[Osteoid osteoma of the hand - Diagnostics and operative treatment]

Introduction: Osteoid osteoma is a rare benign bone tumor displaying typical clinical symptoms and radiological signs in most cases. Characteristic symptoms are nocturnal pain alleviated by non-steroid antiinflammatory drugs. Radiological findings are also characteristic, the central osteolytic 'nidus' is surrounded by reactive sclerosis. These lesions are rare in the hand, typical symptoms may be absent, furthermore, atypical symptoms may occur. Characteristic radiographic signs may also be missing. Therefore, diagnosis may prove difficult. In the case of radiological/clinical suspicion, HRCT (high-resolution CT) is recommended. Aim: Our aim is to summarize the pathophysiology, occurrence and clinical features of these lesions and also the difficulties that accompany diagnosis on the hand. Treatment options will also be discussed. Method: Retrospective analysis was performed at Semmelweis University, Department of Orthopedics, between March 2014 and December 2018. Inclusion criteria were: patients who had undergone treatment for osteoid osteoma during this period. Data from the 6 patients who have undergone open surgery for osteoid osteoma of the hand will be presented as case reports. Results: During this period, a total of 112 patients were treated for osteoid osteoma at our Department, 8 lesions were found on the hand (7%). Among the cases presenting on the hand, typical nocturnal pain was absent in 3 cases, and in 1 case the pain did not respond to non-steroid antiinflammatory drugs. Open surgery and curettage was performed in 6 cases with good results. Conclusion: Osteoid osteoma on the hand is rare, typical symptoms may be missing, and atypical symptoms may occur. Radiographic findings may be nondescript, HRCT is recommended in the case of clinical suspicion. Performing radiofrequency ablation for osteoid osteoma of the hand may pose difficulties, curettage is the gold standard of treatment. Curettage alleviates symptoms well. Orv Hetil. 2020; 161(7): 263-268.