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Osteochondroma of the distal tibia leading to deformity and stress fracture of the fibula
Foot and Ankle Surgery 9 (2003) 129–130 www.elsevier.com/locate/fas
Case Report
Osteochondroma of the distal tibia leading to deformity and stress fracture of the fibula A.D. Skyrme*, R. Chana, G.P.F. Selmon, A. Butler-Manuel Conquest Hospital, St Leonards-on-Sea, E Sussex TN37 7RD, UK
1. Introduction Osteochondromata are one of the most common benign bone tumours, the majority of which are asymptomatic and can, therefore, be managed conservatively [1,2]. There are numerous reports in the literature of complications secondary to tibial osteochondromata; however, there is only one report of deformity of the distal fibula secondary to a tibial osteochondroma [3]. We report a unique case of stress fracture and deformity of the distal fibula associated with this benign bone tumour. 2. Case report A 37 year-old woman presented with an acutely painful right ankle following minor trauma. The patient also gave a clear history of increasing pain in the ankle over a period of months, precipitated by any prolonged activity. Radiographs revealed a distal tibial osteochondroma with secondary deformity and localised sclerosis of the fibula at the same level (Fig. 1); a subsequent bone scan confirmed a stress fracture at this level (Fig. 2). The patient was managed with a below knee non-weight bearing plaster for 6 weeks until fracture union and then underwent excision of the exostosis electively. The patient recovered uneventfully, with excellent ankle function.
Fig. 1. Distal tibial osteochondroma showing deformity and sclerosis of the fibula.
3. Discussion Complications of distal tibial osteochondromata are commonly associated with multiple hereditary osteochondromatosis; the complications include varus and valgus ankle deformity, ankle instability, fibular shortening, tapering of the distal tibial epiphysis, fracture through the stalk of the lesion, tibiofibular diastasis or synostosis and * Corresponding author. Address: 116 Kidbrooke Park Road, Blackheath, London SE3 ODX, UK. Tel./fax: þ44-208-516-8071. E-mail address: [email protected] (A.D. Skyrme). 1268-7731/03/$ - see front matter q 2003 Published by Elsevier Science Ltd. doi:10.1016/S1268-7731(03)00022-5
Fig. 2. Bone scan confirming a stress fracture of the fibula at the level of the tibial osteochondroma.
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A.D. Skyrme et al. / Foot and Ankle Surgery 9 (2003) 129–130
chronic pain [4,5]. This unique report, however, documents a case of fibular deformity with a stress fracture secondary to a distal tibial osteochondroma. We have successfully used conservative management of the acute injury followed by excision of the lesion electively at a later date. References [1] Spatz DK, Guille JT, Kumar SJ. Distal tibiofibular diastasis secondary to osteochondroma in a child. Clin Orth Related Res 1997;345:195–7.
[2] Davids JR, Glancy GL, Eilert RE. Fracture through the stalk of pedunculated osteochondromas. A report of three cases. Clin Orth Related Res 1991;271:258–64. [3] Danielsson LG, el-Haddad I, Quadros O. Distal tibial osteochondroma deforming the fibula. Acta Orth Scand 1990; 61(5):469 – 70. [4] Snearly WN, Peterson HA. Management of ankle deformities in multiple hereditary osteochondroma. J Paediatr Orth 1989;9: 427– 32. [5] Chin KR, Kharrazi FD, Miller BS, Mankin HJ, Gebhardt MC. Osteochondromas of the distal aspect of the tibia or fibula. Natural history and treatment. J Bone Joint Surg (Am) 2000; 82(9):1269–78.
Case Report
Osteochondroma of the distal tibia leading to deformity and stress fracture of the fibula A.D. Skyrme*, R. Chana, G.P.F. Selmon, A. Butler-Manuel Conquest Hospital, St Leonards-on-Sea, E Sussex TN37 7RD, UK
1. Introduction Osteochondromata are one of the most common benign bone tumours, the majority of which are asymptomatic and can, therefore, be managed conservatively [1,2]. There are numerous reports in the literature of complications secondary to tibial osteochondromata; however, there is only one report of deformity of the distal fibula secondary to a tibial osteochondroma [3]. We report a unique case of stress fracture and deformity of the distal fibula associated with this benign bone tumour. 2. Case report A 37 year-old woman presented with an acutely painful right ankle following minor trauma. The patient also gave a clear history of increasing pain in the ankle over a period of months, precipitated by any prolonged activity. Radiographs revealed a distal tibial osteochondroma with secondary deformity and localised sclerosis of the fibula at the same level (Fig. 1); a subsequent bone scan confirmed a stress fracture at this level (Fig. 2). The patient was managed with a below knee non-weight bearing plaster for 6 weeks until fracture union and then underwent excision of the exostosis electively. The patient recovered uneventfully, with excellent ankle function.
Fig. 1. Distal tibial osteochondroma showing deformity and sclerosis of the fibula.
3. Discussion Complications of distal tibial osteochondromata are commonly associated with multiple hereditary osteochondromatosis; the complications include varus and valgus ankle deformity, ankle instability, fibular shortening, tapering of the distal tibial epiphysis, fracture through the stalk of the lesion, tibiofibular diastasis or synostosis and * Corresponding author. Address: 116 Kidbrooke Park Road, Blackheath, London SE3 ODX, UK. Tel./fax: þ44-208-516-8071. E-mail address: [email protected] (A.D. Skyrme). 1268-7731/03/$ - see front matter q 2003 Published by Elsevier Science Ltd. doi:10.1016/S1268-7731(03)00022-5
Fig. 2. Bone scan confirming a stress fracture of the fibula at the level of the tibial osteochondroma.
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A.D. Skyrme et al. / Foot and Ankle Surgery 9 (2003) 129–130
chronic pain [4,5]. This unique report, however, documents a case of fibular deformity with a stress fracture secondary to a distal tibial osteochondroma. We have successfully used conservative management of the acute injury followed by excision of the lesion electively at a later date. References [1] Spatz DK, Guille JT, Kumar SJ. Distal tibiofibular diastasis secondary to osteochondroma in a child. Clin Orth Related Res 1997;345:195–7.
[2] Davids JR, Glancy GL, Eilert RE. Fracture through the stalk of pedunculated osteochondromas. A report of three cases. Clin Orth Related Res 1991;271:258–64. [3] Danielsson LG, el-Haddad I, Quadros O. Distal tibial osteochondroma deforming the fibula. Acta Orth Scand 1990; 61(5):469 – 70. [4] Snearly WN, Peterson HA. Management of ankle deformities in multiple hereditary osteochondroma. J Paediatr Orth 1989;9: 427– 32. [5] Chin KR, Kharrazi FD, Miller BS, Mankin HJ, Gebhardt MC. Osteochondromas of the distal aspect of the tibia or fibula. Natural history and treatment. J Bone Joint Surg (Am) 2000; 82(9):1269–78.