J Korean Orthop Assoc.  2017 Feb;52(1):33-39. 10.4055/jkoa.2017.52.1.33.

The Optimal Surgical Approach and Complications in Resecting Osteochondroma around the Lesser Trochanter

• Jeon DG
• Cho WH
• Song WS
• Kong CB
• Lee SY
• Kim DY

• KMID: 2369569
• DOI: http://doi.org/10.4055/jkoa.2017.52.1.33

Abstract

PURPOSE
Surgical risks associated with the resection of osteochondroma around the proximal tibia and fibula, as well as the proximal humerus have been well established; however, the clinical presentation and optimal surgical approach for osteochondroma around the lesser trochanter have not been fully addressed.
MATERIALS AND METHODS
Thirteen patients with osteochondroma around the lesser trochanter underwent resection. We described the chief complaint, duration of symptom, location of the tumor, mass protrusion pattern on axial computed tomography image, tumor volume, surgical approach, iliopsoas tendon integrity after resection, and complication according to the each surgical approach.
RESULTS
Pain on walking or exercise was the chief complaint in 7 patients, and numbness and radiating pain in 6 patients. The average duration of symptom was 19 months (2-72 months). The surgical approach for 5 tumors that protruded postero-laterally was postero-lateral (n=3), anterior (n=1), and medial (n=1). All 4 patients with antero-medially protruding tumor underwent the anterior approach. Two patients with both antero-medially and postero-laterally protruding tumor received the medial and anterior approach, respectively. Two patients who underwent medial approach for postero-laterally protruded tumor showed extensive cortical defect after resection. One patient who received the anterior approach to resect a large postero-laterally protruded tumor developed complete sciatic nerve palsy, which was recovered 6 months after re-exploration.
CONCLUSION
For large osteochondromas with posterior protrusion, we should not underestimate the probability of sciatic nerve compression. When regarding the optimal surgical approach, the medial one is best suitable for small tumors, while the anterior approach is good for antero-medial or femur neck tumor. For postero-laterally protruded large tumors, posterior approach may minimize the risk of sciatic nerve palsy.

Keyword

osteochondroma; femur neck; surgical procedure

MeSH Terms

Femur Neck
Femur*
Fibula
Humans
Humerus
Hypesthesia
Osteochondroma*
Sciatic Nerve
Sciatic Neuropathy
Tendons
Tibia
Tumor Burden
Walking

Figure

• 

  Figure 1 (A) A 20-year-old man with tumors protruding postero-laterally complained of numbness and radiating pain on prolonged sitting position (case 3). (B) Axial magnetic resonance imaging shows antero-medially protruding tumor. (C) The tumor was excised via the medial approach. A large medial cortical defect was confirmed, postoperatively. (D) To prevent fractures, internal fixation and autogenous bone graft was performed at 1 week from the index operation.

• 

  Figure 2 (A) Plain radiograph shows a huge osteochondroma in the lesser trochanter and femur neck (case 6). (B) Axial compiuted tomography demonstrates a mass protruding both antero- and postero-medially. (C) Postoperative radiograph shows excised tumor through the anterior approach, however, the patient developed complete sciatic nerve palsy. (D) At 18 hours from the identification of palsy, re-exploration of sciatic nerve was done. The continuity of the nerve was well preserved; however, it showed scarring of 5 cm due to a long-term compression by the tumor.

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