PRESENTED BY: INTERNS 5TH BATCH DR. SASHMI MANANDHAR DR. ADITI MISHRA DR.

APARNA MISHRA

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A CASE PRESENTED AS.

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 PARTICULARS:

NAME: MS. ASHA NAGARKOTI AGE/SEX: 15Y/F ADDRESS: KOHALPUR 4, BANKE ADMISSION DATE: AUG 22, 2010 (4 DAYS BACK) OPERATION DATE: AUG 23, 2010 (3 DAYS BACK)

C/O:

SWELLING AT THE LEFT UPPER BACK FOR 3 YEARS

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 SWELLING:

SITE: UPPER LEFT BACK SIZE: INITIALLY SMALL, BUT PROGRESSIVELY INCREASING PAIN: ABSENT NON MOBILE

ASSOCIATED

HISTORY:

NO TRAUMA NO FAMILY HISTORY NO DIFFICULTY IN MOVING ARMS NO SWELLING AT ANY OTHER SITE
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 BONY

PROMINENCE:

SITE: LEFT SCAPULAR REGION, LATERAL ASPECT SIZE: 6 X 4 CMS SURFACE: SMOOTH, NO NODULARITY OVERLYING SKIN: NORMAL MOBILITY: ABSENT TENDERNESS: ABSENT

ROM:

FULL DNVS: INTACT OPPOSITE SIDE: NORMAL

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 XRAY

LEFT SHOULDER AP VIEW HOMOGENOUS OPACITY AT ANTERO MEDIAL ASPECT OF CLAVICLE EXTENDING FROM SCAPULA OTHER STRUCTURES NORMAL

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 HB:

12.6 gm % BT: 200 CT: 1000 GROUP: B +VE HIV, HBsAG: NON REACTIVE

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OSTEOCHONDROMA OF LEFT SCAPULA

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 EXCISION

IN TOTO DRAIN IN SITU BIOPSY SENT

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Definition: Common benign bone tumor

developmental malformation Not a true neoplasm Small overgrowth of cartilage at the physeal plate arising within periosteum Enchondral ossification turning into bony protuberance covered by a cartilaginous cap
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 Fast

  

growing end of long bones Distal femur Proximal tibia Proximal humerus

Ilium Found

in metaphysis of long bones near

physis Rare in joints

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 Incidence:

0 % are single lesion b. 5-10% multiple heriditary exostosis Occurs in any bone preformed in cartilage
a. Age:

teenager/ young adults

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A. Morpholgical: Pedunculated: common Sessile Projecting part : a. cortical component b. cancellous component Cap of cartilage B. Heriditary Multiple heriditary exostosis: AD condition

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 No

clinical Symtom: dicovered incidentally pain: bursa involvement Irritation, parasthesia, neuropathies: adjacent nerve impingement Bony overgrowth False aneurysm

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 Radiograph

: exostosis arising from metaphysis. Cartilage cap not visible on X-ray CT scan, MRI

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 Surgery IF a. b. c.

en block resection

Large, unsightly Pressure symptoms Suggestive of malignancy

Osteotomies to correct deformity in MHE RECURRENCE Rare : if failure to remove entire cartilage cap

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 Previous

lesion grows rapidly Low grade chondrosarcoma Cartilaginous cap: more than 2cm Enlargement after end of growth of person Malignant degeneration: rare 1% in solitary 5% in Multiple Heriditary Exostosis

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AND THE JOURNALS SAY.

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4, JOURNAL OF ORTHOPAEDIC TRAUMA

WELL DOCUMENTED CASE DISPLACED SALTER HARIS TYPE II PHYSEAL # PRECEDED OSTEOCHONDROMA

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 2002,

journal : bone marrow transplant 8 children Mean 88 months( yr) 12-84 months Incidence of 20% Condtioning regimen: busulfan & cyclophosphamide 4 received growth hormone

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 2002,Journal

of clinical patholagy 40ysr/M, heriditary multiple exostosis proximal tibia, distal and proximal femur Resection for chondrosarcoma HPE: low grade osteosarcoma in osseous stalk h/o papillary carcinoma thyroid No EXT 1 or EXT2 mutation

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 15

yr Swelling and pain in the rt great toe Diagnosis: subungal osteochondroma t/t: excision 1yr later: recurrent pain Dissection of tumor + cartilaginous cap removed; high speed burr saucerization+ curette Best to treat subungal lesion aggressively by saucerization rather than simple excision.
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 World

journal of surgical oncology, 2010 41yrs/M, pain in scapula for 10 yrs CT exostosis at anterior inferior aspect of scapula endoscopically assisted removal Feasible technique n early recovery, short hospital stay, cosmetically superior

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 International

spinal cord society,2004 23yrs/M , multiple exostosis and mental retardation Progressive paraparesis CT :exostosis spinal decompression

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THANK YOU

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