OSTEOID OSTEOMAS OF THE CARPUS AND HAND: A REVIEW OF THE SCOTTISH BONE TUMOR REGISTRY

Abstract

Background: Osteoid Osteomas were first described by Bergstrand (1930), and were later elaborated by Jaffe (1935). They account for 12% of all benign bone tumors. Approximately 6–8% of lesions occur in the hand, and can be extremely difficult to diagnose.

Aims: A retrospective review of osteoid osteomas from the Scottish Bone Tumor Registry is presented focusing on the unusual clinical features of lesions of the carpus and hand.

Results: 19 patients (8 male, 11 female) were identified from the registry. The mean age at presentation was 27.5 Yrs (10–56 Yrs). 78% of lesions occurred within 2nd–3rd decade of life. Pain over the involved area most noticeably at night, was the usual presentation. 21% gave history of associated trauma. Phalangeal lesions accounted for 68.4% tumors with the proximal phalanx predominating.4 lesions involved the distal phalanx. There were 3 metacarpal and 3 carpal lesions. Carpal bones involved included the Capitate (2), and the Trapezium (1). Clubbing was noticed in distal phalanx lesions. The mean time from presentation to diagnosis was 5.6 months. 9 patients were initially misdiagnosed as having either a traumatic or infective condition.3 patients required a bone scan for diagnosis. All patients underwent surgical excision, with 2 requiring bone grafting. Follow up ranged from 1–9 Yrs (mean 3Yrs). There were no instances of recurrence or spontaneous regression.

Discussion: Osteoid Osteoma is an infrequent tumor of the hand. Absence of typical pain pattern, unobtrusive radiographic features (absence of reactive bone, inapparent nidus), and variations in the histological picture make diagnosis in this region difficult. Lesions are easily misdiagnosed and successful treatment often delayed. Isotope bone scan is diagnostic and CT accurately visualizes the nidus. Awareness of these characteristics may aid early diagnosis. Surgical excision is usually curative and has excellent prognosis.