gms | German Medical Science

Objectives/Interrogation: The hand and wrist bones are infrequent sites for osteoid osteoma. Diagnosis of this tumor could be difficult and challenging. It consists of a well-demarcated osteoblastic mass that is surrounded by a distinct zone of reactive bone sclerosis. It is associated with characteristic clinical features, like local pain,usually more severe at night and often completely responds to aspirin and other NSAIDs. However, initially the lesion causes unspecific symptoms, and the radiographic changes are discrete. An accurate clinical history and a high index of suspicion are required.

Methods: Records of 5 patients who had osteoid osteoma of the hand and wrist were reviewed and analyzed in a retrospective study. All patients underwent surgery between 2014 and 2018, the patient data included symptoms, history of trauma, night pain, relief of pain by NSAIDS and duration from onset of symptoms to operation.

Results and Conclusions: There were 4 men and 1 woman, with an avarage age of 21.6±1 (range:21-23) years, 3 lesions on the right, 2 lesions on the left side. 2 cases involved the proximal phalanx of the middle finger, 2 cases the distal phalanx of the thumb and 1 lesion at the hamate. All patients had severe pain, which was worse at night, 2 of them were not responding to NSAIDs. None of the patient reported history of trauma. One patient had previous synoviectomy because of PIP joint synovitis one year before her presentation to our department, her complaints were not decreased after the surgery, there were no sings of osteoid osteoma on the X-rays. The duration of the symptoms was from 6 to 28 months. Physical examination at presentation revealed local swelling and point tenderness. In the phalanges, osteoid osteoma induced marked fusiform soft tissue swelling. Distal phalanx involvement caused finger clubbing. All patients had preopeative X-rays, but only two cases showed obvious signs of osteoid osteoma. High resolution CT scans were performed in all cases and showed the osteoid osteoma in every case as an obvious lytic lesion with a central granular opacity surrounded by a well-defined sclerotic margin. One patient underwent a CT-guided percutaneous ablation, but his symptoms recurred after 5 months. All the patients were treated surgically, by removal of the tumour, with complete resolution of all symptoms. The diagnoses were confirmed by histological examination. There were no recurrance during the follow up period (6 months - 12 months).