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Advances in Orthopedics 2014The aim of this study is to systematically review the literature with regards to surgical treatment of patients with hip joint osteochondromas, and to report our... (Review)
Review
The aim of this study is to systematically review the literature with regards to surgical treatment of patients with hip joint osteochondromas, and to report our surgical management of three paediatric patients who had femoral neck or acetabular osteochondromas in association with acetabular dysplasia. We performed a systematic review using PubMed and Embase databases for all studies that reported surgical treatments for patients with peritrochanteric or acetabular osteochondroma with or without acetabular dysplasia. We also retrospectively reviewed three patients who were diagnosed with a hip osteochondroma in association with actetabular dysplasia. These patients were known to have hereditary multiple exostoses (HME). The systematic review revealed 21 studies that met our inclusion criteria. All studies were case reports and retrospective in nature and failed to conclude a uniform treatment plan. The three reported cases illustrate successful excision of hip osteochondromas and treatment of acetabular dysplasia. Early excision of hip osteochondromas might prevent acetabular dysplasia in HME patients. Routine radiographic pelvic survey at the time of diagnosis of HME is recommended for early detection of hip osteochondromas and acetabular dysplasia in these children.
PubMed: 24963411
DOI: 10.1155/2014/180254 -
The Journal of Knee Surgery Jun 2015Extraskeletal para-articular osteochondromas of the infrapatellar fat pad are unique soft-tissue tumors whose etiology and clinical history remain poorly understood. We... (Review)
Review
Extraskeletal para-articular osteochondromas of the infrapatellar fat pad are unique soft-tissue tumors whose etiology and clinical history remain poorly understood. We report three cases and a systematic review of the literature. Three females, aged 47, 54, and 70 years, presented with pain and a parapatellar knee mass. All three underwent marginal excision with no complications and no recurrence. In the literature, 32 reports describing 42 cases were identified. Mean age at presentation was 51.1 years (range: 12-75). There were 25 females and 20 males. Seven patients (15.6%) had a history of antecedent trauma. Mean duration of presenting symptoms was 63.9 months (range: 2-300). All patients except for one underwent open excision. Mean follow-up was 14.9 months (range: 3-96). There were no reports of recurrence or malignant transformation. Para-articular extraskeletal osteochondromas of the infrapatellar fat pad have a benign clinical history regardless of whether they are managed by arthroscopic or open marginal excision.
Topics: Adipose Tissue; Aged; Bone Neoplasms; Female; Humans; Middle Aged; Osteochondroma; Patella
PubMed: 24875941
DOI: 10.1055/s-0034-1378192 -
Clinical Orthopaedics and Related... Apr 2014Subungual exostosis is a relatively common benign bone tumor that occurs in the distal phalanges of the toes and can be a source of pain and nail deformity. There is... (Review)
Review
BACKGROUND
Subungual exostosis is a relatively common benign bone tumor that occurs in the distal phalanges of the toes and can be a source of pain and nail deformity. There is controversy about the treatment of these lesions and there are few studies that have synthesized what is known and provided meaningful information on treatment.
QUESTIONS/PURPOSES
We performed a systematic review to address the following questions: (1) What is the best surgical approach for excising these lesions? (2) What is the age range, sex distribution, and presenting symptoms of subungual exostoses and which toe is most frequently affected? (3) What complications arise from treatment?
METHODS
Two authors independently searched multiple databases (Medline, 1950-May 2013; Cochrane EBM database, and EMBASE, 1980-May 2013 provided by OVID; ACP Journal Club, 2003-May 2013; CINAHL by EBSCO, 1937-May 2013; and PubMed by NLM, 1940-May 2013), and key words were chosen to achieve a broad search strategy. We included studies on the management of toe exostoses with > 10 cases and we excluded studies that reported on upper extremity exostoses or osteochondromas. Demographic and treatment data were collected from each article by two independent authors and collated. A total of 124 abstracts were screened, and 116 articles were reviewed in full, of which 13 met the inclusion criteria.
RESULTS
Complete marginal excision through a fish mouth incision protecting the nail led to a recurrence rate of 4% and satisfactory clinical results, defined as no requirement for postoperative intervention and a satisfactory clinical appearance in 73%. Most studies provided incomplete descriptions of specific surgical techniques used. Fifty-five percent of the patients were younger than 18 years of age. A history of toe trauma before diagnosis was present in approximately 30% of the cases. Delayed diagnosis occurred in approximately 10% of the cases and onychodystrophy occurred in more than 10%.
CONCLUSIONS
There is weak evidence to guide management of subungual exostosis. Adequate wound management postexcision aiming to minimize disruption to the nail bed and matrix may prevent onychodystrophy, which is a common complication of treatment.
Topics: Adolescent; Adult; Age Distribution; Bone Neoplasms; Exostoses; Female; Humans; Hypertrophy; Male; Middle Aged; Nail Diseases; Orthopedic Procedures; Osteochondroma; Patient Satisfaction; Postoperative Complications; Radiography; Recurrence; Sex Distribution; Toe Phalanges; Toes; Treatment Outcome; Young Adult
PubMed: 24146360
DOI: 10.1007/s11999-013-3345-4 -
The Journal of Foot and Ankle Surgery :... 2012Dysplasia epiphysealis hemimelica is a rare entity. It is characterized by cartilage overgrowth in the epiphyses and is considered to be an epiphyseal osteochondroma. It... (Review)
Review
Dysplasia epiphysealis hemimelica is a rare entity. It is characterized by cartilage overgrowth in the epiphyses and is considered to be an epiphyseal osteochondroma. It usually presents during childhood and can cause pain and functional limitations. The aim of the present study was to describe the entity through our cases and published data and to present the results of our suggested treatment. A systematic search was performed to retrieve and describe all studies on dysplasia epiphysealis hemimelica. Studies were included if sufficient information on the patient characteristics, lesion location, treatment, and outcomes were described. In addition, we report on 7 of our patients. In our review, 48 studies were found, of which 42 could be included. Owing to the large heterogeneity in the studies, no pooling of data was performed. The studies included 138 patients with 255 lesions. Approximately 27% were female patients. The age at presentation ranged from 3 months to 66 years; however, in most, the entity was discovered before 8 years of age. No apparent guidelines were presented concerning the treatment strategy; however, most investigators performed resection because of pain or limitations in the range of motion. Most lesions were located in the ankle or foot (139 of 255). In our own cases, 5 of 7 patients experienced pain, limited range of motion, or activity restriction. The mean follow-up period was 4 years. Dysplasia epiphysealis hemimelica is a rare entity, occurring predominantly in the lower extremity of in young male patients. Its aggressive growth warrants aggressive treatment in the case of pain or functional or range of motion limitations.
Topics: Adolescent; Adult; Aged; Ankle; Bone Diseases, Developmental; Child; Child, Preschool; Female; Femur; Foot; Humans; Infant; Male; Middle Aged; Radiography; Retrospective Studies; Tibia; Young Adult
PubMed: 22819617
DOI: 10.1053/j.jfas.2012.05.008 -
Virchows Archiv : An International... Sep 2002Despite substantial knowledge on the clinicopathology of chondrogenic skeletal neoplasms, only limited insights into the biology of the different tumor variants are... (Review)
Review
Despite substantial knowledge on the clinicopathology of chondrogenic skeletal neoplasms, only limited insights into the biology of the different tumor variants are available. There are virtually no established molecular markers for identification and classification of these neoplasms. In this paper, we present a systematic review of the biochemistry and cell biology of chondrogenic neoplasms of the bone focussing on our own recent investigations. The hallmark of all differentiated chondrogenic tumors is the presence of neoplastic chondrocytic cells responsible for the formation of the characteristic cartilaginous tumor matrix. These cells can show the full differentiation potential of physiologic chondrocytes depending on the tumor entity investigated. The high phenotypic diversity of physiologic chondrocytes explains the previously poorly understood, striking heterogeneity of the neoplastic cells and their surrounding extracellular matrix not only between different but also within chondrogenic tumors. In our studies, tumor classifications, so far based only on histomorphological criteria, were either confirmed or corrected: mesenchymal chondrosarcomas represent the prototypic neoplasm of pre-chondrogenic undifferentiated cells undergoing multifocal chondrocytic differentiation. Enchondromas, osteochondromas, and conventional chondrosarcomas are neoplasms of multi-phenotypically differentiated chondrocytes. Clear cell chondrosarcomas appear to be neoplasms of hypertrophic chondrocytic cells. A peculiar biology is displayed by dedifferentiated chondrosarcomas, which at least in most cases show neither "anaplasia" nor "dedifferentiation", but most likely "transdifferentiation" of part of the neoplastic cells to a cellular phenotype of a different mesenchymal differentiation lineage. Chondroblastomas do not show any chondroblastic differentiation at all. Our studies delineate molecular markers of chondrogenic neoplasms of the skeleton, which have the potential to be the basis of a new biology-orientated classification of skeletal neoplasms. The expression analysis of extracellular matrix genes, in particular of the collagen types, might be able to play herein a leading role in classification and diagnosis, similar to the cytokeratin subtypes or the CDs (cluster of differentiation) for the classification and diagnosis of neoplasms of the epithelia and the lymphatics.
Topics: Animals; Biomarkers, Tumor; Bone Neoplasms; Chondrocytes; Chondrosarcoma; Collagen Type II; Humans; Immunohistochemistry; Phenotype
PubMed: 12242518
DOI: 10.1007/s00428-002-0641-x