Osteochondromas originating from unusual locations complicating orthopedic discipline: case series

Herein, we report clinical, radiological, and follow-up results of seven cases of extraordinary located osteochondromas and highlight the importance of rare and unusual properties of unusual locations of osteochondromas. Seven patients with extraordinary located osteochondromas were treated in our institution (Antalya Memorial Hospital) between the period of February 2009 and March 2014 were reported. The patients were classified according to the localization, symptomatology, and the presence of neurovascular involvement or organ compression. The results were discussed with the existing literature data. Five of our patients had unusual symptomatology. Surgical excision was performed on six of seven patients. One patient was followed with scheduled outpatient visits alone. Our clinical follow-up results were good to excellent. In our case series, one patient with clavicular involvement had impaired shoulder mechanic which resulted in painful shoulder, while another with pubic ramus involvement had obstructive urination symptoms and dysuria. One patient with scapular involvement had snapping scapula symptoms, while two patients with fibular head involvement had peroneal nerve compression and tibial nerve compression symptoms in each. One patient with ischial ramus involvement had sciatica, whereas another with first rib involvement had radiological evidences for subclavian artery compression due to osteochondroma without any symptom. Based our experience, the flat bones which are usually ossified by intramembranous type of ossification during the fetal period (including the scapula, ilium, pubic ramus, ischium ramus, ribs and clavicle) are much less commonly affected and often have unusual symptoms. The osteochondromas originating from the fibular head may seem innocent to an orthopedic surgeon. However, an orthopedic surgeon should be alert to tibiofibular synostosis and nerve compression in this patient population.