Osteoid osteoma of the wrist and hand

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Abstract

Osteoid osteoma is a relatively rare bone tumor, but it has both a typical pain symptom complex and histology. Bone scintigraphy is nearly always positive. Radiographs show a relatively radiolucent ″nidus” in a sclerotic area. Computed tomographic scans are valuable, and sometimes necessary, in showing this typical nidus. Magnetic resonance imaging has limited indications. Localizations outside the knee, hip, and spine region are rare. When osteoid osteoma presents in the hand and wrist, the diagnosis is not always obvious. Pain is commonly-although not universally-present, and radiographs can be normal in one third of cases, or atypically alternated in another third. Intraoperative localization is not always obvious. Preoperative bone labeling with tetracycline may aid in localization. The treatment consists of resection and curettage, with generally favorable outcomes. Copyright © 2000 by American Society for Surgery of the Hand

Section snippets

Age and sex

A few larger series have been reported. In 1987, Ambrosia et al1 published a series of 19 cases, 11 males and 8 females, with a mean age of 23 years (range, 8 to 70 years). The multicenter report conducted by Allieu, Lussiez, and the Groupe d'Etude de Tumeurs Osseuses (GETO)2 in 1988 found 46 cases with 21 males and 19 females who had a mean age of 28 years (range, 6 to 70 years). The series of Bednar et al3 in 1993 consisted of 23 cases in the hand and wrist and 22 other localizations in the

Localization

The series of Ambrosia et al,1 Allieu, Lussiez, and GETO,2 Bednar et al,[3], [4] and Doyle et al5 show a similar distribution within the hand and wrist (Fig 1).All bones can be involved, and there is no clear predilection for any particular site. Some localizations are so difficult and confusing to diagnose that patients have been treated for other incorrect diagnoses for years.[6], [7], [8], [9], [10], [11], [12], [13], [14] In the carpus, the scaphoid is most often involved.

Clinical features

Pain is the most common complaint, typically with a nocturnal predominance, which can be reduced or eliminated by aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs). In Bednar's series, pain relief was seen in 86% of patients,[3], [4] whereas in the French report,2 only 26% had pain relief with aspirin or NSAIDs.

Most commonly, the pain is well localized except in cases involving intra-articular localizations accompanied by synovitis, which present with a more diffuse pain area. The

Radiology and other imaging techniques

The typical radiographic feature of OO is a zone of sclerosis surrounding a central zone of lucency (nidus). The nidus remains small (up to 1 cm diameter). In the center of the nidus, a small, dense area of calcification may be present. Plain radiography, sometimes augmented with additional tomography, is usually sufficient for the diagnosis (Fig 6).24However, in the hand and wrist, these typical findings can be absent, even when the films are re-examined retrospectively (Fig 7).25

Three

Pathology

Macroscopically, OO is a small, reddish tumor within a zone of bone sclerosis. In subperiosteal locations, the tumor can be seen on the surface of the bone. Intraoperative visualization may be enhanced by having the patient take a few doses of the antibiotic tetracycline, the day before surgery. During resection, an ultraviolet (UV) light used in a darkened operating room causes the lesion to fluoresce bright yellow.

Microscopically, a sharp border is seen between the tumor (the nidus) and the

Treatment

There have been reports of spontaneous regression (″burning out”) of the symptoms. Although this observation alone can be adapted in high risk patients or in those with lesions in inaccessible locations, surgical removal and histologic examinations are the mainstays of treatment in cases involving the hand and wrist.

Adequate local excision and curettage is the most common surgical treatment option. The nidus must be removed completely or the tumor will recur. A portion of the surrounding

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    Copyright © 2001 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.