SAFE METHODS FOR THE REMOVAL OF OSTEOCHONDROMAS

To investigate the outcome of operative procedures designed to reduce the likelihood of neurovascular injury, fracture and tumor recurrence. The literature frequency of neurovascular injuries is about 10% and recurrences have been reported to be common when resections are undertaken before skeletal maturity. Prospective analysis of the outcomes following resection of exostoses in two hundred and fifty children and adolescents. Preoperative CT-angiograms iwere undertaken in patients with multiple exostoses surrounding the shoulder, knee and hip joints. Peduculated exostoses were removed by detaching the base and retrogradely removing the lump. Broader based exostoses were opened and decancellated so that the cap could be collapsed down away from adjoining and adherent neurovascular structures. This approach also enabled the cap to be separated from adjacent bone such as the pelvis or fibula with femoral or tibial exostosis, respectively. The outcomes included assessments of neurovacular status, bone healing and recurrence after five years. No patients had early or late evidence of neurovascular damage although the neurovascular structures were adherent to many of the exostoses. No patients had recurrence of their exostoses which was likely due to most of them having being removed after skeletal maturity. In addition, the cortical defect left by the resections healed with six to nine months of the surgery. Our conclusions are to remove exostoses after skeletal maturity in order to minimise recurrence risk. Use preoperative CT-angiograms with large solitary or multiple exostoses to aid in operative planning. Decancellate large exostoses in order to collapse the cap away from adherent neurovascular and skeletal structures.