"Disappearing" osteochondroma a case report.
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Abstract:
Osteochondroma is the most frequent benign tumor of the bone. Its migration is well-known but its spontaneous disappearance is rarely reported.A three years and nine months follow-up study of an osteochondroma occurring in the left humerus of a one-year-old boy is reported.The broad-based lump was located on the anteromedial aspect of the left humerus at the proximal diaphysis. The diagnosis of solitary osteochondroma was made roentgenographycally. The lesion was followed with roentgenograms without treatment.Roentgenograms made three months later showed no apparent change in the lesion, but subsequent roentgenograms made fourteen and twenty-four months after the initial roentgenograms showed the gradual regression of the lesion. The final roentgenograms made three years and nine months after the initial roentgenograms showed the lesion to have completely disappeared without surgical intervention.Spontaneous resolution or regression of osteochondromas is rarely recorded, but it is suggested that it may be more frequent.Keywords:
Diaphysis
Objectives Shortening of the fetal long bones is a sonographic soft marker for screening of Down syndrome in the second trimester that can be influenced by ethnicity. The purpose of this study was to provide normal reference ranges for femur and humerus diaphysis length during the second trimester of pregnancy in an Iranian population. Methods This cross-sectional study was performed on 3011 singleton fetuses at 15 to 28 weeks' menstrual age. The relationship between menstrual age and both femur and humerus diaphysis length was determined, and percentile values for each menstrual week were provided. Results The median femur diaphysis length ranged from 18.05 mm at 15 menstrual weeks to 52.20 mm at 28 menstrual weeks, and the mean humerus diaphysis length ranged from 17.65 mm at 15 menstrual weeks to 48.10 mm at 28 menstrual weeks. There was a linear relationship between menstrual age and both femur diaphysis length (R2 = 0.957) and humerus diaphysis length (R2 = 0.941). Conclusions We have provided normal reference ranges for femur and humerus diaphysis length during the second trimester of pregnancy in an Iranian population.
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The article presents the results of surgical rehabilitation of 21 patients with diaphyseal fractures of humerus diaphysis, with localization in the middle-lower third of the diaphysis, using transosseous osteosynthesis with an external fixation device. Evaluation of the results was carried out by retrospective analysis of the outcomes of surgical rehabilitation of patients with humerus diaphysis fractures using transosseous osteosynthesis by external fixation apparatus in the period from 2015–2020. It showed that the modified closed transosseous osteosynthesis by external fixation apparatus and the use of a rod line-up allows significantly reducing the risks of complications in comparison with the traditional technology of bone and intraosseous fixation and achieving excellent and good results in 85.7% of patients with diaphyseal fractures of the humerus.
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The incidence of spontaneous humeral fractures in first-lactation dairy heifers in New Zealand has emphasised the need to understand the thoracic limb bone growth of dairy heifers. Previous research has indicated that a predisposing factor to spontaneous humeral fracture is nutrition. In addition, it has been hypothesised that liver copper concentration affects bone strength and may be a potential factor associated with humeral fracture risk. The aim of this study was to compare bone morphology in the mid-diaphysis of the metacarpus and humerus of heifers affected and unaffected by spontaneous humeral fractures, and determine the effect of copper status at death on bone morphology. The metacarpus and humerus were collected from heifers affected and unaffected by humeral fractures, and scanned using peripheral quantitative computed tomography (pQCT). The mid-diaphysis of the humerus of the affected group had reduced cortical bone mineral density and a trend for reduced cortical content and total bone content, which contributed to a reduced stress–strain index. The trend for reduced bone length in affected humeri provides additional support for the hypothesis of inhibited humeral growth. Heifers with low copper liver concentrations had reduced humerus lengths and reduced cortical bone mineral densities. These data support the hypothesis that the developmental window for humeral fracture is recent, and possibly associated with periods of inadequate nutrition.
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Osteochondromas are the most common benign tumours of the bone. They are solitary or multiple, pedunculated or sessile exophytic outgrowths from the bone surface that are composed of cortical and medullary component with an overlying hyaline cartilage cap. Marrow and cortical continuity with the underlying parent bone is the characteristic of the lesion; they mostly arise from the metaphysis of the bone. Osteochondromas arising from the diaphysis are rare; and nerve palsy arising in the setting of a diaphyseal osteochondroma is even rarer. This is a report of solitary osteochondroma arising from diaphysis of left humerus in a 10 years old boy, which resulted in median nerve palsy. Surgical excision relieved the symptoms completely. The aim of this case report was to draw attention to an unusual etiology of median nerve palsy caused by an osteochondroma arising from the diaphysis of humerus which is a rare site, and to emphasize its importance.
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Metaphysis
Long bone
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In this study, we present an eight-year-old patient with intraosseous hemangioma in the right humerus diaphysis. The humerus diaphysis is an unusual localization for hemangioma. To our knowledge, this is the first case of intraosseous hemangioma in the humerus diaphysis in a pediatric patient. Treatment of intraosseous hemangiomas is controversial; options range from untreated follow-up to en-bloc resection. Intralesional curettage and grafting with cortico-cancellous allograft were performed in this case. Around 22 months postoperatively, she showed full shoulder and elbow function and there was no evidence of local recurrence or metastasis.
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Although the clinical experience with reamed intramedullary nailing has been successful for the treatment of femur and tibia fractures, similar success has not been duplicated when this technique has been applied in the humerus. Although the cortical vascular response to nailing of the humerus is presently assumed to be similar to that of the femur, the response of the humerus to reaming has not been documented in vivo. The following case depicts avascularity of the humeral diaphyseal cortex as a complication of reamed intramedullary nailing and illustrates the sensitivity of the humerus to this treatment.
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The humerus lies within the brachium, articulating proximally with the scapular glenoid to form the shoulder joint and distally with the radius and ulna to form the elbow joint. This chapter looks at humeral diaphyseal fractures, fractures of the distal humerus. Operative techniques: Salter-Harris type I and II fractures of the proximal humerus; Salter-Harris type III fractures of the proximal humerus; Medial approach to the humeral diaphysis for bone plate application; Medial approach to the distal humerus for bone plate application; Lateral approach to the humeral diaphysis for bone plate application; Lateral approach to the distal humerus for bone plate application; Lateral condylar fractures; Medial condylar fractures; Intracondylar Y-T fractures; Intramedullary pinning; Pin-plate application; Linear external skeletal fixation of the humerus; Supracondylar humeral fractures; Placement of a medial to lateral transcondylar positional cortical bone screw for humeral intracondylar fissure.
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Of 1000 osteosarcoma cases recorded in the Mayo Clinic records, approximately 7% of the lesions occurred in the diaphysis of long bones, mostly in the femur, tibia, and humerus. The average age of the patients with these lesions was 28 years (range: 8 to 67). The duration of their symptoms before diagnosis was greater than that for patients with conventional osteosarcoma in the metaphysis. In approximately 20% of the cases, the radiographic appearance mimicked that of Ewing's sarcoma. Amputation surgery was the major form of treatment. The 2-, 5- and 15-year survival was 42%, 29%, and 20%, respectively.
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The cross-sectional geometric parameters were determined serially along the diaphysis of 3 paired humeri and femora of chimpanzees by using the computed X-ray tomographic scans, and compared with those of humans. In magnitude, the femoral parameters were greater and humeral parameters were less, respectively, in humans than in chimpanzees. While the changing pattern among the parameters along the diaphysis was very similar both in the femur and humerus of chimpanzees, the pattern in the humans was reversed between the cross-sectional area and area moments of inertia. In chimpanzees, the femoral parameters increased toward the most proximal diaphysis, whereas humeral parameters yielded a moderate peak in a portion slightly proximal to mid-shaft. Potential mechanisms responsible for these findings were discussed.
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Background. The humerus is a common localisation of cancer metastases. The restoration of anatomical order and tumor resection within humerus is important for patients quality of everyday life and for their pain relief. The surgical treatment is one of the most important part of the whole oncological ways of tratment.
The study objective was a clinical assesment of tumor resection and reconstruction within humerus according to matastasis localisation and the choice of surgical technique.
Material and methods. In the years 1999-2002 19 patients underwent surgery due to pathological fracture or/and cancer metastasis within humerus. The shaft localisation of the tumor was found in 8 cases and in 11 patients the metastatic foci were found in proximnal diaphysis. In patients with proximal diaphysis localisation of the tumor the partial resection with subsequent joint exchange procedure was made. The humeral shaft metastatic cancer changes were treated by the segmental resection with subsequent surgical cement filling or auto/allogenical bone grafting combined with intramedullary nail or AO/ASIF plate stabilisation. The average follow-up period was 8,5 months.
Results. In patients after resection with shoulder joint alloplasty according to the Enneking test a very good result was found in 7 and very good in 4 cases.
In patients with femoral shaft metastatic tumor locaslisation, 6 good and 2 fair results were found. In 1 patient after 2 months rehabilitation a reoperation was needed due to the mechanical destabilisation. The best results were found in patients after intramedullary nailing.An acute soft tissue inflamation requiering surgical treatment was found in 1 patient after shoulder joint replacement.
Conclusions. After clinical analysis of the material we highly recomend the partial humeral bone resection with subsequent shoulder alloplasty in patients with proximal humeral diaphysis metastatic localisation. In cases with shaft localisation a better results were found after intramedullary nailing compared to common plate technique.
The study objective was a clinical assesment of tumor resection and reconstruction within humerus according to matastasis localisation and the choice of surgical technique.
Material and methods. In the years 1999-2002 19 patients underwent surgery due to pathological fracture or/and cancer metastasis within humerus. The shaft localisation of the tumor was found in 8 cases and in 11 patients the metastatic foci were found in proximnal diaphysis. In patients with proximal diaphysis localisation of the tumor the partial resection with subsequent joint exchange procedure was made. The humeral shaft metastatic cancer changes were treated by the segmental resection with subsequent surgical cement filling or auto/allogenical bone grafting combined with intramedullary nail or AO/ASIF plate stabilisation. The average follow-up period was 8,5 months.
Results. In patients after resection with shoulder joint alloplasty according to the Enneking test a very good result was found in 7 and very good in 4 cases.
In patients with femoral shaft metastatic tumor locaslisation, 6 good and 2 fair results were found. In 1 patient after 2 months rehabilitation a reoperation was needed due to the mechanical destabilisation. The best results were found in patients after intramedullary nailing.An acute soft tissue inflamation requiering surgical treatment was found in 1 patient after shoulder joint replacement.
Conclusions. After clinical analysis of the material we highly recomend the partial humeral bone resection with subsequent shoulder alloplasty in patients with proximal humeral diaphysis metastatic localisation. In cases with shaft localisation a better results were found after intramedullary nailing compared to common plate technique.
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