Osteochondroma in Jordanian Patients: Clinical Manifestations and Management

Abstract

Introduction: Osteochondroma is the most common benign bone tumour which can be solitary or multiple. Although usually asymptomatic, its associated deformities and secondary malignant transformation potential might be associated with significant morbidity and mortality. There are significant variations of different clinical aspects of osteochondroma among different populations, which might be related to different population characteristics including genetic variance. Aim: To review the clinical features and management characteristics of Osteochondroma among Jordanian patients and to compare these features with other populations. Materials and Methods: This was a retrospective study in which the medical records of all osteochondroma patients who had undergone surgery for one or more lesions over the period from March 2004 till June 2017 were reviewed. A total of 88 patients with a confirmed histopathological diagnosis of osteochondroma were included. The following information was collected; age, gender, location, imaging studies, indications for surgery, operative procedure, complications and recurrence. Results: Solitary Osteochondroma (SO) was four times more common than Multiple Osteochondromas (MO). In SO, male/ female ratio was 2/1, 69% (48/70) of patients presented before the age of 20 years. 4.3% (3/70) had recurrence after excision, 1.4% (1/70) had corrective osteotomy. In MO; male/female ratio was 1.25/1, 89% (16/18) presented before the age of 20 years, 2.2 (39/18) was the average number of tumours per patient, 50% (9/18) had a positive family history, 5.6% (1/18) had corrective osteotomy and none had a recurrence. Tumours around the knee were the most common location in both groups. X-ray was the only imaging study in two-third of tumours. Common indications for surgery included mass (49/109) and pain (39/109). Rare indications included; vascular claudication (1/109), soft tissue osteochondroma (1/109), and bursa formation (2/109). Neither group had a post-resection fracture nor a secondary chondrosarcoma transformation. Conclusion: In this series, there was a low over all risk of recurrence, post-resection fracture and secondary malignant transformation. Compared to other populations, Jordanian Osteochondroma patients presented a mild form of MO with low number of tumours in each patient (p-value =0.01) and low risk of associated deformities (p-value=0.025). Hence, we recommend a conservative resection approach for osteochondroma especially in anatomically inaccessible locations.

Keywords

• bone tumour
• chondrosarcoma
• multiple osteochondroma
• solitary osteochondroma