Challenges and Solutions in Managing Recurrent Distal Tibia Interosseous Osteochondroma: A Case Study and Review of Literature
Authors:   Department of Orthopaedics, All India Institute of Medical Sciences Jodhpur, Rajasthan, India,, Yadav Sandeep Kumar , Rajnish Rajesh Kumar ,   Department of Orthopaedics, All India Institute of Medical Sciences Jodhpur, Rajasthan, India,, Aggarwal Aakarsh ,   Department of Orthopaedics, All India Institute of Medical Sciences Jodhpur, Rajasthan, India,, Gupta Saurabh ,   Department of Orthopaedics, All India Institute of Medical Sciences Jodhpur, Rajasthan, India,, Elhence Abhay ,   Department of Orthopaedics, All India Institute of Medical Sciences Jodhpur, Rajasthan, India,, Chithira Anju G. ,   Department of Pathology and Lab Medicine, All India Institute of Medical Sciences Jodhpur, Rajasthan, India.
Published: December 2024

Introduction: Osteochondroma, a common benign bone tumor, predominantly affects young individuals, with a higher prevalence in males. It typically manifests as a bony growth capped with cartilage near bone growth plates, often extending away from joints. While most cases are asymptomatic, some may present with pain, swelling, or mechanical complications necessitating surgical intervention. Recent research implicates genetic mutations, particularly in the EXT-1 gene, in osteochondroma development, with homozygous EXT1 deletion commonly found in sporadic cases.

Case Report: A 15-year-old girl presented to out patient department with recurrent osteochondroma in the distal tibia, an unusual location, with complications such as fibular deformation and ankle varus deformity. Initial surgery was performed elsewhere through an anterolateral approach, but the patient experienced persistent pain and serous discharge from the surgical scar. Examination revealed an unhealed scar with a discharging sinus and a firm, bony swelling on the left lower leg, along with a reduced range of motion. X-ray and MRI confirmed a pedunculated mass emerging from the distal tibial metaphysis, causing extraneous compression and deformity of the fibula without intraosseous infiltration. Histopathological examination of the resected specimen confirmed osteochondroma recurrence. Surgical management involved en bloc resection of the tumor and perichondrium through a posterolateral approach, with subsequent debridement of the previous surgical wound. Post-operative recovery was uneventful. Literature review indicates that observation is suitable for asymptomatic lesions, while symptomatic cases or those with concerning imaging findings may require surgery. Complications following surgical excision are reported, with recurrence rates ranging from 2% to 11.6%, highlighting the importance of complete resection to minimize relapse and risk of malignant transformation. Careful consideration is warranted in pediatric cases to prevent growth plate damage.

Conclusion: Osteochondroma management involves tailored surgical intervention based on symptoms and imaging findings, with complete resection recommended to optimize outcomes and minimize recurrence, particularly in pediatric patients.

Keywords: Osteochondroma, benign bone tumor, distal tibia, recurrent osteochondroma, interosseous osteochondroma.