Clinical Examples: Osteoid Osteoma

Osteoid osteoma is a benign painful skeletal tumor of unknown etiology which most often occurs in the extremities. Radiographs usually show a small sclerotic bone island within a circular radiolucent area. They may be associated with adjacent soft tissue swelling, endosteal and cortical sclerosis. Classically, they are painful, and the pain responds dramatically to aspirin. These are benign, frequently do not progress, and pose little health risk. Excision is indicated for inadequate pain control or questionable diagnosis. Excision margins may be difficult to estimate because of associated adjacent sclerosis. These tumors have high rates of bone turnover, allowing the use of metabolic bone markers such as tetracycline or technetium, as demonstrated in these cases.
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Case 1. This 18 year old man presented with a two year history of pain and swelling of the distal aspect of his proximal phalanx.
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Plain films showed sclerosis within a radiolucent area and adjacent cortical/endosteal sclerosis.
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MRI confirmed a cortical nidus.
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The tumor was removed with a burr.
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Despite extensive resection, over three quarters of the cortical circumference remained, and structural reinforcement was not necessary.
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The defect was packed with cancellous bone harvested from the dorsal distal radius.
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Case 2. (Case of Charles Melone MD)
This patient presented with a pathologic scaphoid fracture associated with an osteoid osteoma.
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This was managed  with scaphoid excision and 4 corner fusion. The patient was given oral tetracycline  preoperatively to aid in tumor marking. This view is of the  distal scaphoid, looking at the fracture line.
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The same view in ultraviolet light shows light yellow fluorescence of the central nidus.
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Case 3. This 26 year old woman presented with recurrent pain and swelling two years following excision of an osteoid osteoma of the ring finger middle phalanx head. Bone scan shows intense activity in this area, consistent with either persistence or recurrence of osteoid osteoma.
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The patient was given perioperative  technetium and tumor resection was guided using a hand held technetium probe.
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The tumor was resected using a  dorsal tendon splitting exposure.
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Debridement was continued until normal counts were demonstrated . This left  a thin  cortical shell which was reconstructed with a corticocancellous graft from the distal radius.
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