- Email: [email protected]
Arthroscopic Assisted Resection of Juxta-articular Osteoid Osteoma
Arthroscopic Assisted Resection of Juxtaarticular Osteoid Osteoma Mario Morbidi, MD,1 Angelo Ventura, MD,2 and Carlo Della Rocca, MD,3 Osteoid osteoma is a benign tumor of bone. It affects teenagers and young adults and classically involves the diaphysis of long bones. A juxta-articular case of osteoid osteoma involving the distal epiphysis of the tibia misdiagnosed by magnetic resonance imaging and correctly addressed by computed tomography scan and bone scans is presented. In the present case, because the location of the disease was juxta-articular, arthroscopy was used to remove the tumor. Our results show that this technique can be used in the treatment of such cases. ( The Journal of Foot & Ankle Surgery 46(6):470 – 473, 2007) Key words: arthroscopy, osteoid osteoma, benign bone tumor
O steoid osteoma (OO) is a benign tumour of the bone that frequently occurs during adolescence, and is rare in the child and even rarer in the young adult. Clinical features associated with OO are well known and include a circumscribed pain that frequently increases during night time and is typically alleviated with aspirin or other nonsteroidal antiinflammatory drugs. In our case, an unusual and initially misdiagnosed case of juxta-articular OO is presented, which stresses the importance of an appropriate imaging-guided and clinical diagnostic protocol and the very atypical localization of the disease. When the correct diagnosis was addressed, the authors successfully removed the bone growth with a minimally invasive arthroscopic technique because of its close localization to the talar joint. Case Report A 34-year-old man referred a long-lasting pain at his right ankle, which was disabling during physical activities (ie, soccer and jogging). His general practitioner recommended an x-ray, which did not reveal anything of significance (Figure 1). Subtalar cartilage damage was diagnosed, and a magnetic resonance image (MRI) of the ankle was then prescribed, which showed, at first examination, positive results for synovial chondromatosis (Figure 2). The patient underwent an ankle surgical arthroscopy for articular deAddress correspodence to: AngeloVentura, C.T.O. A. Alesini, ASL RM C, II Orthopaedic Division, Via S. Nemesio 21, 00145, Rome, Italy. E-mail: [email protected]. 1 Casa di Cura Nostra Signora della Mercede, Rome, Italy. 2 II Orthopaedic Division, C.T.O. “A. Alesini”, ASL RMC, Rome, Italy. 3 Dipartimento di Medicina Sperimentale, Università di Roma Sapienza, Polo Pontino. Sede di Latina I.C.O.T. Latina, Italy. Copyright © 2007 by the American College of Foot and Ankle Surgeons 1067-2516/07/4606-0011$32.00/0 doi:10.1053/j.jfas.2007.04.002
470
THE JOURNAL OF FOOT & ANKLE SURGERY
bridment, but 5 months later he came to our department because of recurrence of symptoms. He was seen in our office, where we took his history again and made a complete orthopaedic physical examination. His pain was then nocturnal, which was relieved with acetyl salicylic acid (ASA) and other nonsteroidal antiinflammatory drugs. A computed tomography (CT) scan was prescribed at this point and revealed a 5.5-mm diameter lesion with sclerotic borders and a partially calcified “nidus” at the anterior aspect of the medial malleolus, which suggested an OO lesion (Figure 3). A triphasic bone scan was then performed, resulting in concentration of the radioactive drug on the same area described as pathological by the CT (Figure 4). Diagnosis of OO was then made, and the patient underwent an arthroscopic removal of the tumor. A standard 2-portal ankle arthroscopy without distraction was performed while the patient was under epidural anesthesia (1). Ischemic tourniquet was adopted for the whole procedure. The intraarticular balance revealed only aspecific synovitis and few chondral lesions of the talar dome, which were treated with radiofrequency; no lesions of the articular tibia were found. Based on the imaging studies, a coring reamer with a collared pin positioner (Arthrex, Naples, FL) was introduced by an accessory portal, and, while under image intensifier control, was drilled up to 5 cm to remove the neoplasm. A maximum of 6 ⫻ 6 cm of material was removed according to preoperative studies (Figure 5). The lesion was filled with arthroscopically inserted bone wax, and a postoperative drainage was introduced and held in place for 24 hours. Pathology of the study of the arthroscopic coring confirmed clinical suspicion (Figure 6). On the second postoperative day, the patient referred a drastic reduction of symptoms and was discharged. On day 3 postoperatively, he started walking with crutches, and passive, continuous motion was started. Postoperative follow-up at day 15 and at 1, 3, 6 months, and 1 year showed no clinical recurrence of the disease, which was confirmed by MRI at 1 year postoperative (Figure 7).
FIGURE 3 Imaging of the nidus on the preoperative CT scan.
FIGURE 1 Preoperative standard x-ray of the affected ankle showing any possible focal bone lesions.
FIGURE 4 Preoperative triphasic bone scan study. Depot of the radioactive drug at the lesion side.
FIGURE 2 Preoperative nuclear magnetic resonance (NMR) pattern of the focal lesion.
Discussion OO is a benign osteogenic tumor that is usually less than 1 cm in diameter, comprising 11% of all benign bone tumors. It occurs primarily in adolescents and less often in
children, and is rare in patients more than 40 years of age. Malignant transformation has never been reported. The presenting symptom is a well-localized pain, which may be more severe at night and is relieved by aspirin or other prostaglandin inhibitors. Moreover, because OO is a vascular tumor, substances that cause vasodilation such as alcohol may precipitate an acute pain crisis. Typical locations are the proximal femur or the diaphysis
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FIGURE 5 Intraoperative, fluoroscopy-assisted reaming of the lesion. The arthroscope is in place in the joint.
FIGURE 7 Postoperative nuclear magnetic resonance (NMR) at 1 year after surgery. Absence of relapse and good bone healing without evidence of arthroscopic-related joint damage.
FIGURE 6 Pathology of the specimen: areas of osteoblast shoots surrounded by reactive cortical bone (staining: hematoxylin and eosin, 40⫻)
of long bones, although it is classically described occurring at the foot or in the posterior spine. Often, its diagnosis is clinical, because the typical nidus and surrounding sclerosis cannot be observable on x-ray. However, many authors describe this lesion almost ubiquitously: at the os calcis (2), the head of the right, third metacarpal bone (3), the body of the cervical spine (4), the fourth cervical body (5), the coronoid process (6), the petrous bone (7), the clavicle (8), the rib (9), the hamate (10), the acetabulum (11), the elbow (12), the lower end of the femur (13), the scapula (14), the foot bones (15), and distal phalanges of the hand (16). At x-ray examination, intense bony reaction to a small nidus is the hallmark of OO; however, it may be difficult to observe on x-ray because of the oval, radiolucent nidus surrounded by the disproportionally large, dense reactive zone that is only 3 to 5 mm in diameter. Although it is usually located in the cortex, nidus may also occur at the subperiosteal and endosteal levels. A CT scan is fundamental in detecting OO. The nidus is best localized with CT slices that are 1 to 2 mm thick, and the window settings of the CT scanner should be adjusted so that the dense reaction around the lesion does not obscure the small, low-density 472
THE JOURNAL OF FOOT & ANKLE SURGERY
nidus. Radiographic evaluation should also include bone scanning, which usually shows moderate or intense radioisotope uptake. It should also include MRI, which generally has a small role in the diagnosis because of its low signal, but it can be helpful in confirming the diagnosis or ruling out other lesions. Differential diagnosis should exclude Garre’s osteomyelitis (chronic sclerosing osteomyelitis), Brodie’s abscess, and stress fracture. Garre’s osteomyelitis is a chronic sclerosing osteomyelitis affecting young patients, which features a dense sclerotic reaction of the affected bone on radiographs. The lesion usually involves the entire circumference of the bone and is much more widespread than a stress fracture. Stress fractures affect particularly lower limb bones such as the femoral neck, proximal tibia, distal fibula, and metatarsal bones. Radiographic patterns are intense, and localized periosteal bone reaction is consistent with a history of intense trauma or the presence of bone-affecting diseases. A thinner, linear, sclerotic appearance of a stress fracture should be characteristic enough to distinguish the 2 lesions. Serial radiographs generally show little or no change within a short time in sclerosing osteomyelitis, whereas a typical stress fracture has a rapidly evolving course over several weeks. Brodie’s abscess is a localized form of primitive metaphyseal osteomyelitis in which, occasionally, an acute infection is contained locally by the host defences. In such
instances, the infection becomes surrounded by scar tissue and the rim of reactive bone, resulting in a cavity or cyst that is filled with pus, which may ultimately become sterile and form a bone abscess. On x-ray, an ovalar osteolysis is present and surrounded by a sclerotic reactive rim. Among various surgical and nonsurgical options, arthroscopy was selected in this case because disease localization was close to the joint surface, and open surgery would have jeopardized postoperative recovery; ankle arthrotomy would have imposed the need for a more invasive surgical approach, a longer hospitalization time, and the need for a major postoperative rehabilitation program (17). A nonsurgical option, such as radiofrequency, was excluded. Although it is currently used in bone tumors, especially in OO (18, 19) and in bone metastasis (20), it has been described on easily accessible sites (21), and its use is recommended if the tumor is located in the appendicular skeleton and pelvis (22). Moreover, a clear pathological diagnosis was mandatory given the patient’s history of a previous failed surgery. With radiofrequency, no specimen could have been obtained nor could fine needle aspirations have been reported to be successful with bone radiofrequency (23). Therefore, it is the authors’ opinion that this case is reported not only because of the arthroscopic-assisted removal of bone lesion from the ankle, a rarely used procedure in bone tumor surgery (as is reported in the literature) (24 –26), but also because it is relevant to describe the tumor’s atypical location and the patient’s unusual history and age, which stressed the correct diagnostic protocol.
5. 6.
7.
8. 9.
10.
11.
12. 13.
14.
15.
16. 17. 18.
Conclusion
19.
A painful joint in an active young man can sometimes lead to a misguided diagnosis of a cartilage disorder. The present case shows the importance of a level of suspicion toward such diagnosis, if unusual, and stresses how identification of unusual bone disorders should been made on the basis of their clinical presentation including their location, and not on imaging studies alone. Our final results show that arthroscopy can be successfully used as a diagnostic and, subsequently, valuable therapeutic tool for such conditions. References
20.
21.
22.
23.
1. Evans RD, Pehde C, Ledbetter K. Ankle arthroscopy. Clin Podiatr Med Surg 18:467– 480, 2001. 2. Morris GB, Goldman FD. Osteoid osteoma causing subtalar joint arthralgia: a case report. J Foot Ankle Surg 42:90 –94, 2003. 3. Uda H, Mizuzeki T, Tsuge K. Osteoid osteoma of the metacarpal bone presenting after an injury. Scand J Plast Reconstr Surg Hand Surg 36:238 –242, 2002. 4. Suttner NJ, Chandy KJ, Kellerman AJ. Osteoid osteomas of the body
24. 25.
26.
of the cervical spine. Case report and review of the literature Br J Neurosurg 16:69 –71, 2002. Muthukumar N. Osteoid osteoma—a rare cause of brachial neuralgia. Child Nerv Syst 18:161–163, 2002. Becker PL, Heywood HB 3rd, Crosby LA. Osteoid osteoma of the coronoid process: case report and review of the literature. J Shoulder Elbow Surg 9:446 – 448, 2000. Iffenecker C, Rocher P, Rabia MH, Dhina Z, Bobin S, Quillard J, Doyon D. Osteoid osteoma of the petrous bone. Neuroradiology 39: 821– 823, 1997. Shaffrey CI, Moskal JT, Shaffrey ME. Osteoid osteoma of the clavicle. J Shoulder Elbow Surg 6:396 –399, 1997. McDermott MB, Kyriakos M, McEnery K. Painless osteoid osteoma of the rib in an adult. A case report and a review of the literature Cancer 77:1442–1449, 1996. Resnick RB, Jarolem KL, Sheskier SC, Desai P, Cisa J. Arthroscopic removal of an osteoid osteoma of the talus: a case report. J Foot Ankle Int 16:212–215, 1995. Glickman LT, McCabe SJ, Murray JF. Osteoid osteoma of the hamate: report of a case and review of the literature. Ann Plast Surg 31:87–90, 1993. Karray S, Zlitni M, Karray M, Moalla M, Zouari M, Douik M, Sliman N. Osteoid osteoma of the acetabulum. Int Orthop 17:54 –56, 1993. Ruggieri P, Biagini R, Ferraro A, Picci P, Capanna R. Osteoid osteoma of the elbow. A study of twelve cases Ital J Orthop Traumatol 15: 154 –163, 1989. van Linthoudt D, Vernet O, Pazera A, Ott H. Osteoid osteoma of the lower end of the femur—a diagnostic problem. Schweiz Rundsch Med Prax 78:620 – 624, 1989. Mosheiff R, Liebergall M, Ziv I, Amir G, Segal D. Osteoid osteoma of the scapula. A case report and review of the literature Clin Orthop 262:129 –131, 1991. De Palma L, Greco F, Coletti V. [Osteoid osteoma of the foot]. Arch Putti Chir Organi Mov 38:113–122, 1990. Evans RD, Pehde C, Ledbetter K. Ankle arthroscopy. Clin Podiatr Med Surg 18:467– 480, 2001. Bowen CV, Dzus AK, Hardy DA. Osteoid osteomata of the distal phalanx. J Hand Surg [Br] 12:387–390, 1987. Maruyama M, Asano T, Kenmochi T, Kainuma O, Iwasaki K, Miyauchi H, Saigo K, Miura F, Kobayashi S, Ochiai T. Radiofrequency ablation therapy for bone metastasis from hepatocellular carcinoma: case report. Anticancer Res 23:2987–2989, 2003. Schaefer MP, Smith J. The diagnostic and therapeutic challenge of femoral head osteoid osteoma presenting as thigh pain: a case report. Arch Phys Med Rehabil 84:904 –905, 2003. Venbrux AC, Montague BJ, Murphy KP, Bobonis LA, Washington SB, Soltes AP, Frassica FJ. Image-guided percutaneous radiofrequency ablation for osteoid osteomas. J Vasc Interv Radiol 14:375– 380, 2003. Rosenthal DI, Hornicek FJ, Torriani M, Gebhardt MC, Mankin HJ. Osteoid osteoma: percutaneous treatment with radiofrequency energy. Radiology 229:171–175, 2003. Torriani M, Rosenthal DI. Percutaneous radiofrequency treatment of osteoid osteoma. Pediatr Radiol 32:615– 618, 2002. Moreland WS, Zagoria RJ, Geisinger KR. Use of fine needle aspiration biopsy in radiofrequency ablation. Acta Cytol 46:819 – 822, 2002. Bojanic I, Orlic D, Ivkovic A. Arthroscopic removal of a juxtaarticular osteoid osteoma of the talar neck. J Foot Ankle Surg 42:359 –362, 2003. Banerjee D, Eriksson K, Morris H. Arthroscopically treated intraarticular osteoid osteoma in the ankle—a report of 3 cases. Acta Orthop 76:721–724, 2005.
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O steoid osteoma (OO) is a benign tumour of the bone that frequently occurs during adolescence, and is rare in the child and even rarer in the young adult. Clinical features associated with OO are well known and include a circumscribed pain that frequently increases during night time and is typically alleviated with aspirin or other nonsteroidal antiinflammatory drugs. In our case, an unusual and initially misdiagnosed case of juxta-articular OO is presented, which stresses the importance of an appropriate imaging-guided and clinical diagnostic protocol and the very atypical localization of the disease. When the correct diagnosis was addressed, the authors successfully removed the bone growth with a minimally invasive arthroscopic technique because of its close localization to the talar joint. Case Report A 34-year-old man referred a long-lasting pain at his right ankle, which was disabling during physical activities (ie, soccer and jogging). His general practitioner recommended an x-ray, which did not reveal anything of significance (Figure 1). Subtalar cartilage damage was diagnosed, and a magnetic resonance image (MRI) of the ankle was then prescribed, which showed, at first examination, positive results for synovial chondromatosis (Figure 2). The patient underwent an ankle surgical arthroscopy for articular deAddress correspodence to: AngeloVentura, C.T.O. A. Alesini, ASL RM C, II Orthopaedic Division, Via S. Nemesio 21, 00145, Rome, Italy. E-mail: [email protected]. 1 Casa di Cura Nostra Signora della Mercede, Rome, Italy. 2 II Orthopaedic Division, C.T.O. “A. Alesini”, ASL RMC, Rome, Italy. 3 Dipartimento di Medicina Sperimentale, Università di Roma Sapienza, Polo Pontino. Sede di Latina I.C.O.T. Latina, Italy. Copyright © 2007 by the American College of Foot and Ankle Surgeons 1067-2516/07/4606-0011$32.00/0 doi:10.1053/j.jfas.2007.04.002
470
THE JOURNAL OF FOOT & ANKLE SURGERY
bridment, but 5 months later he came to our department because of recurrence of symptoms. He was seen in our office, where we took his history again and made a complete orthopaedic physical examination. His pain was then nocturnal, which was relieved with acetyl salicylic acid (ASA) and other nonsteroidal antiinflammatory drugs. A computed tomography (CT) scan was prescribed at this point and revealed a 5.5-mm diameter lesion with sclerotic borders and a partially calcified “nidus” at the anterior aspect of the medial malleolus, which suggested an OO lesion (Figure 3). A triphasic bone scan was then performed, resulting in concentration of the radioactive drug on the same area described as pathological by the CT (Figure 4). Diagnosis of OO was then made, and the patient underwent an arthroscopic removal of the tumor. A standard 2-portal ankle arthroscopy without distraction was performed while the patient was under epidural anesthesia (1). Ischemic tourniquet was adopted for the whole procedure. The intraarticular balance revealed only aspecific synovitis and few chondral lesions of the talar dome, which were treated with radiofrequency; no lesions of the articular tibia were found. Based on the imaging studies, a coring reamer with a collared pin positioner (Arthrex, Naples, FL) was introduced by an accessory portal, and, while under image intensifier control, was drilled up to 5 cm to remove the neoplasm. A maximum of 6 ⫻ 6 cm of material was removed according to preoperative studies (Figure 5). The lesion was filled with arthroscopically inserted bone wax, and a postoperative drainage was introduced and held in place for 24 hours. Pathology of the study of the arthroscopic coring confirmed clinical suspicion (Figure 6). On the second postoperative day, the patient referred a drastic reduction of symptoms and was discharged. On day 3 postoperatively, he started walking with crutches, and passive, continuous motion was started. Postoperative follow-up at day 15 and at 1, 3, 6 months, and 1 year showed no clinical recurrence of the disease, which was confirmed by MRI at 1 year postoperative (Figure 7).
FIGURE 3 Imaging of the nidus on the preoperative CT scan.
FIGURE 1 Preoperative standard x-ray of the affected ankle showing any possible focal bone lesions.
FIGURE 4 Preoperative triphasic bone scan study. Depot of the radioactive drug at the lesion side.
FIGURE 2 Preoperative nuclear magnetic resonance (NMR) pattern of the focal lesion.
Discussion OO is a benign osteogenic tumor that is usually less than 1 cm in diameter, comprising 11% of all benign bone tumors. It occurs primarily in adolescents and less often in
children, and is rare in patients more than 40 years of age. Malignant transformation has never been reported. The presenting symptom is a well-localized pain, which may be more severe at night and is relieved by aspirin or other prostaglandin inhibitors. Moreover, because OO is a vascular tumor, substances that cause vasodilation such as alcohol may precipitate an acute pain crisis. Typical locations are the proximal femur or the diaphysis
VOLUME 46, NUMBER 6, NOVEMBER/DECEMBER 2007
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FIGURE 5 Intraoperative, fluoroscopy-assisted reaming of the lesion. The arthroscope is in place in the joint.
FIGURE 7 Postoperative nuclear magnetic resonance (NMR) at 1 year after surgery. Absence of relapse and good bone healing without evidence of arthroscopic-related joint damage.
FIGURE 6 Pathology of the specimen: areas of osteoblast shoots surrounded by reactive cortical bone (staining: hematoxylin and eosin, 40⫻)
of long bones, although it is classically described occurring at the foot or in the posterior spine. Often, its diagnosis is clinical, because the typical nidus and surrounding sclerosis cannot be observable on x-ray. However, many authors describe this lesion almost ubiquitously: at the os calcis (2), the head of the right, third metacarpal bone (3), the body of the cervical spine (4), the fourth cervical body (5), the coronoid process (6), the petrous bone (7), the clavicle (8), the rib (9), the hamate (10), the acetabulum (11), the elbow (12), the lower end of the femur (13), the scapula (14), the foot bones (15), and distal phalanges of the hand (16). At x-ray examination, intense bony reaction to a small nidus is the hallmark of OO; however, it may be difficult to observe on x-ray because of the oval, radiolucent nidus surrounded by the disproportionally large, dense reactive zone that is only 3 to 5 mm in diameter. Although it is usually located in the cortex, nidus may also occur at the subperiosteal and endosteal levels. A CT scan is fundamental in detecting OO. The nidus is best localized with CT slices that are 1 to 2 mm thick, and the window settings of the CT scanner should be adjusted so that the dense reaction around the lesion does not obscure the small, low-density 472
THE JOURNAL OF FOOT & ANKLE SURGERY
nidus. Radiographic evaluation should also include bone scanning, which usually shows moderate or intense radioisotope uptake. It should also include MRI, which generally has a small role in the diagnosis because of its low signal, but it can be helpful in confirming the diagnosis or ruling out other lesions. Differential diagnosis should exclude Garre’s osteomyelitis (chronic sclerosing osteomyelitis), Brodie’s abscess, and stress fracture. Garre’s osteomyelitis is a chronic sclerosing osteomyelitis affecting young patients, which features a dense sclerotic reaction of the affected bone on radiographs. The lesion usually involves the entire circumference of the bone and is much more widespread than a stress fracture. Stress fractures affect particularly lower limb bones such as the femoral neck, proximal tibia, distal fibula, and metatarsal bones. Radiographic patterns are intense, and localized periosteal bone reaction is consistent with a history of intense trauma or the presence of bone-affecting diseases. A thinner, linear, sclerotic appearance of a stress fracture should be characteristic enough to distinguish the 2 lesions. Serial radiographs generally show little or no change within a short time in sclerosing osteomyelitis, whereas a typical stress fracture has a rapidly evolving course over several weeks. Brodie’s abscess is a localized form of primitive metaphyseal osteomyelitis in which, occasionally, an acute infection is contained locally by the host defences. In such
instances, the infection becomes surrounded by scar tissue and the rim of reactive bone, resulting in a cavity or cyst that is filled with pus, which may ultimately become sterile and form a bone abscess. On x-ray, an ovalar osteolysis is present and surrounded by a sclerotic reactive rim. Among various surgical and nonsurgical options, arthroscopy was selected in this case because disease localization was close to the joint surface, and open surgery would have jeopardized postoperative recovery; ankle arthrotomy would have imposed the need for a more invasive surgical approach, a longer hospitalization time, and the need for a major postoperative rehabilitation program (17). A nonsurgical option, such as radiofrequency, was excluded. Although it is currently used in bone tumors, especially in OO (18, 19) and in bone metastasis (20), it has been described on easily accessible sites (21), and its use is recommended if the tumor is located in the appendicular skeleton and pelvis (22). Moreover, a clear pathological diagnosis was mandatory given the patient’s history of a previous failed surgery. With radiofrequency, no specimen could have been obtained nor could fine needle aspirations have been reported to be successful with bone radiofrequency (23). Therefore, it is the authors’ opinion that this case is reported not only because of the arthroscopic-assisted removal of bone lesion from the ankle, a rarely used procedure in bone tumor surgery (as is reported in the literature) (24 –26), but also because it is relevant to describe the tumor’s atypical location and the patient’s unusual history and age, which stressed the correct diagnostic protocol.
5. 6.
7.
8. 9.
10.
11.
12. 13.
14.
15.
16. 17. 18.
Conclusion
19.
A painful joint in an active young man can sometimes lead to a misguided diagnosis of a cartilage disorder. The present case shows the importance of a level of suspicion toward such diagnosis, if unusual, and stresses how identification of unusual bone disorders should been made on the basis of their clinical presentation including their location, and not on imaging studies alone. Our final results show that arthroscopy can be successfully used as a diagnostic and, subsequently, valuable therapeutic tool for such conditions. References
20.
21.
22.
23.
1. Evans RD, Pehde C, Ledbetter K. Ankle arthroscopy. Clin Podiatr Med Surg 18:467– 480, 2001. 2. Morris GB, Goldman FD. Osteoid osteoma causing subtalar joint arthralgia: a case report. J Foot Ankle Surg 42:90 –94, 2003. 3. Uda H, Mizuzeki T, Tsuge K. Osteoid osteoma of the metacarpal bone presenting after an injury. Scand J Plast Reconstr Surg Hand Surg 36:238 –242, 2002. 4. Suttner NJ, Chandy KJ, Kellerman AJ. Osteoid osteomas of the body
24. 25.
26.
of the cervical spine. Case report and review of the literature Br J Neurosurg 16:69 –71, 2002. Muthukumar N. Osteoid osteoma—a rare cause of brachial neuralgia. Child Nerv Syst 18:161–163, 2002. Becker PL, Heywood HB 3rd, Crosby LA. Osteoid osteoma of the coronoid process: case report and review of the literature. J Shoulder Elbow Surg 9:446 – 448, 2000. Iffenecker C, Rocher P, Rabia MH, Dhina Z, Bobin S, Quillard J, Doyon D. Osteoid osteoma of the petrous bone. Neuroradiology 39: 821– 823, 1997. Shaffrey CI, Moskal JT, Shaffrey ME. Osteoid osteoma of the clavicle. J Shoulder Elbow Surg 6:396 –399, 1997. McDermott MB, Kyriakos M, McEnery K. Painless osteoid osteoma of the rib in an adult. A case report and a review of the literature Cancer 77:1442–1449, 1996. Resnick RB, Jarolem KL, Sheskier SC, Desai P, Cisa J. Arthroscopic removal of an osteoid osteoma of the talus: a case report. J Foot Ankle Int 16:212–215, 1995. Glickman LT, McCabe SJ, Murray JF. Osteoid osteoma of the hamate: report of a case and review of the literature. Ann Plast Surg 31:87–90, 1993. Karray S, Zlitni M, Karray M, Moalla M, Zouari M, Douik M, Sliman N. Osteoid osteoma of the acetabulum. Int Orthop 17:54 –56, 1993. Ruggieri P, Biagini R, Ferraro A, Picci P, Capanna R. Osteoid osteoma of the elbow. A study of twelve cases Ital J Orthop Traumatol 15: 154 –163, 1989. van Linthoudt D, Vernet O, Pazera A, Ott H. Osteoid osteoma of the lower end of the femur—a diagnostic problem. Schweiz Rundsch Med Prax 78:620 – 624, 1989. Mosheiff R, Liebergall M, Ziv I, Amir G, Segal D. Osteoid osteoma of the scapula. A case report and review of the literature Clin Orthop 262:129 –131, 1991. De Palma L, Greco F, Coletti V. [Osteoid osteoma of the foot]. Arch Putti Chir Organi Mov 38:113–122, 1990. Evans RD, Pehde C, Ledbetter K. Ankle arthroscopy. Clin Podiatr Med Surg 18:467– 480, 2001. Bowen CV, Dzus AK, Hardy DA. Osteoid osteomata of the distal phalanx. J Hand Surg [Br] 12:387–390, 1987. Maruyama M, Asano T, Kenmochi T, Kainuma O, Iwasaki K, Miyauchi H, Saigo K, Miura F, Kobayashi S, Ochiai T. Radiofrequency ablation therapy for bone metastasis from hepatocellular carcinoma: case report. Anticancer Res 23:2987–2989, 2003. Schaefer MP, Smith J. The diagnostic and therapeutic challenge of femoral head osteoid osteoma presenting as thigh pain: a case report. Arch Phys Med Rehabil 84:904 –905, 2003. Venbrux AC, Montague BJ, Murphy KP, Bobonis LA, Washington SB, Soltes AP, Frassica FJ. Image-guided percutaneous radiofrequency ablation for osteoid osteomas. J Vasc Interv Radiol 14:375– 380, 2003. Rosenthal DI, Hornicek FJ, Torriani M, Gebhardt MC, Mankin HJ. Osteoid osteoma: percutaneous treatment with radiofrequency energy. Radiology 229:171–175, 2003. Torriani M, Rosenthal DI. Percutaneous radiofrequency treatment of osteoid osteoma. Pediatr Radiol 32:615– 618, 2002. Moreland WS, Zagoria RJ, Geisinger KR. Use of fine needle aspiration biopsy in radiofrequency ablation. Acta Cytol 46:819 – 822, 2002. Bojanic I, Orlic D, Ivkovic A. Arthroscopic removal of a juxtaarticular osteoid osteoma of the talar neck. J Foot Ankle Surg 42:359 –362, 2003. Banerjee D, Eriksson K, Morris H. Arthroscopically treated intraarticular osteoid osteoma in the ankle—a report of 3 cases. Acta Orthop 76:721–724, 2005.
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