressed... (Observational Study)
Observational Study
BACKGROUND
Spinal osteochondroma (or exostosis) is a rare benign tumour whose clinical manifestations are delayed due to their slow growth and location. Few studies have addressed the characteristics and the diagnostic and therapeutic peculiarities of spinal osteochondroma in children. The objective of this multicentre observational study was to assess the outcomes of a cohort of children after surgery for spinal osteochondroma.
HYPOTHESIS
Surgical excision of spinal osteochondroma in children is not followed by complications or recurrences.
MATERIAL AND METHODS
We included consecutive children who had surgery between 2010 and 2018 at any of eight participating centres to remove spinal osteochondromas. The cause, clinical manifestations, and location of the lesions were collected. The surgical outcomes were evaluated after at least 2 years' follow-up.
RESULTS
We identified 22 patients who had surgery to remove 26 spinal osteochondromas at a mean age of 12.8±2.6 years. Among them, 7 had a solitary osteochondroma (SO group) and 15 had hereditary multiple osteochondromas (HMO group). At diagnosis, 72% of patients had clinical signs (spinal pain, n=4; one or more lumps, n=5; and neurological manifestations, n=3). In the HMO group, the diagnosis was made during routine MRI screening for tumours involving the spinal canal. Most osteochondromas involved the cervical spine (n=13), with no difference between the two groups (p=0.9). The lamina was the most common location but 54% of the tumours were growing within the canal (92% in the HMO group). After a mean follow-up of 5.2±4.4 years, no patients had experienced any recurrences or complications related to the disease or treatment.
DISCUSSION
Surgical excision of spinal osteochondromas in children is effective, with no medium-term recurrences. Our results also confirm the low peri-operative morbidity, even when the canal is involved, and the absence of any effect at last follow-up on spinal alignment. All patients with neurological manifestations at diagnosis made a full recovery.
LEVEL OF EVIDENCE
IV, retrospective observational cohort study.
Topics: Adolescent; Cervical Vertebrae; Child; Humans; Osteochondroma; Retrospective Studies; Spinal Neoplasms; Treatment Outcome
PubMed: 35150927
DOI: 10.1016/j.otsr.2022.103239 -
BMJ Case Reports Aug 2021Stüve-Wiedemann syndrome (SWS) is a rare, autosomal recessive disorder, causing dysautonomia and multisystem failure. Symptoms include skeletal malformations,...
Stüve-Wiedemann syndrome (SWS) is a rare, autosomal recessive disorder, causing dysautonomia and multisystem failure. Symptoms include skeletal malformations, restricted joint mobility and desensitisation to pain. Patients with SWS presenting with intraoral lesions are extremely rare and this is probably due to their shortened lifespan. We present a case of a 9-month-old patient who presented to our Oral and Maxillofacial Surgery (OMFS)Unit with a chronic inflamed ulcer affecting the tongue, secondary to trauma from erupting central incisors. We believe that depapillation in conjunction with an increased pain threshold contributed to its development. The patient was successfully treated by extraction of the lower central incisors and intralesional steroid injections under general anaesthetic. This case highlights that patients with SWS can present to the OMFS clinician with oral lesions and that they can be safely managed under general anaesthesia.
Topics: Exostoses, Multiple Hereditary; Humans; Infant; Oral Ulcer; Osteochondrodysplasias; Tongue Diseases
PubMed: 34344643
DOI: 10.1136/bcr-2020-241530 -
Journal of Orthopaedics Jun 2023Exposure to ionizing radiation in patients with Multiple Hereditary Exostoses (MHE) is inevitable and necessary for the diagnosis and treatment of MHE. Radiation...
BACKGROUND
Exposure to ionizing radiation in patients with Multiple Hereditary Exostoses (MHE) is inevitable and necessary for the diagnosis and treatment of MHE. Radiation exposure has many potentially dangerous consequences, including the increased risk of developing cancer. This is especially concerning in the pediatric patient population since children are more likely to develop adverse effects from radiation than adults. This study aimed to quantify radiation exposure over a five-year period among patients diagnosed with MHE since such information is not currently available in the literature.
METHODS
Diagnostic radiographs, computed tomography (CT) scans, nuclear medicine studies, and intraoperative fluoroscopy exposures were analyzed for radiation exposure in 37 patients diagnosed with MHE between 2015 and 2020.
RESULTS
Thirty-seven patients with MHE underwent 1200 imaging studies, 976 of which were related to MHE and 224 unrelated to MHE. The mean estimated MHE cumulative radiation dose per patient was 5.23 mSv. Radiographs related to MHE contributed the most radiation. Patients from the ages of 10- to 24-years-old received the most imaging studies and exposure to ionizing radiation, especially compared to those under age 10 ( = 0.016). The 37 patients also received a total of 53 surgical-excision procedures, with a mean of 1.4 procedures per person.
CONCLUSIONS
MHE patients are exposed to increased levels of ionizing radiation secondary to serial diagnostic imaging, with those ages 10-24 years old being exposed to significantly higher doses of radiation. Because pediatric patients are more sensitive to radiation exposure and are at an overall higher risk, the use of radiographs should always be justified in those patients.
PubMed: 37234093
DOI: 10.1016/j.jor.2023.05.004 -
Diagnostic and Interventional Imaging Jan 2017Exostoses are the most common benign bone tumors, accounting for 10 to 15% of all bone tumors. They develop at the bone surface by enchondral ossification and stop... (Review)
Review
Exostoses are the most common benign bone tumors, accounting for 10 to 15% of all bone tumors. They develop at the bone surface by enchondral ossification and stop growing when skeletal maturity has been reached. At first, exostoses are covered by a smooth cartilage cap that progressively ossifies with skeleton maturity. Then they may regress, partly or even completely. Osteochondromas may be solitary or multiple, with the latter associated with hereditary multiple exostoses (HME). Exostoses develop during childhood and become symptomatic during the third decade of life in the case of solitary exostoses, or earlier, in case of HME. They stop growing after puberty, when the epiphyseal plates close. Most exostoses remain asymptomatic. Local complications, usually benign, may occur, such as fractures or mechanical impingements upon nearby structures. In rare cases, sarcomatous degeneration occurs. Most of these complications have been described in case reports. This article describes the imaging features of benign complications of exostoses of the shoulder, pelvic girdles and appendicular.
Topics: Aneurysm, False; Bone Neoplasms; Bone and Bones; Bursa, Synovial; Exostoses; Fractures, Bone; Humans; Nerve Compression Syndromes; Osteochondroma; Shoulder Impingement Syndrome; Vascular Diseases
PubMed: 27316575
DOI: 10.1016/j.diii.2015.11.021 -
Connective Tissue Research Jan 2018Multiple hereditary exostoses (MHE) is an autosomal dominant disorder that affects about 1 in 50,000 children worldwide. MHE, also known as hereditary multiple exostoses...
Multiple hereditary exostoses (MHE) is an autosomal dominant disorder that affects about 1 in 50,000 children worldwide. MHE, also known as hereditary multiple exostoses (HME) or multiple osteochondromas (MO), is characterized by cartilage-capped outgrowths called osteochondromas that develop adjacent to the growth plates of skeletal elements in young patients. These benign tumors can affect growth plate function, leading to skeletal growth retardation, or deformations, and can encroach on nerves, tendons, muscles, and other surrounding tissues and cause motion impairment, chronic pain, and early onset osteoarthritis. In about 2-5% of patients, the osteochondromas can become malignant and life threatening. Current treatments consist of surgical removal of the most symptomatic tumors and correction of the major skeletal defects, but physical difficulties and chronic pain usually continue and patients may undergo multiple surgeries throughout life. Thus, there is an urgent need to find new treatments to prevent or reverse osteochondroma formation. The 2016 International MHE Research Conference was convened to provide a forum for the presentation of the most up-to-date and advanced clinical and basic science data and insights in MHE and related fields; to stimulate the forging of new perspectives, collaborations, and venues of research; and to publicize key scientific findings within the biomedical research community and share insights and relevant information with MHE patients and their families. This report provides a description, review, and assessment of all the exciting and promising studies presented at the Conference and delineates a general roadmap for future MHE research targets and goals.
Topics: Animals; Congresses as Topic; Exostoses, Multiple Hereditary; Humans
PubMed: 29099240
DOI: 10.1080/03008207.2017.1394295