osteochondroma ppt

1. PPresented by- Dr. Shubham Nagdev
Department of Orthopaedics
OSTEOCHONDROMA

2. INTRODUCTION
• Osteochondroma is a bony
exostosis projecting from the
external surface of a bone.
• It usually has a hyaline
lined cartilaginous cap

3. Solitary osteochondroma
• When the lesion is seen in a single bone
Multiple ostechondromas
• Iftwo orthree bones are involved , withno family
history
Heriditary Multiple Exostosis
• Widespread ostechondromas associated with a
positive family history

4. PREVELANCE
• Most common skeletal growth/tumor
• Approximate incidence is 50%of all benign bone
tumors
• Male : Female ratio 2:1
• 75% occur before the age of 20
• Many cases may not be diagnosed due to the silent
nature of the disease

5. separation of a fragment of epiphyseal growth plate cartilage
herniates through the periosteal bone cuff
Persistent growth of this cartilaginous fragment and itssubsequent
enchondral ossification (maturation)
subperiosteal osseous excrescence
(Cartilage cap projects from the bone surface)
PATHOPHYSIOLOGY

6. The development of an osteochondroma, beginning
with an outgrowth from the epiphyseal cartilage
Developmental lesion
Mechanism- due to remodelling during the growth phase of
long bones
No growth is seen once skeletal maturity is attained

7. LOCATION
(Common sites)

8. UNCOMMON SITES
• Metacarpals
• Condylar process of the mandible
• Base of the skull
• Talus
• Calcaneus
• Spine
• Distal end of the clavicle( can cause rotator cuff
syndrome)

9. TYPES

10. SESSILE VARIANT
• Creates a broad based exostosis
lacking an elongated projection
• Causes a long asymmetric
elongation of the bone
• Amorphous , spotty calcification is
absent
• Occur at the metaphyseal –
diaphyseal region

11. PEDUNCULATED VARIANT
• Knee is the most common location (tibia and fibula)
• Metaphysis is the common site of involvement
• Lesion has a slender stalk with a cartilaginous dome
• The cartilage may show dense amorphous /spotty
calcification

12. CLINICAL FEATURES
• Most are asymptomatic
• Symptoms arise as a result of their
1. Location
2. Size
3. Pressure effects on adjacent structures
• Tendon or nerve irritation
• Usual complaint is hard palpable mass

13. COMPLICATIONS

14. MALIGNANT TRANSFORMATION
• Presents with
1. Growth of lesion after skeletal maturity
2. Pelvis /shoulder involvement (mostly sessile)
3. <1 % in solitary , >10%in HME
4. Increasing mass and pain at the site of lesion
in absence of fracture, bursitis or nerve
compression
• Radiologically
• Bone destruction
• Dispersed calcification in cartilaginous cap
• Soft tissue mass

15. X RAY - PEDUNCULATED
• Lateral radiograph of a
pedunculated
osteochondroma of the distal
femur.
• COATHANGER
EXOSTOSIS : The lesion
invariably point away
from the joint due to
muscle pull

16. X RAY -SESSILE
• Lateral radiograph of
a sessile
osteochondroma of the
distal femur.

17. CT SCAN
• To see cortical and medullary continuity of the
lesion and parent bone
• Cartilage cap thickness greater than 2 cm in adults
and 3 cm in growing children suggests malignant
transformation

18. MRI
• Donetoseethe continuity of the parent bone with the
cortical and medullary bone in an
osteochondroma.
• Tellsaboutinflammation in reactive bursa formation,
impingement syndromes, and arterial and venous
compromise.
• IOCfor evaluating compression of the spinal cord,
nerve roots, and peripheral nerves.

19. • Patientswithmany large osteochondromas should have regular
radiographic screening exams for the early detection of
malignant transformation
• Ifthe lesion is causing pain/neurologic
symptoms due to compression
• Sudden increase in size
EXCISED
Asymptomatic patients OBSERVATION
TREATMENT
None of the cartilage cap or perichondrium should be leftin
the resection bed or recurrence can occur.

20. HEREDITARY MULTIPLE EXOSTOSIS
• Autosomal dominant
• Caused due to Mutations in the EXT1and EXT2genes
• Multiple osteochondromas
• Asymmetric growth at the knees and ankles and Short
stature
• Malignant transformation rates as high as 25%

21. THANK YOU