Solitary osteochondroma limiting flexion of the proximal interphalangeal joint in an infant: a case report

Pediatric Trigger Finger due to Osteochondroma: A Report of Two Cases

Background: The trigger finger is characterized by the painful blocking of finger flexor tendons of the hand, while crossing the A1 pulley. It is a rare disease in children and, when present, is usually located in the thumb, and does not have any defined cause. Methods: We report 2 pediatric trigger finger cases affecting the long digits of the hand that were caused by an osteochondroma located at the proximal phalanx. Both children held the diagnosis of juvenile multiple osteochondromatosis. They had presented at the initial visit with a painful finger blocking. Surgical approach was decided with wide regional exposure, as compared with the trigger finger traditional surgical techniques, with the opening of the A1 pulley and the initial portion of the A2 pulley, along with bone tumor resection. Results: Patients evolved uneventfully, and recovered the affected finger motion. Conclusion: It is important to highlight that pediatric trigger finger is a distinct ailment from the adult trigger finger, and also in children is important to differentiate whenever the disease either affects the thumb or the long fingers. A secondary cause shall be sought whenever the long fingers are affected by a trigger finger.

Surgical treatment for osteochondromas in pediatric digits

PURPOSE

Osteochondromas in pediatric digits occasionally require surgical treatment due to restricted finger motion and/or angulatory deformity. However, the patients are growing children, and the indication for surgical treatment is controversial. We reviewed our cases in order to clarify characteristics of tumors and to report surgical outcomes.

METHODS

We performed surgeries on 17 osteochondromas in the digits of 16 patients. The average age at surgery was 3.6 years. Ten of 16 patients had solitary osteochondroma, and 6 patients had been diagnosed with multiple osteochondromatosis. We classified osteochondroma into 3 types, according to their locations. Type A is located at the nonepiphyseal metaphysis of the bone (9 lesions), type B in the metaphysis on the epiphyseal plate side (5 lesions), and type C in the diaphysis (3 lesions). Surgery was indicated for either or both restricted motion and angulatory deformity. Simple excision of the tumor was performed in 14 lesions, wedge osteotomy in 2 fingers, and osteotomy with excision of tumor in 1 finger. The average follow-up period was 49 months (range, 14-155 mo).

RESULTS

Surgical outcomes in types B and C were all good, the deformities were well corrected, and range of motion was improved. On the other hand, in type A, 2 cases still had more than 30° of restricted motion at the final follow-up, and another 2 cases showed more than 10° of angulatory deformity.

CONCLUSIONS

For type A, early surgical treatment is recommended to prevent the progress of the finger deformity and to improve motion. When the tumors are oriented more laterally and include less than a third of the joint surface, we recommend sufficient tumor excision, which can include part of the articular surface.

An Osteochondroma Limiting Flexion of the Proximal Interphalangeal Joint in Hereditary Multiple Exostosis: a Case Report

We describe a patient in which an osteochondroma, which resulted from hereditary multiple exostoses, limited flexion of the proximal interphalangeal (PIP) joint at birth. The tumor grew over the original distal head of the proximal phalanx, and the early appearance of a second ossification center on the base of the middle phalanx was observed. The mass was removed surgically when the patient was 17 months old. There was an improvement in the range of motion at a follow-up evaluation 3 years later. The tumor shape and the growth of the affected PIP joint are examined in detail.

Solitary intra-articular osteochondroma of the finger

BACKGROUND

A solitary osteochondroma of the finger occasionally occurs intra-articularly and may cause clinical symptoms, including limited motion and deformity. The present report describes the clinical features and the results of operative treatment for a series of patients who had a solitary intra-articular osteochondroma of the finger.

METHODS

Ten patients with a solitary intra-articular osteochondroma of a phalanx of a finger were managed surgically. Eight patients were male, and two were female. The average age at the time of surgery was fourteen years. Treatment consisted of mass excision for three patients and mass excision with corrective osteotomy for six. One additional patient had a boutonniere deformity and underwent extensor tendon reconstruction combined with mass excision. The average duration of follow-up was forty-four months.

RESULTS

The proximal phalanx was affected in six patients, and the middle phalanx was affected in four. All tumors involved the distal epiphysis. All patients had postoperative improvement in terms of deformity and/or limitation of motion. Six patients had a preoperative mean coronal plane deformity of 29 degrees, which improved to 4 degrees after surgery. The preoperative mean arc of flexion-extension improved from 54 degrees to 78 degrees in four patients who had a motion deficit at the proximal interphalangeal joint and from 60 degrees to 80 degrees in one patient who had a motion deficit at the distal interphalangeal joint. Two patients had a residual flexion contracture, one with preexisting osteoarthritis and one with a longstanding progressive boutonniere deformity. There were no other complications or recurrences.

CONCLUSIONS

Isolated intra-articular osteochondroma of the finger can cause deformity and/or motion limitation. Early mass excision and corrective osteotomy when indicated are recommended to restore full range of motion and to prevent osteoarthritis and secondary deformity.

Surface lesions of the bones of the hand

Surface lesions involving the bones of the hand are uncommon. This pictorial review illustrates the spectrum of conditions including benign primary bone tumours, malignant primary bone tumours and non-neoplastic disorders. The review focuses on the radiographic appearances of these lesions and other techniques such as CT and MR imaging that may suggest a specific diagnosis.

Imaging the complications of osteochondromas

Most osteochondromas are asymptomatic and incidental with typical radiographic characteristics. When symptomatic, complications due to space-occupying effects, mechanical deformity, or malignant transformation are usually the underlying causes. This article addresses the imaging strategy for their identification and evaluation.

Scaphoid osteochondroma mimicking carpal coalition

We present the case of a 10-year-old girl who presented with a block to wrist abduction. Plain radiographs of the wrist suggested a coalition between the carpal bones. A CT scan, however, revealed the presence of an osteocartilaginous lesion on the distal pole of the scaphoid. This was resected and histology showed it to be an osteochondroma.