Hyperplastic Callus Formation in Osteogenesis Imperfecta Simulating Osteosarcoma

¹ From the Department of Orthopaedic Surgery, Orthopaedic Hospital, Los Angeles, and the Departments of Radiology, Orthopaedic Hospital and Los Angeles County-University of Southern California Medical Center, Los Angeles

Massive callus formation following fracture in osteogenesis imperfecta may on rare occasions be so exuberant as to produce a clinical picture indistinguishable from osteogenic sarcoma. Recent case reports of proved sarcomatous change in two cases of osteogenesis imperfecta reaffirm the necessity for accurate diagnosis. Twenty-three reported cases of massive callus formation without sarcoma are reviewed and two cases are added.

The only abnormal laboratory values even in advanced cases are elevated sedimentation rate and elevated serum alkaline phosphatase. Radiation therapy afforded rapid symptomatic relief in one patient and in the other it was given early in the process and seemed to halt further exuberant callus formation. Reconstructive surgery may be useful. It was carried out twice in one patient without eliciting abundant callus formation.

Biopsy be necessary on occasion. The importance of accurate diagnosis is stressed since, in the twenty-one cases reported in the literature, nine amputations were advised and three were actually performed for what were later proved to be benign conditions.

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