Abstract
The purpose of this study was to determine the surgical risks and recurrence rate associated with the excision of osteochondroma from the long bones most frequently operated on in our institution; the femur, tibia, humerus and fibula.
Two hundred and twenty four osteochondromata were excised in total between July 1992 and January 2001. The medical records and radiographs of 126 patients who had 147 osteochondromata excised from the femur, tibia, humerus and fibula were reviewed. Of these, 30 patients presented with multiple osteochondromata, accounting for 48 of the 147. Fifty three involved the femur (2 proximal), 55 the tibia (16 distal), 12 the fibula (2 distal) and 27 the proximal humerus. The mean age at excision was 12.5 years (2–18 years) and the mean follow-up was five years (1 to 10 years).
There were 15 surgical complications (10% of excisions) including one compartment syndrome, five superficial wound infections, two haematoma formations which required evacuation, one partial wound dehiscence, one deep infection with sinus formation which required excision, one sural nerve and one saphenous nerve neuropraxia, one cutaneous nerve entrapment and two hypertophic scar/keloid formations.
The patient with the compartment syndrome had excision of a distal femoral, proximal tibial and fibular osteochondroma during the same procedure and was diagnosed to have won Willebrand disease after the surgery. There were eight recurrences involving five patients with multiple osteochondromata and three in whom the excision was incomplete due to the proximity to neurovascular structures.
Surgical risks related to excision of osteochondroma are relatively frequent and must not be underestimated. Excision should therefore only be performed if strongly indicated. The recurrence rate (5.5%) seems to be higher than previously reported in the literature (2%) and generally affects patients with multiple osteochondromata. Incomplete excision resulted in recurrence in all our cases.
The abstracts were prepared by Mr Richard Buxton. Correspondence should be addressed to him at Bankton Cottage, 21 Bankton Park, Kingskettle, Cupar, Fife KY15 7PY, United Kingdom
