Delayed surgery of elbow Osteochondroma: A case of overcoming barriers in rural Uganda

Osteochondromas are the most common benign bone tumours in children. They typically manifest near the knee, proximal humerus, or distal femur. While often asymptomatic, they can lead to pain, functional impairments, deformities, and pathologic fractures. Involvement of the growth plates can result in severe deformities during childhood growth.

A 15-year-old Ugandan female with no prior medical conditions presented to a mobile clinic with a mass on the left elbow. This mass showed a histopathologically confirmed case of osteochondroma. The distinctive aspect of this case is the location of the mass and the delay in patient care due to surgical inaccessibility and financial constraints, allowing a 13-year growth period for the mass.

While osteochondromas are benign, this mass's location and early onset warranted early biopsy and surgical excision to prevent future complications. The delay in care resulted in emotional distress, eliciting the patient's withdrawal from school and hindering her ability to fulfil culturally significant household duties in Uganda. Proximity to surgical care and cost are the most significant barriers in rural Uganda.

Following complete excision, the persistence of postoperative pain under heavy loads underscores the critical importance of early diagnosis and treatment in mitigating psychological trauma, anxiety, and discomfort associated with large masses.