Percutaneous achillotomy in the treatment of congenital clubfoot: should it be performed in the operating theater or the polyclinic?

BACKGROUND: The aim of this study was to compare the efficacy, advantages, and complications of percutaneous achillotomy in the treatment of clubfoot with the Ponseti method when performed to two different groups under general anesthesia or polyclinic conditions with local anesthesia. METHODS: A retrospective evaluation was made of 96 patients treated for clubfoot in our clinic between January 2013 and June 2016. Fifty-seven patients were separated into two groups according to whether the achillotomy was performed in polyclinic conditions with local anesthesia or under general anesthesia following serial plaster casting with the Ponseti method. RESULTS: The characteristics of age distribution, mean week of tenotomy, side, and sex were similar in both groups. No statistically significant difference was determined between the two groups in respect to complication and recurrence. The durations of hospitalization-observation, separation from the mother, and fasting were found to be statistically significantly shorter in local anesthesia group. CONCLUSION: Although the performance of percutaneous achillotomy with local or general anesthesia has different advantages, it can be considered that especially in centers with high patient circulation, achillotomy with local anesthesia can be more preferable to general anesthesia because it is practical and quick, does not require a long period of fasting or hospitalization, and has a similar complication rate to general anesthesia procedures.

Management of AO type 12C humerus proximal metadiaphyseal fractures with minimally invasive plate osteosynthesis in geriatric patients.

BACKGROUND: To evaluate the treatment efficacy and complications of the lateral minimally invasive plate osteosynthesis (MIPO) method in geriatric patients with a humerus diaphyseal fracture with proximal extension. PATIENTS AND METHODS: The study included a total of 21 patients (18 females, 3 males; mean age 74±6.3 years, range 65-89 years) who underwent surgery with the lateral MIPO technique for a humerus diaphyseal fracture with proximal extension during the period January 2011 to December 2016. None of the patients had additional injuries and all completed regular follow-up. According to the Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation classification system, the fractures were evaluated as 12C1 in 17 cases and 12C3 in 4 cases. All patients were evaluated radiologically and functionally at 6 months and 1 year. In the follow-up evaluations, the Constant-Murley score and the Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) score were used. RESULTS: No non-union, avascular necrosis or infection was seen in any patient. The mean time to union was 15.7 weeks. Impingement syndrome was seen in 2 patients and radial nerve palsy in 2 patients. The mean Constant-Murley score was 70.6±10.2 at 6 months and 84±7.6 at the end of 1 year. The mean Q-DASH score was 38.6±15.1 at 6 months and 21.9±13.1 at the end of 1 year. The increase in the Constant-Murley scores from 6 months to 1 year was statistically significant (p<0.0001). The decrease in the Q-DASH scores between 6 months and 1 year was determined to be statistically significant. In the 2 patients with radial nerve palsy, the functions were seen to completely recover during follow-up. No axillary nerve palsy was seen in any patient. CONCLUSION: Metadiaphyseal humerus fractures with proximal extension in the elderly can be successfully treated with the lateral MIPO technique. When applied correctly, it is a method with high rates of union and low rates of complications.

Evaluation of late redislocation in patients who underwent open reduction and pelvic osteotomy as treament for developmental dysplasia of the hip.

INTRODUCTION: The goal in the treatment of developmental dysplasia of the hip (DDH) is to achieve a stable and concentric reduction and to create a congruent relationship between the femoral head and the acetabulum. This study discusses the causes of loss of reduction in DDH patients who had a concentrically reduced hip at the time of removal of the hip spica cast and cessation of brace use and who later appeared with hip redislocation after mobilisation and ambulation. In addition, the possible interventions in such cases are also discussed. MATERIAL AND METHOD: A retrospective evaluation was made of 13 patients diagnosed with DDH who developed redislocation following primary surgery. 6 of them had undergone the 1st surgery in our department between 2008 and 2016 and 7 had udergone surgery in another centre. For comparison reasons a 2nd group was formed of 13 demographically and clinically matched patients who had no loss of reduction. The groups were compared in terms of acetabular index, pelvic length, pelvic width, abduction degree of plaster, ossifying nucleus diameter, acetabular depth, and acetabular volume parameters. RESULTS: The average age of the patients was 23 months at initial surgery and 29 months at the time of revision surgery. No significant difference was found between the groups in terms of acetabular inclination angle, ossifying nucleus diameter, pelvic size, pelvic width, centre edge angle, acetabular volume, and depth. Contracted inferomedial capsule was found in 1 patient who underwent revision surgery and intact transverse acetabular ligament was seen in 1 patient. The loss of reduction in the remaining 11 patients was associated with high total anteversion of the femoral head and acetabulum. CONCLUSIONS: Correction of increased combined anteversion by femoral osteotomy can create a safe zone in terms of redislocation and can significantly contribute to the stability provided by capsulorrhaphy and pelvic osteotomy.

Management of open fractures using a noncontact locking plate as an internal fixator.

BACKGROUND: The treatment of open fractures leads to major problems which may be due to various reasons. It mainly causes soft tissue problems due to the absorption of a large amount of energy by the soft tissues and bone tissues. Although some recent treatment protocols have eliminated many problems regarding delayed soft tissue closure, it still remains a big challange. This study uses a method called the internal fixator technique with noncontact locking plate (NC-LP) which involves the use of a combination of advantages of open and closed fixation techniques. MATERIALS AND METHODS: 42 patients (32 men and 10 women) having a mean age of 34.11 years (range 17-56 years) with open fractures operated using internal fixator technique between 2007 and 2012 were included in this study. A retrospective chart review was conducted to record the following: age, gender, anatomic region of fractures, fracture etiology, classification of open fractures by Gustilo-Anderson and AO classification, surgeries, length of hospitalization, location and pattern of fracture, length of followup, and complications. RESULTS: The fractures were caused by traffic accidents, shotgun injuries, falls from heights, and industrial crush injuries. Based on the Gustilo-Anderson classification, 31 fractures were Type III and 11 were Type II, where 23 were localized in the tibia and 19 in the femur. Patients delay for a mean of 13.5 h (range 6-24 h) for operation and the mean followup interval was 27.8 months (range 16-44 months). The mean union time was 19.7 weeks (range 16-29 weeks). One patient had delayed union and implant failure, one patient had osteomyelitis, five suffered from surface skin necrosis, and one patient had an angulation of 17° in the sagittal plane, for which no additional intervention was performed. CONCLUSIONS: This case series demonstrates that an "internal fixator technique" is an acceptable alternative to the management of open fractures of the femur or tibia in adult patients. The NC-LP method provided opportunities to achieve a stable fixation with noncontact between the implant and the bone tissues, and the fractures were sufficiently stabilized to allow union with a low complication rate.

Noncontact plating technique in an open fracture.

AIM: In comparison with closed fractures, open fractures have an increased risk of infection, there are soft tissue-related problems, and difficulties are experienced in union. The aim of this study was to evaluate and discuss the results of osteosynthesis applied with a noncontact plate in Gustilo-Anderson Type 2, 3a, and 3b fractures. METHOD: The study included 23 patients applied with debridement + noncontact plate osteosynthesis + soft tissue procedures in a single session for the treatment of an open fracture. A follow-up card was created to evaluate the patients in respect of age, gender, fracture level, fracture etiology, open fracture type, preoperative and postoperative sedimentation and C-reactive protein values, antibiotics used and duration of use, time to union, and complications. RESULTS: In all 23 patients, full bone union was obtained at mean 22.5 weeks (range: 16-36 weeks). Complications developed in 9 patients. Implant failure occurred in 3 patients. In 5 patients, infection developed which required repeated debridements. CONCLUSION: In open fractures, noncontact plating following debridement seems to be a good alternative treatment method to intramedullar nailing, especially in metaphyseal and metaphyseo-diaphyseal fractures and in spiral oblique diafiz fractures. Noncontact plating may also be a good alternative to intramedullar nailing for open fracture treatment if the patients have additional pathologies such as contusion and thoracic injury.

The Use of an "Internal Fixator Technique" to Stabilize Pathologic Fractures Developing Secondary to Osteomyelitis.

BACKGROUND: There is no consensus on the materials and the techniques to use in fixing pathologic fractures secondary to osteomyelitis. This study reports the results of the fixation of pathologic fractures secondary to osteomyelitis using the "internal fixator technique." METHODS: The internal fixator technique was performed on 11 children and adolescents with fractures secondary to osteomyelitis between 2003 and 2010. A retrospective chart review was conducted to record the following: age, sex, the anatomic region of infection, the time delay from symptom onset to fracture, the classification of chronic osteomyelitis, the Cierny-Mader classification, the causative organism, surgeries, the length of hospitalization, the location and the pattern of fracture, the duration of infection, the length of follow-up, and complications. RESULTS: The patients included 7 male and 4 female patients with a mean age of 8.7 (range, 6 to 13) years. Pathologic fractures were as follows: 7 femur and 4 tibia. Nine of them were in the metaphysis and 2 others were located in the diaphysis. The time delay from symptom onset to fracture was 3.36 (1 to 9) months. The anatomic region of infection was the diaphysis in 2 cases and the metaphysis in 9 cases. Fractures patterns were short oblique and transverse. The length of hospitalization was a mean of 7 days. The duration of infection ranged from 1 to 12 (mean, 4.38) months. The mean duration of follow-up was 57.09 (range, 36 to 73) months from the initial presentation. Only 2 patients developed shortening, for which no additional intervention was performed. CONCLUSIONS: This case series demonstrates that the "internal fixator technique" is an acceptable alternative to the management of pathologic fractures of the femur or the tibia in children and adolescents with unresolved acute and chronic osteomyelitis. Infections were resolved in all cases and fractures were sufficiently stabilized to allow union with a low complication rate. LEVEL OF EVIDENCE: Level IV-therapeutic.

A comparison of percutaneous trephine excision and open surgery in the treatment of osteoid osteoma.

PURPOSE: The aim of this study was to compare CT-assisted percutaneous excision, which is a closed, economic method and a more cosmetic approach, and open surgery in the treatment of osteoid osteoma. MATERIALS AND METHODS: Fifty-three patients (12 female and 41 male patients) who had percutaneous excision (n = 24) and open surgery (n = 29) were evaluated retrospectively. The mean age was 16.6 years and the mean duration of follow-up was 53.5 months. During percutaneous excision, a trephine was advanced through the labeling wire and the site, including the nidus, was excised en-bloc and the incision walls were curetted. During the open surgery, the localization of the nidus was marked using c-arm X-ray and the nidus was accessed by lifting the cortical bone, layer-by-layer, using burr. The nidus was excised and its cavity curetted. RESULTS: The result was successful in 22 and a failure in three patients who had closed excision. The result was successful in 20 and a failure in nine patients who had open surgery. The mean duration of operation was 44.37 minutes in the percutaneous excision group and 80.6 minutes in the open surgery group. There was no difference in the pre-operative VAS values between the two groups, whereas the post-operative VAS values were statistically significantly different. There was also a statistically significant difference in the duration of the operation and the length of the hospital stay between the groups. CONCLUSION: Percutaneous excision with trephine is a more successful, effective, minimally invasive, safe and a better cosmetic approach in the treatment of osteoid osteoma. This method is also a cheap method that does not require expensive equipment.

Management of infectious fractures with "Non-Contact Plate" (NCP) method.

The aim of this study was to evaluate the outcomes of internal fixation with Non-Contact Plating (NCP) after deep infection caused by previous surgeries of the tibia or femur fractures. The study included 15 patients (4 female and 11 male). The mean age patients was 36.6 years (range, 21-64 years). There were 6 femur and 9 tibia fractures. The mean follow-up period was 25.7 months (range, 15-45 months). The study comprised 11 open and 4 closed fractures. External fixator was used in 3, plate in 4, and intramedullary nail in 8 patients for index surgery. Deep infection was diagnosed via clinical findings, laboratory parameters, and microbiological evaulation. Deep infection was diagnosed within a mean period of 5.5 weeks (range, 2-10 weeks). The infecting organism was methicillin-resistant staphylococcus aureus (MRSA) in 5, methicillin-sensitive staphylococcus aureus (MSSA) in 6, pseudomonas auroginosa in 2, and enterobacteriacea in 2 patients. Union achieved in all patients. Mean time to union was 17 (range, 11-38) weeks. Delayed union was observed in 3 patients who required additional surgeries. Of these one patient developed osteomyelitis. The NCP is an effective alternative method in the treatment of deep infection encountered after internal or external fixation for the tibia, or femur fractures.

Open reduction and Kirschner wire fixation with triceps lengthening for neglected elbow dislocations.

PURPOSE. To evaluate outcome of open reduction and Kirschner wire fixation with triceps lengthening for neglected elbow dislocations. METHODS. Records of 6 women and 14 men aged 7 to 60 (mean, 20) years who underwent open reduction and Kirschner wire fixation with triceps lengthening for neglected elbow dislocations were reviewed. The dislocations were posterolateral (n=11), posterior (n=4), and posteromedial (n=5). No patient had a neurologic deficit. Elbow stiffness was the main indication for surgery. The duration of dislocation was 25 to 45 days in 11 patients and >45 days in 9; the mean was 47 days. The Mayo Elbow Performance Index (MEPI) was used to assess outcome at the final follow-up. The maximum score was 100. Scores of 90 to 100 were considered excellent, 75 to 89 good, 60 to 74 fair, and <60 poor. RESULTS. The mean follow-up period was 39.1 months. At the final follow-up, the mean MEPI score was 79.3; outcome was excellent in 6 patients, good in 8, fair in 4, and poor in 2. The mean MEPI was 86.4 and 70.6 for patients with ≤45 or less and >45 days of dislocation, respectively. The mean range of movement improved from 20 to 84.5 degrees (p<0.001). The 2 groups were significantly different in terms of MEPI (p=0.005) and range of movement (p=0.001). The MEPI correlated negatively with the duration of dislocation (r= -0.562, p=0.01). The range of movement correlated negatively with patient age (r= -0.649, p=0.002). CONCLUSION. Open reduction and Kirschner wire fixation with triceps lengthening, together with active postoperative elbow movements achieved favourable results for neglected elbow dislocations, especially in younger patients and those in whom the duration of dislocation was <45 days.

Nonunion of the medial cuneiform: a rare case.

Isolated medial cuneiform fractures are quite rare. Conservative treatment is adequate in most cases, while deplaced or unstable fractures are treated surgically. Nonunion is seen extremely rarely after medial cuneiform fractures. There is only one case report in the literature. This case presented here is a 62-year-old male patient who had an isolated medial cuneiform fracture resulting from the impact of a falling metal object. Conservative treatment was performed initially. The patient was diagnosed as nonunion after physical and radiological examinations nine months after he presented to the outpatient clinic. Internal fixation with a mini plate and one staple after reduction was performed surgically. Defective region was filled with a 2 mL of autograft, and the operation was terminated.

Bilateral Knee Pain Associated with Bone Infarction in a Patient with Behcet's Disease.

We describe a 31-years-old female patient with severe pain in both knees who had been diagnosed as Behcet's disease (BD) for 12 years. She had had a history of complications due to BD including superior vena cava thrombosis, pulmonary thromboembolism, uveitis, and erythema nodosum and has reported the administration of corticosteroid therapy irregularly. After radiologic evaluation, she has been diagnosed with bone infarction of both left and right knee with the existance of lupus anticoagulants (LA) positivity. Severe joint pain without the evidence of arthritis must alert the clinician to the possibility of bone necrosis of the extremity, although those may rarely occur bilateral in BD.

Primary xanthofibroma in the calcaneus: a case report.

Xanthoma or xanthofibroma is a lesion, characterized by foamy histiocytes (xanthoma cell) and is mostly seen in soft tissue. Xanthoma may also occur in in the skeletal system of patients with an abnormal lipid metabolism. We present a 22-year-old man with primary xanthofibroma in the calcaneus, who was treated by curettage and grafting of the lesion.

Outcome in unilateral or bilateral DDH treated with one-stage combined procedure.

UNLABELLED: The surgical treatment of patients with neglected developmental dysplasia of the hip (DDH) has been the subject of controversy. We asked if age affected outcome in patients with neglected DDH with unilateral or bilateral dislocation who underwent one-stage combined procedures. We retrospectively reviewed the results of 40 patients (51 hips) treated with a one-stage combined procedure consisting of open reduction, pelvic osteotomy, and femoral shortening. The average age at the time of surgery was 5.4 years for Group I (bilateral dislocation, 22 hips) and 6.7 years for Group II (unilateral dislocation, 29 hips). Mean followup was 5.4 years for Group I and 6.7 years for Group II. According to the modified score system of Trevor et al, 13 hips rated excellent, three were good, and six were fair in Group I; the ratings were 14, nine, and six hips respectively in Group II. Four patients had a limb-length discrepancy of approximately 1.5 cm in Group I. Twelve hips in Group I and 18 hips in Group II had osteonecrosis of varying severity. Our data suggest the outcomes of the children who were 5.5 years or younger in Group I and 8 years or younger in Group II were better. LEVEL OF EVIDENCE: Level IV, case series. See the Guidelines for Authors for a complete description of levels of evidence.

Post therapeutic lower extremity rotational profiles in children with DDH.

PURPOSE: The purpose of this study was to investigate post-therapeutic lower extremity rotational profiles in children with developmental dislocation of the hip (DDH), the differences between these values and those of normal children, and the relationship between these differences and clinical and radiological results. METHODS: In 82 lower extremities of 64 patients, the foot-progression angle was measured clinically and the transmalleolar axis angle photographically, and hip rotations and thigh-foot angle were measured both clinically and photographically. The data obtained were compared with Staheli's data for normal children. In addition, clinical and radiographic data were compared within subgroups and with Staheli's data. Student's t-test and one-way ANOVA were used for statistical evaluation. RESULTS: The medial rotation of the hip, the average clinical value was 44.66 masculine, and the photographic value was 42.28 masculine. Lateral rotation of the hip, the average clinical value was 38.01 masculine, and the average photographic value was 37.29 masculine. Thigh-foot angle, his angle was clinically 8.23 masculine and photographically 9.68 masculine. Angle of the transmalleolar axis, the photographic average was 21.59 masculine. Foot-progression angle, the clinical average was 10.70 masculine. It was determined that the lower extremity rotational profiles of children with DDH treated after walking did not differ from those of normal children, but that the internal and external hip rotations of McKay type III and IV patients were below those of normal children and of McKay type I and II patients. CONCLUSION: Lower extremity rotational profiles in children with DDH who received appropriate treatment were the same as those for normal children.

Effect of lymphedema on the recovery of fractures.

BACKGROUND: Lymphedema delays the healing of any wound by negatively affecting its inflammatory period. Whether it affects bone healing in a similar negative manner is unknown. Therefore, we experimentally investigated the effect of lymphedema on fracture recovery. METHODS: We used thirty 200- to 250-g Sprague-Dawley rats for the experiment. The rats were randomly divided into two groups of 15 rats each for the experimental lymphedema and control groups. Lymphedema development was confirmed by measuring the circumference and diameter of the extremities together with lymphoscintigraphy. Twenty days after the development of lymphedema, a fracture model was created in both groups in the right tibia with mid-diaphyseal osteotomy and fixing with an intramedullary Kirschner wire. After 6 weeks, all rats were sacrificed and the callus tissue that formed along the osteotomy was compared between groups with respect to radiographic, histological, and biomechanical characteristics. RESULTS: The three-point bending test yielded an average stiffness value of 1227 N/mm (n = 6) in the control group and 284 N/mm (n = 7) in the experimental lymphedema group (P < 0.05). At the end of week 6, radiographic evaluation showed that solid knitting was obtained in the control group, whereas in the lymphedema group delayed or no knitting was observed. In the control group, histological investigation revealed normal callus morphology. Trabecular bone was normal and osteoblast and osteoclast activity was clearly evident. The bone was stained homogeneously with hematoxylin and eosin, and ossification was within normal limits. In the lymphedema group, however, the histological appearance was mostly that of scar tissue. In addition, osteoblast and osteoclast activity was much less visible or absent. CONCLUSIONS: Lymphedema negatively affected bone healing in rats. However, the mechanism of this negative effect and its occurrence in humans are still unknown. Further experimental and clinical studies are needed to support and extend our findings.

Successful treatment of hemophilic hand pseudotumors by only radiotherapy.

Hemophilic pseudotumor is a rare complication of hemophilia. We describe a 14-year-old young male with hemophilic pseudotumor in the second and fifth fingers of the left hand. We treated him only with radiotherapy. A total dose of 2000 cGy in 10 fractions was administered in 2 weeks. Factor VIII was not given. After 4 months, complete healing was seen. The patient was followed up at 24 months, and there was no evidence of recurrence and no bone growth disturbance. Based on our experience and a review of the literature, radiotherapy can be an effective alternative modality in treating hemophilic pseudotumor.

Outcome of open comminuted tibial plateau fractures treated using an external fixator.

BACKGROUND: The purpose of this study was to evaluate the outcome of open severe comminuted tibial plateau fractures treated with minimal internal fixation and circular external fixation frames. METHODS: Fifteen open comminuted tibial plateau fractures were involved in this retrospective study. In eight knees, the fracture was reduced through an extended open traumatic wound. In seven patients, another limited incision over the major fracture line or area of comminution was performed to assist in reducing the articular reduction. Simultaneous bone grafting, soft tissue reconstruction, and stabilization of the fracture using a circular external fixator were carried out. RESULTS: The patients were followed for an average of 32 months (range 24-54 months). The average time to union of the fractures and frame removal was 22.8 weeks (range 16-44 weeks). The quality of the reduction of the joint surface was rated as anatomical in four patients, good in five patients, fair in three patients, and poor in three patients. Four patients experienced loss of articular reduction. The Knee Society Clinical Rating scores indicated that three knees were excellent, seven were good, one was fair, and four were poor. Complications included one case of septic arthritis, one of osteomyelitis, one of malunion, and four with loss of reduction. CONCLUSIONS: This technique provided acceptable results for open severe comminuted fractures of the tibial plateau without comminuted posterior wall fractures. The most significant disadvantage of the technique is insufficient anatomical reduction and loss of reduction in comminuted posterior wall fractures in the coronal plane. This technique should be combined with a minimally invasive internal fixation method to prevent loss of reduction in open severe comminuted and irreducible tibial plateau fractures.

Is varus osteotomy necessary in one-stage treatment of developmental dislocation of the hip in older children?

PURPOSE: Innominate osteotomy, varisation-derotation osteotomy, and shortening osteotomy are the most common surgical procedures used to achieve pelvifemoral realignment in the treatment of children over three years of age with developmental hip dislocation. It is well known that varus osteotomy can improve the acetabular index but it does have some disadvantages. The aim of this study was to discuss the results obtained with patients treated only with Salter osteotomy, derotation osteotomy, and shortening, without varus osteotomy, and to evaluate the need for varisation on the basis of these results. METHODS: Between 1996 and 2001, twenty-four hips, sixteen unilateral and four bilateral, of a total of twenty patients treated with this method and available for final controls were evaluated. The study included sixteen female and four male patients with a mean age of 4 years 2 months (ranging between 2 years 10 months and 8 years). The mean follow-up period was determined as 6.57 years (range 5-10 years). McKay's clinical criteria, Sever's radiological criteria, and the evaluation system modified by Trevor et al. were used for evaluation of the results. RESULTS: Based on McKay's clinical criteria, eighteen hips (75%) were classified as type I, four hips (16%) as type II, and two hips (9%) as type III. According to Sever's radiological criteria, thirteen hips (54%) were graded as grade I, nine hips (37.5%) as grade II, and two (8.5%) as grade III. According to the modified evaluation system of Trevor et al. the results were categorized as excellent in thirteen hips, good in nine hips, and moderate in two hips. Pre-operative mean acetabular index was measured as 37.3 degrees (28 degrees -50 degrees ) and early post-operative mean acetabular index as 26 degrees (18 degrees -38 degrees ). In the final radiological examination the mean acetabular index was measured as 18.3 degrees and the mean CE angle as 30.1 degrees (15 degrees -38 degrees ). Avascular necrosis affecting the results developed in five hips. CONCLUSION: It is concluded that in older children with developmental dislocation of the hip (DDH) treated with one-stage combined surgical intervention, adequately stable concentric reduction can be achieved without varisation and that varus osteotomy is not always necessary.

Osseous lipoma: eleven new cases and review of the literature.

This study describes the clinical features, radiological appearance, and treatment of 11 new cases of osseous lipoma and reviews 301 other cases in the literature. Osseous lipomas are classified by the site of origin: either within bone (intraosseous lipoma) or on the surface of bone (juxtacortical). Intraosseous lipomas include intramedullary and intracortical lesions. Surface lipomas include subperiosteal and parosteal lesions. The authors added their cases to those found in the literature. Intramedullary osseous lipoma (n=262) : the most common presenting symptoms were pain and swelling (69%). The most frequent localisations were the calcaneus (24%) and the femur (22%). On plain radiographs, these lesions consisted of a well-circumscribed radiolucent area with central calcification and a sclerotic rim, occasionally with cortical expansion. Computed tomography (CT) and magnetic resonance imaging (MRI) showed that the lesions had attenuation values and a signal intensity identical to that of adipose tissue. In symptomatic lesions and in cases with impending fracture, operative treatment was indicated. Parosteal lipoma (n=47): the most common presenting symptoms were local swelling and pain (58%). This lesion was most frequent in the radius (31%) and in the femur (23%). The classic radiographic appearance of parosteal lipoma was that of an exostosis-like bony prominence capped with a radiolucent layer of fat. CT-scan and MRI showed similar features. Intracortical (n=2) and subperiosteal lipomas (n=11): only a few cases were found in the literature. Their localisation differs from that of the other osseous lipomas. The differential diagnosis of osseous lipoma in general is extensive and should include benign and malignant tumours. Combination of radiological and histological data is essential to determine whether an osseous lipoma is actually present.