This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowReprints and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Chin, K. R.
Right arrow Articles by Gebhardt, M. C.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Chin, K. R.
Right arrow Articles by Gebhardt, M. C.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Technorati  
What's this?
The Journal of Bone and Joint Surgery 82:1269 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.

Osteochondromas of the Distal Aspect of the Tibia or Fibula

Natural History and Treatment*

Kingsley R. Chin, M.D., F. Daniel Kharrazi, M.D., Bruce S. Miller, M.D., Henry J. Mankin, M.D. and Mark C. Gebhardt, M.D.

Investigation performed at the Orthopaedic Oncology Service, Massachusetts General Hospital, and the Children's Hospital, Harvard Medical School, Boston, Massachusetts
*No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.
Department of Orthopaedic Surgery, Massachusetts General Hospital, Gray Building, Room 606, 55 Fruit Street, Boston, Massachusetts 02114-2696. E-mail address for K. R. Chin: kchin{at}partners.org E-mail address for B. S. Miller: bmiller@partners.org. E-mail address for H. J. Mankin: hmankin@partners.org. E-mail address for M. C. Gebhardt: gebhardt.mark@mgh.harvard.edu.
Orthopaedic Sports Medicine, Kerlan-Jobe Orthopaedic Clinic, 6801 Park Terrace, Los Angeles, California 90045.

Background: There is little information on the natural history or treatment of osteochondromas arising from the distal aspect of either the tibia or the fibula. It is believed that there is a risk of deformation of the ankle if these exostoses are left untreated or if the physis or neurovascular structures are injured during operative intervention.

Methods: We reviewed the records of twenty-three patients who had been treated for osteochondroma of the distal aspect of the tibia or fibula between 1980 and 1996. Four of the patients had hereditary multiple cartilaginous exostoses. There were seventeen male and six female patients, and the average age at the time of presentation was sixteen years (range, eight to forty-eight years).

Results: Preoperative radiographs showed evidence of plastic deformation of the fibula in eleven patients who had a large osteochondroma. Four patients elected not to have an operation. The tumor was excised in nineteen patients. Postoperatively, all nineteen patients had a Musculoskeletal Tumor Society score of 100 percent for function of the lower extremity with pain-free symmetrical and unrestricted motion of the ankle at the latest follow-up examination. Partial remodeling of the tibia and fibula gradually diminished the asymmetry of the ankles in all nineteen operatively managed patients; however, the remodeling was most complete in the younger patients. Pronation deformities of the ankle did not change after excision of the tumor. Complications of operative treatment included four recurrences (only three of which were symptomatic), one sural neuroma, one superficial wound infection, and one instance of growth arrest of the distal aspects of the tibia and fibula.

Conclusions: Osteochondromas of the distal and lateral aspects of the tibia were more often symptomatic than those of the distal aspect of the fibula; they most commonly occurred in the second decade of life with ankle pain, a palpable mass, and unrestricted ankle motion. Untreated or partially excised lesions in skeletally immature patients may become larger and cause plastic deformation of the tibia and fibula and a pronation deformity of the ankle. Ideally, operative intervention should be delayed until skeletal maturity, but, in symptomatic patients, partial excision preserving the physis may be necessary for the relief of symptoms and the prevention of progressive ankle deformity. However, partial excision is associated with a high rate of recurrence, so a close follow-up is required. Skeletally mature patients who are symptomatic may require excision of the tumor.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 J Am Acad Orthop SurgHome page
J. R. Stieber and J. P. Dormans
Manifestations of Hereditary Multiple Exostoses
J. Am. Acad. Ortho. Surg., March 1, 2005; 13(2): 110 - 120.
[Abstract] [Full Text] [PDF]