Osteochondroma of the distal tibia in an adolescent: a case report

A 14-year-old female presented with a painful right ankle that had been worsening over the preceding 2 years. Clinical and radiographic inspection revealed marked bowing with a pathologic fracture of the fibula secondary to the laterally outgrowing bone lesion from the distal tibia proximal to the growth plate. Computerized tomography revealed a 2.44 x 4.48-cm bone tumor proximal to the ankle joint, and this was consistent with her complaint of pain and the observed malposition of the distal leg and ankle. Although the radiographic characteristics of the lesion were indicative of osteochondroma, a typically asymptomatic and benign tumor that is usually identified as an incidental finding, the large size and symptoms associated with the lesion described in this article make it rather unusual. In this particular case, excessive bony outgrowth, pain, joint malposition, and pathologic fracture necessitated surgical intervention. The patient was successfully treated with resection of the tumor, after which gradual restoration of the alignment of the distal leg ensued without the need for fibular osteotomy. After more than 3 years of postoperative follow-up, neither radiographic nor clinical evidence of recurrence had been observed and the patient displayed a pain-free range of ankle motion without any physical limitations.