The Rizzoli Multiple Osteochondromas Classification revised: describing the phenotype to improve clinical practice.

Multiple osteochondromas (MO) is a rare disorder, characterized by benign osteocartilaginous tumors (osteochondromas), arising from the perichondrium of bones. The osteochondromas increase during growth, frequently causing deformities and limitations. Our study aims to analyze the data captured by the Registry of Multiple Osteochondromas, to refine Istituto Ortopedico Rizzoli (IOR) Classification, providing a representative picture of the phenotypic manifestations throughout the lifespan. We conducted a single-institution cross-sectional study. Patients were categorized according to IOR Classification, which identifies three patients' classes on the presence/absence of deformities and/or limitations. The present dataset was compared with our previously published data, to refine the classification. Nine hundred sixty-eight patients were included: 243 children (<10 years), 136 adolescents (10-15 years), and 589 adults. Of the entire population, half patients presented at least one deformity, and one quarter reported at least one limitation. Compared with our previous study, the amount of children was more than doubled and the percentage of mild/moderate cases was notably increased, giving a better disease overview throughout the lifespan and suggesting a different cut-off for dividing Class II in subclasses. We confirmed that MO is characterized by phenotypic heterogeneity, suggesting that an early classification of the disease may offer a useful tool to follow disease pattern and evolution, to support clinical practice, and to propose timely interventions.

Surgical Treatment of Solitary Periarticular Osteochondromas About the Knee in Pediatric and Adolescent Patients: Complications and Functional Outcomes.

BACKGROUND: Solitary osteochondromas, or osteocartilaginous exostoses (OCEs), represent the most common benign bone tumor. Despite frequently causing symptoms about the knee in younger populations, there is minimal previous literature investigating surgical treatment. METHODS: We retrospectively reviewed the records of patients <20 years old who had undergone surgical treatment of symptomatic, pathologically confirmed, solitary periarticular knee OCE at a single pediatric center between 2003 and 2016. The clinical course, radiographic and pathological features, and complications were assessed. Prospective outreach was performed to investigate patient-reported functional outcomes. RESULTS: Two hundred and sixty-four patients (58% male, 81% athletes) underwent excision of a solitary OCE about the knee at a mean age (and standard deviation) of 14.3 ± 2.24 years. Fifty-five percent of the procedures were performed by orthopaedic oncologists, 25% were performed by pediatric orthopaedic surgeons, and 20% were performed by pediatric orthopaedic sports medicine surgeons, with no difference in outcomes or complications based on training. Of the 264 lesions, 171 (65%) were pedunculated (versus sessile), 157 (59%) were in the distal part of the femur (versus the proximal part of the tibia or proximal part of the fibula), and 182 (69%) were medial (versus lateral). Postoperatively, 96% of the patients returned to sports at a median of 2.5 months (interquartile range, 1.9 to 4.0 months). Forty-two patients (16%) experienced minor complications not requiring operative intervention. Six patients (2%) experienced major complications (symptoms or disability at >6 months or requiring reoperation), which were more common in patients with sessile osteochondromas (p = 0.01), younger age (p = 0.01), and distal femoral lesions as compared with proximal tibial lesions (p = 0.003). Lesion recurrence was identified in 3 patients (1.1%). Overall, the median Pediatric International Knee Documentation Committee (Pedi-IKDC) and mean Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) scores were 97 (interquartile range, 93 to 99) and 16.7 ± 8.15, respectively, at a median duration of follow-up of 5.8 years. CONCLUSIONS: In our large cohort of pediatric patients who underwent excision of solitary knee osteochondromas, most patients were male adolescent athletes. Most commonly, the lesions were pedunculated, were located in the distal part of the femur, and arose from the medial aspect of the knee. Regardless of surgeon training or lesion location, patients demonstrated excellent functional outcomes, with minimal clinically important postoperative complications and recurrences, although patients with sessile lesions and younger age may be at higher risk for complications. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The Natural History of Benign Bone Tumors of the Extremities in Asymptomatic Children: A Longitudinal Radiographic Study.

BACKGROUND: Benign bone tumors are common incidental findings in the pediatric population during radiographic evaluation. Counseling these patients requires reassurance and raises questions about the natural history of these tumors over time. The purpose of this study was to estimate the prevalence and observe the behavior of benign childhood bone tumors in an asymptomatic population. METHODS: A historical, longitudinal radiographic collection of healthy children was reviewed, which included comprehensive left-sided radiographs of the extremities at yearly intervals. In this study, 262 subjects with 25,555 radiographs were screened for benign bone tumors at a median age of 8 years (range, 0 to 18 years). All potential tumors were reviewed by a multidisciplinary panel, which confirmed the radiographic diagnosis of each lesion, the age at which the lesion first appeared, and the age at which it had resolved. Prevalence rates were calculated using the number of distinct subjects available for each radiographic location and age. RESULTS: Thirty-five tumors were identified in 33 subjects, including 19 nonossifying fibromas, 8 enostoses, 6 osteochondromas, and 2 enchondromas. The prevalence rate for all tumors combined increased with age and was 18.9% overall. The overall prevalence rates for specific tumor types were 7.5% for nonossifying fibromas, 5.2% for enostoses, 4.5% for osteochondromas, and 1.8% for enchondromas. Nonossifying fibromas demonstrated a bimodal distribution of prevalence, with a peak at 5 years (10.8%) and another after skeletal maturity (13.3%). The median age at the first appearance for all tumors combined was 9 years (range, 2 to 15 years), but varied by tumor type. Nonossifying fibromas often resolved (7 [37%] of 19), with further resolution possible beyond the last available radiograph. Enostoses, osteochondromas, and enchondromas persisted until the last available radiographs in all subjects. CONCLUSIONS: The prevalence of benign childhood bone tumors of the extremities was 18.9% in a historical asymptomatic population. Longitudinal radiographs allowed observation of the timing of the first appearance and the potential for resolution for each tumor type. These findings provide unique evidence to answer many commonly encountered questions when counseling patients and their families on benign bone tumors. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Osteochondromas: An Updated Review of Epidemiology, Pathogenesis, Clinical Presentation, Radiological Features and Treatment Options.

Osteochondroma, the most common benign bone tumor, is a projection on the external surface of the bone, which can be sessile or pedunculated. 85% of osteochondromas present as solitary lesions, while 15% occur in the context of hereditary multiple exostoses (HME), a genetic disorder that is inherited in an autosomal dominant manner. Although often asymptomatic, symptoms may eventuate from compression of adjacent vessels or nerves, fractures, osseous deformities, bursa formation, or malignant transformation. Cartilage cap thickness >2 cm in adults or >3 cm in children as well as new onset of pain or growth, or rapid growth of the lesion, especially after the closure of the growth plate, might reflect cancerous transformation. Surgical resection is indicated for symptomatic lesions, complications, cosmetic reasons or malignant transformation. Excision of the tumor with free margin is the treatment of choice. Local recurrence is less than 2% if complete resection is achieved.

The natural history of multiple osteochondromas in a large Italian cohort of pediatric patients.

IMPORTANCE: Multiple osteochondromas is a rare hereditary skeletal disorder, characterized by bony protrusions arising from growth plates on long bones during skeletal development. The disorder frequently leads to diminished stature, deformities and functional limitations. Understanding of the natural history of multiple osteochondromas and its evolution in children and adolescents is limited. OBJECTIVE: To provide valuable information on the natural history of multiple osteochondromas, to inform recommendations for treatment and prevent impairments caused by osteochondromas. DESIGN: This retrospective cohort study in children with multiple osteochondromas includes longitudinal data collected from first to last follow-up visit for patient demographics, and over 36 months for disease evolution. SETTING: Data were collected from the Registry of Multiple Osteochondromas, which includes data from circa 1200 patients with multiple osteochondromas treated from 2003 to 2017 at IRCCS Istituto Ortopedico Rizzoli in Bologna. PARTICIPANTS: Patients ≤18 years with multiple osteochondromas, who provided written informed consent and had data for ≥1 12-month follow-up visit. MAIN OUTCOME(S) AND MEASUREMENT(S): Demographics, clinical features, incidence of surgeries, and disease evolution (progression or regression) were assessed. Results were summarized using descriptive statistics, annual rates of new clinical features and surgeries, and Kaplan-Meier estimates. Patient height was evaluated following Italian growth charts. RESULTS: 158 patients were included in these analyses. Throughout follow-up, 80.4% of patients developed new osteochondromas, 57.6% developed new deformities, 23.4% developed new functional limitation(s). New osteochondroma(s) were developed by 28.5% patients by Month 12, 39.9% at Month 24, 50% at Month 36. Most new osteochondromas were detected in the younger population; patients aged 0-4 years underwent a significantly higher number of lesions within 12, 24 and 36 months of follow-up. The overall incidence of patients with ≥1 new deformity within 12 months was 17.7%, with incidences decreasing with increasing age (p = .023). In addition, the analyses on height highlight that 13 years is a cut off age for slow growth of the stature (p < .0005). At last follow-up visit, 46.2% of patients had disease progression, while regression (spontaneous and surgical) occurred in 7.6% (p = .007). CONCLUSIONS AND RELEVANCE: This natural history study reports the main set of clinically relevant data for patients with multiple osteochondromas during skeletal development, providing insight for patient management and development of therapeutic interventions.

Tumors of the scapula: A retrospective analysis identifying predictors of malignancy.

BACKGROUND: Osseous tumors of the shoulder girdle occur most frequently in the proximal humerus, scapula and clavicle. Prior studies have determined that tumors occurring in the scapula have a higher risk of malignancy, but few have looked exclusively at tumors of this site to describe incidence, clinical features and potential predictors of malignancy. As imaging technologies for diagnosis have improved, it is important to re-evaluate if patterns of incidence have changed and if new imaging findings could potentially be predictors of malignancy. METHODS: This retrospective analysis identified 173 patients from a pediatric and an adult hospital between 1990 and 2015. All patients with tumors of the scapula either of bony origin or with bony invasion were included. Diagnosis, tumor location, and patient demographics were collected. Bivariate and logistic regression analyses were performed to identify potential predictors of malignancy. RESULTS: Chondrosarcoma and osteochondroma were the most common malignant and benign tumors, respectively. Benign tumors were more prevalent in the pediatric population. Tumors occurred most frequently in the body of the scapula. Risk for malignancy increased with age (OR 1.09, 95% CI 1.05-1.12), tumors invading multiple sites (OR 10.85, 95% CI 2.37-49.72) and tumors that were lucent (OR 7.02, 95% CI 1.14-43.21) or had a mixed radiographic appearance (OR 11.47, 95% CI 1.36-99.65). CONCLUSIONS: Including neoplasia in the differential diagnosis for shoulder complaints is important because the scapula is a site of increased risk of malignancy. Patterns of incidence and prevalence have not changed in the last years with the use of more advance techniques of imaging studies. Older age, lucent or mixed imaging, and tumors that span multiple sites of the scapula were found to be predictors of malignancy. Additional cross-sectional anatomy studies may be warranted for further evaluation in patients presenting with these characteristics given the higher concern for malignant disease. LEVEL OF EVIDENCE: Level IV, Prognostic Study.

Talar-sided osteochondral lesion of the subtalar joint following the intra-articular calcaneal fracture: study via a modified computed tomography mapping analysis.

INTRODUCTION: This study is to report the prevalence of osteochondral lesions in subtalar joint following intra-articular calcaneal fracture, including the relationship between fracture severity and lesion characteristics, using modified computed tomography (CT) mapping analysis. METHODS: Thirty patients with intra-articular calcaneal fracture who were preoperatively imaged with modified CT mapping analysis were recruited. The presence of talar-sided osteochondral lesions (OLTS) of subtalar joint was noted with lesion area defined by Akiyama's mapping classification. Lesion severity was assessed via Ferkel's classification, and fracture severity via Sanders' classification. RESULTS: Lesions were found in 28 patients (93.3%), mostly at anterior [16 (57.1%) lesions] or central [13 (46.4%) lesions] areas of posterior talar facet. Most common grade of lesion severity was grade I (mild) seen in 24 (80%) patients. Most fractures were classified as Sanders' grade III and IV with 12 (40%) and 12 (40%) patients noted, respectively. High severity of fracture denoted by Sanders' grade IV showed a trend of higher prevalence of OLTS at anterior and central sites of posterior talar facet (P = 0.181). Lesion severity was significantly higher in patients with double lesions than patients with single lesions (P = 0.005). However, OLTS were not significantly related with osteoarthritic changes in follow-up radiographs (P > 0.05). CONCLUSIONS: The prevalence of OLTS is very high following intra-articular calcaneal fractures. Most lesions occur at anterior or central area of posterior talar facet and are more likely to occur in patients with higher fracture severity. Lesion severity was significantly higher in patients with double lesions than patients with single lesions.

The incidence and distribution of primary fibula tumors and tumor-like lesions: A 35-year experience.

PURPOSE: Primary bone tumors of the fibula are rare. There are only a few studies reporting the incidence, histologic, and anatomic distribution of primary fibula tumors. This study aimed to comprehensively report the incidence, presenting symptoms, and histologic tumor types with the anatomic and histologic distribution of primary bone tumors of the fibula. METHODS: Between January 1983 and December 2017, 6457 primary bone tumors and tumor-like lesions were diagnosed and treated in our musculoskeletal oncology surgery clinic. Of these, 264 (4.08%) were primary bone tumors and tumor-like lesions of the fibula. We retrospectively reviewed patients' records, histopathology records, and radiologic images regarding age, gender, anatomic localization, histopathologic diagnosis, and treatment methods. RESULTS: There were 209 (79.2%) benign and 55 (20.8%) malignant lesions. The most common benign and malignant tumors were osteochondroma (51 of 209; 24.4%) and chondrosarcoma (16 of 55; 29.1%). The proximal fibula was the most common location for both benign and malignant tumors (141 of 209; 67.5% and 45 of 55; 81.8%, respectively), followed by the distal fibula (52 of 209; 24.9% and 8 of 55; 14.5%, respectively) and the diaphysis (17 of 209; 8.14% and 2 of 55; 3.64%, respectively). CONCLUSION: The incidence of primary bone tumors is higher than that reported in previous studies. Benign lesions constitute the majority of cases. One-fifth of all cases are malignant. The most common anatomic site involving the primary fibula tumors is the proximal fibula. LEVEL OF EVIDENCE: III.

Histopathological pattern of primary bone tumours and tumour-like lesions in Ile-Ife, Nigeria.

INTRODUCTION: Bone tumours are relatively rare in comparison with neoplasms in other parts of the body. Previous studies have noted higher frequencies of these tumours in young adults with potentially devastating consequences. METHODS: This study aimed to demonstrate the histopathological pattern of primary bone tumours and tumour-like lesions in Ile-Ife, Nigeria with emphasis on relative frequencies and distribution according to age, sex and anatomical location. A 13 year (1991-2003) retrospective study was carried out on 100 cases of primary bone tumours and tumour-like lesions. Records were retrieved from the surgical registers of the Histopathology Department, Qbafemi Awolowo University Teaching Hospitals Complex, Ile-Ife. Original histopathological slides were retrieved for examination and when they were unavailable, the paraffin blocks were searched out and new slides were made. RESULTS: A total of 100 cases met the inclusion criteria for this study accounting for 1.55% of the 6,464 cases of all neoplasms seen within this period. Of the 100 cases, 50 were malignant (50%), 28 were benign (28%) and 22 had tumour-like lesions (22%). The male to female ratio was 1.3:1 and the most common benign and malignant tumours were osteochondroma and osteosarcoma respectively. The femur was the most frequently involved bone in primary malignant lesions (24%) followed by the pelvis and the maxilla (14% each). CONCLUSION: The age, sex and morphological distribution of benign and malignant bone tumours is similar to earlier reports in other African and international journals. Tumour-like lesions occur more frequently in females than in males. The femur is the most favourable site for malignant primary bone tumours and the jaw bones for tumour-like lesions.

Osteochondromas of the Proximal Humerus. Diagnostic and Therapeutic Management. / Osteocondromas del extremo proximal del húmero. Manejo diagnóstico y terapéutico.

OBJECTIVE: 1) To recall the epidemiology and signs of osteochondromas of the proximal humerus (OPH); 2) determine treatment indications; 3) and make recommendations for surgical treatment. METHODS: Retrospective, observational and longitudinal study of 20 solitary and 12 multiple osteochondromas of the proximal humerus. We analyzed the epidemiological, clinical and imaging characteristics and treatment results with an average time of follow-up of the operated cases of 45 months. RESULTS: Eleven (55%) males and 9(45%) females with an average age of 21 years presented solitary osteochondromas. Twelve (60%) cases were operated on at a mean age of 23 years because they were symptomatic or, in one case, malignancy was suspected. Two solitary osteochondromas could have spontaneously regressed. Multiple osteochondromas were found in 11(92%) males and one (8%) female of whom 3required surgery. There were no complications or recurrences. Functional outcome was excellent in all patients. DISCUSSION: Osteochondromas of the proximal humerus are relatively common, although most publications are case reports or short series. CONCLUSIONS: Osteochondromas of the proximal humerus do not differ from those in other locations. Symptomatic cases and those in which malignancy is suspected would be operated, the former preferably at the end of growth. The surgical treatment is summarized in planning the approach, using CT and/or MRI, extraperiosteal en bloc resection, and eventual bone reconstruction, ideally with allograft.

[Osteochondromas: introducing the subungual osteochondroma]. / Osteocondromas: presentación del osteocondroma subungueal.

INTRODUCTION: Subungual osteochondromas are benign tumors of the sub- or periungual region, causing lifting, ulceration and deformity at that level. OBJECTIVE: To research the incidence of subungual osteochondromas in a specific pediatric population. MATERIAL AND METHODS: Retrospective, transversal, descriptive and observational study based on the review of records with a histopathological result of osteochondroma from 2001 to 2014. RESULTS: The pathological assessment featured four osteochondromas that corresponded to the subungual presentation, with an equal gender distribution of 1:1, an average age of 9.5 years, right: left ratio of 3:1; the 4th finger was the most affected. DISCUSSION: Subungual osteochondroma has an incidence of 8.5% of all osteochondromas.

INTRODUCCIÓN: Los osteocondromas subungueales son tumoraciones benignas de la región sub- o periungueal que ocasionan elevación, ulceración y deformidad a dicho nivel. OBJETIVOS: Investigar la incidencia de osteocondroma subungueal en un segmento de población pediátrica. MATERIAL Y MÉTODOS: Estudio retrospectivo, transversal, descriptivo y observacional, basado en la revisión de expedientes con resultado histopatológico de osteocondroma de 2001 a 2014. RESULTADOS: Cuatro de los osteocondromas correspondieron a la presentación subungueal, con una distribución por sexos de 1:1 y un promedio de edad de 9.5 años, relación 3:1, derecho:izquierdo; el cuarto dedo fue el más afectado. DISCUSIÓN: El osteocondroma sunbungueal presenta una incidencia de 8.5% de todos los osteocondromas.

An Osteological Study on the Prevalence of Osteochondromas.

BACKGROUND: Osteochondromas are frequently reported to be the most common benign tumor of bone. However, there is not definitive data on their prevalence rate as they are often clinically silent, with previous studies estimating 1-3%. METHODS: We examined a large osteologic collection of 2954 skeletons to identify likely osteochondromas. One author examined all bones excluding the skull in each skeleton for atypical cortical projections. These candidates were then evaluated by an orthopedic resident and then a fellowship trained pediatric orthopedic surgeon for final inclusion using strict criteria. RESULTS: 13 cases of osteochondroma were identified from 2954 skeletons to yield a prevalence of 0.44% (95% confidence interval 0.20% - 0.68%) in the study population. All were located on long bones: three in the humerus, six in the femur and four in the tibia. CONCLUSIONS: We found a prevalence of 0.44% for osteochondromas, which is approximately half the lowest value reported in previous literature.

Osteocondromas: presentación del osteocondroma subungueal / Osteochondromas: introducing the subungual osteochondroma

Resumen: Introducción: Los osteocondromas subungueales son tumoraciones benignas de la región sub- o periungueal que ocasionan elevación, ulceración y deformidad a dicho nivel. Objetivos: Investigar la incidencia de osteocondroma subungueal en un segmento de población pediátrica. Material y métodos: Estudio retrospectivo, transversal, descriptivo y observacional, basado en la revisión de expedientes con resultado histopatológico de osteocondroma de 2001 a 2014. Resultados: Cuatro de los osteocondromas correspondieron a la presentación subungueal, con una distribución por sexos de 1:1 y un promedio de edad de 9.5 años, relación 3:1, derecho:izquierdo; el cuarto dedo fue el más afectado. Discusión: El osteocondroma sunbungueal presenta una incidencia de 8.5% de todos los osteocondromas.

Abstract: Introduction: Subungual osteochondromas are benign tumors of the sub- or periungual region, causing lifting, ulceration and deformity at that level. Objective: To research the incidence of subungual osteochondromas in a specific pediatric population. Material and methods: Retrospective, transversal, descriptive and observational study based on the review of records with a histopathological result of osteochondroma from 2001 to 2014. Results: The pathological assessment featured four osteochondromas that corresponded to the subungual presentation, with an equal gender distribution of 1:1, an average age of 9.5 years, right: left ratio of 3:1; the 4th finger was the most affected. Discussion: Subungual osteochondroma has an incidence of 8.5% of all osteochondromas.

[Interest of imaging in tumors benign bone in children]. / Intérêt de l'imagerie dans les tumeurs osseuses bénignes chez l'enfant.

Benign bone tumors are more common than malignant tumors in pediatrics. The exostosis (ostéchondrome) is the most common. The different imaging techniques are pivotal in the study of tumors including its standard radiography. The aim of this work is to highlight the interest in imaging the diagnostic management of bone benign tumors in children through a retrospective study of 169 patients. All patients were investigated by plain radiography, scanner supplement with multiplanar reconstruction before and after injection of PDC and / or MRI 1. 5 Tesla was performed according to the indication. The average age is 6 years with a slight male predominance. Clinically, the swelling is present in 35% of cases. The pain in 29% of cases. The most common location is the metaphyseal long bone on: Femur: 25% of cases, humerus: 17% of cases, Tibia: 21% of cases. Main Benign tumors are found exostosis (20. 12%), bone cyst (31. 95%) and osteoblastoma (16, 57%). The imagery is used to specify the topography and extension of the lesion in the bone provide arguments in favor of benign and sometimes in favor of the cause of the injury. The only standard radiograph often provides a diagnosis of certainty in some cases.

Management of extremity arterial pseudoaneurysms associated with osteochondromas.

Arterial pseudoaneurysms associated with osteochondromas are rare and most publications on this topic are case reports. The management of this double entity is not standardized. We wanted to update it. Literature searches on MEDLINE and EMBASE were performed using the keywords "artery pseudoaneurysm" and "osteochondroma". Patient demographics, clinical presentations, diagnostic and therapeutic modalities were reviewed. In sum, 101 cases were analyzed. Overall, young adults represented the majority of the affected population with a masculine preponderancy (86%). Painful swelling (51%) was the most commonly physical finding. Distal femur was the most common site of the osteochondroma (86%). Multiple hereditary exostosis was seldom reported (36%). Diagnostic confirmation was dominated by arteriography (55%). Popliteal artery (77%) was the most commonly injured vessel. The treatment was open surgery with vascular repair and optimal exostectomy. Arterial repair was performed with saphenous vein grafting (40%) or lateral suture (39%). Postoperative courses were often uneventful (97%). Arterial pseudoaneurysms resulted from osteochondromas were dominated by those involving the popliteal artery. The use of arteriography to confirm the diagnosis may be limited to the benefit of non-invasive radiological methods because endovascular treatment is not relevant in the setting of osteochondroma-induced arterial pseudoaneurysm.

[Prevalence and clinical characteristics of oral bony outgrowth in a Moroccan population]. / Prévalence et caractéristiques cliniques des hypertrophies osseuses buccales dans une population marocaine.

OBJECTIVES: Oral bony outgrowths (OBOs) are localized bony protuberances that arise from the cortical plate. Various types of OBOs have been described, the precise designation of which depends on anatomic location such as torus palatinus, torus mandibularis, buccal exostosis, or palatal exostosis. We had for aim to determine the prevalence and clinical characteristics of OBOs in a Moroccan population. METHODS: This cross-sectional study was conducted between March 15 and June 30, 2011 at the Rabat-Salé teaching hospital dental consultation and treatment center, in Morocco. Three hundred and fifty-three patients (160 female and 193 male patients), 11 to 82 years of age, were examined clinically and radiologically to determine the presence of OBO. RESULTS: Twenty-four patients (6.8%) presented with OBOs. The prevalence for exostosis, torus mandibularis, torus palatinus, and associated OBOs was 3.1%, 2%, 0.8%, and 0.9% respectively. There was a significant difference (P=0,01) between the average age for patients presenting with OBO (43.2±12 years of age) and the average age for patients without any OBO (36.5±16 years of age). The prevalence of OBOs in female patients (7.3%) was higher than in male patients (6.3%) but the difference was not significant (P=0.439). Patients with occlusal parafunctional activity presented with significantly more OBO (P=0.016). DISCUSSION: The reported prevalence of OBO is extremely variable, according to age, gender, and ethnic group. The occurrence of OBO could be triggered by genetic factors associated with environmental factors.

Incidence, histopathologic analysis and distribution of tumours of the hand.

BACKGROUND: The aim of this large collective and meticulous study of primary bone tumours and tumourous lesions of the hand was to enhance the knowledge about findings of traumatological radiographs and improve differential diagnosis. METHODS: This retrospective study reviewed data collected from 1976 until 2006 in our Bone Tumour Registry. The following data was documented: age, sex, radiological investigations, tumour location, histopathological features including type and dignity of the tumour, and diagnosis. RESULTS: The retrospective analysis yielded 631 patients with a mean age of 35.9 ± 19.2 years. The majority of primary hand tumours were found in the phalanges (69.7%) followed by 24.7% in metacarpals and 5.6% in the carpals. Only 10.6% of all cases were malignant. The major lesion type was cartilage derived at 69.1%, followed by bone cysts 11.3% and osteogenic tumours 8.7%. The dominant tissue type found in phalanges and metacarpals was of cartilage origin. Osteogenic tumours were predominant in carpal bones. Enchondroma was the most commonly detected tumour in the hand (47.1%). CONCLUSIONS: All primary skeletal tumours can be found in the hand and are most often of cartilage origin followed by bone cysts and osteogenic tumours. This study furthermore raises awareness about uncommon or rare tumours and helps clinicians to establish proper differential diagnosis, as the majority of detected tumours of the hand are asymptomatic and accidental findings on radiographs.

Distribution and evaluation of bone and soft tissue tumors in the middle Black Sea Region.

OBJECTIVE: The aim of this study was to evaluate the characteristics of bone and soft tissue tumors operated on at the Department of Orthopedics and Traumatology at Ondokuz Mayis University Faculty of Medicine Hospital between January 1987 and January 2012. METHODS: This descriptive study retrospectively evaluated 1,925 patients hospitalized with a preliminary diagnosis of tumor. Patients were analyzed for age, gender, tumor incidence and localization. Three hundred and forty-nine patients found to have non-tumor causes. The 94 patients discharged at their own request or deceased during follow-up were not included in the tumor group. RESULTS: Of the 1,482 (76.9%) patients diagnosed with tumor, 687 (46.4%) were bone tumors, 586 (39.5%) soft tissue tumors and 209 (14.1%) metastatic tumors. The most common benign bone tumor was osteochondroma (118; 25%), followed by enchondroma (68; 14.4%) and giant cell tumor (59; 12.5%), and the most common malignant bone tumor was osteosarcoma (58; 27%), followed by chondrosarcoma (36; 16.7%) and Ewing's sarcoma (33; 15.3%). The most common benign soft tissue tumor was cystic hygroma (96; 22%), followed by lipoma (75; 17.2%) and hemangioma (52; 11.9%), and the most common malignant soft tissue tumors were pleomorphic cell tumor (29; 19.3%) and liposarcoma (29; 19.3%), followed by pleomorphic undifferentiated sarcoma (21; 14%). Seventy (33.5%) of the metastatic tumors were of pulmonary origin, 36 (17.2%) were of breast origin and the primary site of the tumor was not clearly determined in 58 (27.8%) patients. CONCLUSION: The distribution of bone and soft tissue tumors appear to have certain characteristics but can show regional differences. We believe that the establishment of a larger series through the collection of these types of studies from centers in which bone and soft tissue tumor surgery is performed will provide important information on the epidemiological features of bone and soft tissue tumors.

[Osteochondroma and multiple osteochondromas: recommendations on the diagnostics and follow-up with special consideration to the occurrence of secondary chondrosarcoma]. / Osteochondrom und multiple Osteochondrome : Empfehlungen zur Diagnostik und Vorsorge unter besonderer Berücksichtigung des Auftretens sekundärer Chondrosarkome.

PURPOSE: Osteochondroma represents the most common form of benign bone tumor. Clinical manifestations include deformity of bone, compression of surrounding tissue and vascular or neurological compromise. Osteochondromas may be solitary (solitary osteochondroma, SO) or multiple (multiple osteochondromas MO). Recurrence after surgery is a known problem especially in MO and malignant transformation is rare but more common in MO than in solitary cases. Reliable recommendations regarding diagnostics and clinical follow-up are currently lacking. PATIENTS AND METHODS: A comprehensive literature review and a review of own patient files with SO/MO treated between 2000 and 2011 in this hospital were performed. The age of patients at diagnosis, tumor localization, clinical aspects, recurrence and the risk of malignant transformation in secondary (i.e. epiexostotic) chondrosarcoma were analyzed. The follow-up including patients who received surgery ranged between 2 and 127 months for patients with SO and between 2 and 84 months for MO. RESULTS: A total of 39 patients with SO from this hospital were included in the study. Out of 36 patients who received surgery 3 recurrences were registered after an average time of 62 months. In addition, 11 patients with MO were identified and all received surgery. In 5 out of 11 cases recurrences occurred after an average time of 20.6 months. Secondary chondrosarcomas were not recorded in this series. According to the literature an increased risk of malignant transformation was found for osteochondromas of the axial skeleton, in the proximal aspect of the extremities, as well as for recurrent tumors and for MO. Pain and/or increase in size of lesions after skeletal maturation were the most common clinical signs of transformation. There was a wide time interval between the initial diagnosis and the development of secondary chondrosarcoma. In MO secondary chondrosarcoma has been described before skeletal maturity. CONCLUSIONS: The risk of malignant transformation of SO is generally low. Axial lesions as well as recurrent osteochondromas and MO seem to have an increased risk of malignant transformation. The follow-up, requiring sufficient primary diagnostics, includes regular self-control and can usually be clinically carried out in more peripherally located lesions but in certain cases supplementary X-ray imaging is needed. In cases of anatomical regions which are more difficult to access manually, follow-up examination by magnetic resonance imaging (MRI) is the method of choice. Especially MO patients seem to benefit from long-term follow-up: when the tumor is located in the trunk and in (proximal) long bones MRI or whole-body MRI, respectively, should be performed once a year after skeletal maturity because of the higher risk of malignant transformation in these patients.

[Characteristics of pain in oncologic disease of the knee]. / Caracterización del dolor de la rodilla con patología oncológica.

BACKGROUND: 10% of > 55-year-old adults suffer some kind of non-neoplastic knee pain and 75% of the musculoskeletal neoplastic disease develops in the knee. OBJECTIVE: to identify clinical characteristics of knee pain in neoplastic knee pathology. METHODS: after appropriate authorization of the Local Committee of Investigation and under informed consent, we made a crosssectional and a risk analysis study. We included 160 patients who were seeking medical help due to knee pain. They answered a standardized questionnaire relating to the characteristics of their pain symptomatology. Data were integrated into two groups with knee pain; a) neoplasic (cases, n = 65), b) non-neoplasic (controls, n = 95) and analyzed (SPSS v.15™). We used homogeneity tests between groups (p > 0.05); inferential analysis (Student t test, χ(2)) and risk assessment (OR), p ≤ 0.05, (CI 95%), Statistical power was > 0.80. RESULTS: female gender predominated (55%); age was 40.3 ± 19.6 years. The most prevalent diagnoses were knee osteoarthritis 37% for non-neoplasic group; giant cell tumor 10% for benign neoplasic group and osteosarcoma 6.1% for neoplasic malignant group. Knee pain lasting < 4 months (OR 7.6; CI 95% 3.48-16.5) and severe intensity (OR 5.7; CI 95% 2.82-11.64), constant pain (OR 2.9; CI 95% 1.37-6.36), rapidly progressive fluctuation (OR 31; CI 95% 7.01-137) and nocturnal predominance (OR 7.72; CI 95% 3.2-18.5) were characteristics of neoplasic knee pain. CONCLUSIONS: the neoplasic knee pain was characterized for a rapid onset, severe and constant pain, progressive, fluctuation and predominantly by night-time.