Large distal tibia osteochondroma with deformed fibula: Excision and anatomical reconstruction of ankle syndesmosis

INTRODUCTION Osteochondroma is a benign cartilaginous disease of the bone. Its exophytic growth can occasionally result in periarticular deformity and pain. We describe a case of large osteochondroma of the lateral malleolus causing deformity and pain in a growing child. METHODS A 12 year-old...

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Main Authors:	Goh, Kian Liang, Mohammad Amin, Mohammad Azril, Sharifudin, Mohd Ariff, Anwarali Khan, Mohammed Harris
Format:	Conference or Workshop Item
Language:	English
Published:	2016
Subjects:	RD701 Orthopedics
Online Access:	http://irep.iium.edu.my/50897/ http://irep.iium.edu.my/50897/7/50897.pdf

id	iium-50897
recordtype	eprints
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English
topic	RD701 Orthopedics
spellingShingle	RD701 Orthopedics Goh, Kian Liang Mohammad Amin, Mohammad Azril Sharifudin, Mohd Ariff Anwarali Khan, Mohammed Harris Large distal tibia osteochondroma with deformed fibula: Excision and anatomical reconstruction of ankle syndesmosis
description	INTRODUCTION Osteochondroma is a benign cartilaginous disease of the bone. Its exophytic growth can occasionally result in periarticular deformity and pain. We describe a case of large osteochondroma of the lateral malleolus causing deformity and pain in a growing child. METHODS A 12 year-old boy with multiple hereditary exostosis, presented with a huge left ankle osteochondroma which became painful for the past 1 year with worsening deformity of the lateral malleolus. He could not participate in sport activities due to the ankle deformity and pain. Examination revealed multiple small bony swelling over both wrists, knees and scapulae. Local examination revealed a bony swelling at the left lateral malleolus measuring 8X8 cm with varus deformity of the ankle. However, the range of ankle motion was full. Radiograph revealed a large sessile bony outgrowth on the distal lateral tibia compressing the lateral malleolus with thinning of the bone and widening of the syndesmotic joint (Figure 1). He underwent excision of the tumour and anatomical reconstruction of the syndesmotic ligament via anterior approach. Multiple drill holes were made at the base of the lesion and the tumour was osteotomized. The ankle syndesmosis had 2 cm widening and reconstruction was performed using tightrope(Arthrax) with endobuttons. Postoperatively, he was immobilised with backslab for 2 weeks and allowed full-weight bearing after 6 weeks. RESULTS At one year follow-up, the lateral malleolus has remodelled and the syndesmotic joint has anatomically reduced with the tightrope (Figure 2). No recurrence was detected. The pain resolved and he had no residual deformity. DISCUSSIONS Multiple osteochondromas is an autosomal dominant disorder with a very high penetrance. The lesions usually develop within the first two decades of life and cease to grow with the closure of the physeal plate [1]. Most are asymptomatic throughout their lives but they may present with ankle pain, a palpable mass and unrestricted ankle motion [2]. Pain in osteochondromas are commonly caused by compressive effect, bursitis, arthritis and tendon, nerve or vessel impingements [3,4]. Ankle involvement is not uncommon and has been reported from 25% to 54% in patients with multiple hereditary exostosis [5]. Untreated or partially excised lesions may potentially lead to plastic deformation of the distal tibia and fibula and pronation deformity of the ankle in skeletally immature patients [2]. Lateral malleolus erosion and impending fracture has been reported which required excision and cast immobilisation [6]. From our literature review, this is the first reported case of syndesmotic reconstruction in an ankle osteochondroma with syndesmotic widening. Syndesmotic reconstruction should be considered if widening is significant. If left untreated, syndesmotic instability may lead to early ankle pain and osteoarthritis. Due to the high growth potential in children, the lateral malleolus and the distal tibia have high propensity to remodel to normal alignment. CONCLUSION Excision of osteochondroma and anatomical reconstruction of the syndesmotic joint with tightrope suture has a good outcome with no complications. This method is particularly advantageous in a growing child as no removal of hardware is required.
format	Conference or Workshop Item
author	Goh, Kian Liang Mohammad Amin, Mohammad Azril Sharifudin, Mohd Ariff Anwarali Khan, Mohammed Harris
author_facet	Goh, Kian Liang Mohammad Amin, Mohammad Azril Sharifudin, Mohd Ariff Anwarali Khan, Mohammed Harris
author_sort	Goh, Kian Liang
title	Large distal tibia osteochondroma with deformed fibula: Excision and anatomical reconstruction of ankle syndesmosis
title_short	Large distal tibia osteochondroma with deformed fibula: Excision and anatomical reconstruction of ankle syndesmosis
title_full	Large distal tibia osteochondroma with deformed fibula: Excision and anatomical reconstruction of ankle syndesmosis
title_fullStr	Large distal tibia osteochondroma with deformed fibula: Excision and anatomical reconstruction of ankle syndesmosis
title_full_unstemmed	Large distal tibia osteochondroma with deformed fibula: Excision and anatomical reconstruction of ankle syndesmosis
title_sort	large distal tibia osteochondroma with deformed fibula: excision and anatomical reconstruction of ankle syndesmosis
publishDate	2016
url	http://irep.iium.edu.my/50897/ http://irep.iium.edu.my/50897/7/50897.pdf
first_indexed	2023-09-18T21:12:02Z
last_indexed	2023-09-18T21:12:02Z
_version_	1777411316277837824
spelling	iium-508972016-07-20T05:42:16Z http://irep.iium.edu.my/50897/ Large distal tibia osteochondroma with deformed fibula: Excision and anatomical reconstruction of ankle syndesmosis Goh, Kian Liang Mohammad Amin, Mohammad Azril Sharifudin, Mohd Ariff Anwarali Khan, Mohammed Harris RD701 Orthopedics INTRODUCTION Osteochondroma is a benign cartilaginous disease of the bone. Its exophytic growth can occasionally result in periarticular deformity and pain. We describe a case of large osteochondroma of the lateral malleolus causing deformity and pain in a growing child. METHODS A 12 year-old boy with multiple hereditary exostosis, presented with a huge left ankle osteochondroma which became painful for the past 1 year with worsening deformity of the lateral malleolus. He could not participate in sport activities due to the ankle deformity and pain. Examination revealed multiple small bony swelling over both wrists, knees and scapulae. Local examination revealed a bony swelling at the left lateral malleolus measuring 8X8 cm with varus deformity of the ankle. However, the range of ankle motion was full. Radiograph revealed a large sessile bony outgrowth on the distal lateral tibia compressing the lateral malleolus with thinning of the bone and widening of the syndesmotic joint (Figure 1). He underwent excision of the tumour and anatomical reconstruction of the syndesmotic ligament via anterior approach. Multiple drill holes were made at the base of the lesion and the tumour was osteotomized. The ankle syndesmosis had 2 cm widening and reconstruction was performed using tightrope(Arthrax) with endobuttons. Postoperatively, he was immobilised with backslab for 2 weeks and allowed full-weight bearing after 6 weeks. RESULTS At one year follow-up, the lateral malleolus has remodelled and the syndesmotic joint has anatomically reduced with the tightrope (Figure 2). No recurrence was detected. The pain resolved and he had no residual deformity. DISCUSSIONS Multiple osteochondromas is an autosomal dominant disorder with a very high penetrance. The lesions usually develop within the first two decades of life and cease to grow with the closure of the physeal plate [1]. Most are asymptomatic throughout their lives but they may present with ankle pain, a palpable mass and unrestricted ankle motion [2]. Pain in osteochondromas are commonly caused by compressive effect, bursitis, arthritis and tendon, nerve or vessel impingements [3,4]. Ankle involvement is not uncommon and has been reported from 25% to 54% in patients with multiple hereditary exostosis [5]. Untreated or partially excised lesions may potentially lead to plastic deformation of the distal tibia and fibula and pronation deformity of the ankle in skeletally immature patients [2]. Lateral malleolus erosion and impending fracture has been reported which required excision and cast immobilisation [6]. From our literature review, this is the first reported case of syndesmotic reconstruction in an ankle osteochondroma with syndesmotic widening. Syndesmotic reconstruction should be considered if widening is significant. If left untreated, syndesmotic instability may lead to early ankle pain and osteoarthritis. Due to the high growth potential in children, the lateral malleolus and the distal tibia have high propensity to remodel to normal alignment. CONCLUSION Excision of osteochondroma and anatomical reconstruction of the syndesmotic joint with tightrope suture has a good outcome with no complications. This method is particularly advantageous in a growing child as no removal of hardware is required. 2016-05 Conference or Workshop Item NonPeerReviewed application/pdf en http://irep.iium.edu.my/50897/7/50897.pdf Goh, Kian Liang and Mohammad Amin, Mohammad Azril and Sharifudin, Mohd Ariff and Anwarali Khan, Mohammed Harris (2016) Large distal tibia osteochondroma with deformed fibula: Excision and anatomical reconstruction of ankle syndesmosis. In: 46th Malaysian Orthopaedic Association Annual General Meeting/Annual Scientific Meeting & 10th ASEAN Arthroplasty Association Meeting , 26th-28th May 2016, Johot Bahru. Johor. (Unpublished)

Large distal tibia osteochondroma with deformed fibula: Excision and anatomical reconstruction of ankle syndesmosis

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