To investigate the outcome of operative procedures designed to reduce the likelihood of neurovascular injury, fracture and tumor recurrence. The literature frequency of neurovascular injuries is about 10% and recurrences have been reported to be common when resections are undertaken before skeletal maturity. Prospective analysis of the outcomes following resection of exostoses in two hundred and fifty children and adolescents. Preoperative CT-angiograms iwere undertaken in patients with multiple exostoses surrounding the shoulder, knee and hip joints. Peduculated exostoses were removed by detaching the base and retrogradely removing the lump. Broader based exostoses were opened and decancellated so that the cap could be collapsed down away from adjoining and adherent neurovascular structures. This approach also enabled the cap to be separated from adjacent bone such as the pelvis or fibula with femoral or tibial exostosis, respectively. The outcomes included assessments of neurovacular status, bone healing and recurrence after five years. No patients had early or late evidence of neurovascular damage although the neurovascular structures were adherent to many of the exostoses.

No patients had recurrence of their exostoses which was likely due to most of them having being removed after skeletal maturity. In addition, the cortical defect left by the resections healed with six to nine months of the surgery.

Our conclusions are to remove exostoses after skeletal maturity in order to minimise recurrence risk. Use preoperative CT-angiograms with large solitary or multiple exostoses to aid in operative planning. Decancellate large exostoses in order to collapse the cap away from adherent neurovascular and skeletal structures.

Introduction and Aims: There is a variety of different procedures advocated to address the problems of cosmesis and limited abduction in Sprengel’s shoulders which are based on an understanding of the morphology of the deformity from two-dimensional images. We have reviewed the morphology of the scapulae using 3D CT to determine whether there are sub-groups in which different treatments would be more appropriate.

Method: We assessed 14 consecutive patients (age two to 21 years) between 1996–2002, using a spiral CT scanner with 1.5mm and 3mm slices. These were then reconstructed to give 3D images. These images were then rotated and measured to determine the dimensions, elevation, rotation and shape of the scapula, compared to the normal side. We also looked for the presence of an omovertebral connection and superior hook, and at the range of movement of the shoulder and incidence of associated anomalies.

Results: There was marked variation in the elevation of the scapulae. Three of the 14 had a very abnormal, small, high scapula with multiple associated anomalies. We called these dysplastic. The other 11 scapulae were longer (105%, range 64–132%) and narrower (85%, range 50–133%). They were rotated so the glenoid faced caudally. One out of 11 had a superior hook. The location of the tether could be determined by the shape of the medial border. There is a sub-group of Sprengel’s with a dysplastic scapula and multiple associated abnormalities. These may represent a difference in aetiology. Within the non-dysplastic group there was a wide variation in the size, elevation, orientation and length of the supra spinous portion of the scapulae.

Conclusion: We believe that there are different subgroups of Sprengel shoulder in whom different procedures are indicated and that CT scanning with 3D reconstruction is essential to adequately plan the procedure.

Introduction Localised Langerhans-cell histiocytosis of bone (eosinophilic granuloma) is a benign tumour-like condition with a variable clinical course. Different forms of treatment have been reported to give satisfactory results. However, previous series all contain patients with a wide age range. Our aim was to investigate the effect of skeletal maturity on the rate of recurrence of isolated eosinophilic granuloma of bone excluding those arising in the spine.

Methods We followed-up 32 patients with an isolated eosinophilic granuloma for a mean of five years; 17 were skeletally immature.

Results No recurrences were noted in the skeletally immature group even after biopsy alone. By contrast, four of 13 skeletally mature patients had a recurrence and required further surgery.

Conclusions This suggests that eosinophilic granuloma has a low rate of recurrence in skeletally immature patients.

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.