Osteochondromas are the second most common benign bone tumors and are primarily found in children and adolescents.4 They account for 10-15% of all bone tumors and 20-50% of benign bone tumors. Osteochondromas can occur as either an isolated osteochondroma or in association with the condition hereditary multiple osteochondromas (HMO). While isolated osteochondromas typically develop in longer bones and rarely affect the hand, hand involvement is much more likely in HMO, with a particularly high incidence in younger populations. In these cases, osteochondromas can grow on the phalanges, metacarpals, or carpals, and while typically asymptomatic, can lead to pain and/or functional impairments in some patients. Although somewhat controversial, treatment recommendations generally call for careful observation alone unless symptoms are present, in which case surgical options such as resection and corrective osteotomies may be considered.1-4
Pathophysiology
Related Anatomy
Incidence and Related Conditions
Differential Diagnosis
Reproduced from the International statistical classification of diseases and related health problems, 10th revision, Fifth edition, 2016. Geneva, World Health Organization, 2016 https://apps.who.int/iris/handle/10665/246208
A typical patient is a 12-year-old, right-handed boy. After sustaining a little metacarpal fracture in his right hand at age 10, the boy had an X-ray that revealed a mass in that bone. Over time, more masses were identified during follow-up X-rays, particularly in the index and little metacarpals. While the tumors did not result in any pain, they did cause minor functional impairments when performing fine-motor skills, and their appearance was alarming to the boy and his parents. The boy’s pediatrician subsequently diagnosed him with HMO, but did not recommend any immediate treatment beyond observation.
Treatment remains controversial
Controversy often remains regarding the specific surgical procedure to recommend and when to intervene surgically.
Most surgeons recommend excision of painful or deforming lesions in order to minimize the loss of function.
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