Epiphyseal osteochondromas of the upper limb:  a report of 7 cases.
BACKGROUND
Originally described as osteochondromatous lesions arising from the tarsal bones, osteochondromas arising from the epiphysis or carpal/tarsal bones are less common than those arising from the metaphysis. Histologically, all osteochondromas are indistinguishable regardless of the location from which they arise. Few case reports and case series exist describing these lesions in the upper limb.


METHODS
We review 7 cases of osteochondromas arising from epiphyses and ossicles in the upper limb treated at 3 institutions. Patients were followed for an average of 5.7 years. The average patient age at the presentation was 7.8 years.


RESULTS
We identified 25 lesions: 5 distal radial epiphyseal, 3 distal radial metaphyseal, 4 scaphoid, 4 lunate, 4 trapezial, 2 accessory ossicles adjacent to the trapezium, 2 trapezoid, and 1 metacarpal lesion. Three patients presented with pain, 5 with decreased motion, and 3 with angular deformity. In 1 case, the lesion presented as an incidental finding. Four patients underwent a total of 7 procedures: 2 open biopsies, 2 distal radial epiphyseal lesion excisions, 2 revisions, and 1 excision of all lesions with a scaphoid osteotomy.


CONCLUSIONS
Intra-articular and transosseous lesions are more likely to result in angular deformities and loss of motion at the joints, whereas juxtaphyseal and transphyseal lesions are more likely to result in growth disturbances and angular deformities at the physis.


METHODS
Case series, level IV.
Shriners Hospital for Children, Philadelphia, PA 19140, USA. dzlotolow@yahoo.com
Dan A
DA
Zlotolow
Janith
J
Mills
Marybeth
M
Ezaki
Peter R
PR
Carter
Robert J
RJ
Goitz
Matthew
M
Zornitzer
D000293:Adolescent; D001706:Biopsy; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D004838:Epiphyses; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D015831:Osteochondroma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D010027:Osteotomy / Q000379:methods; D010146:Pain / Q000209:etiology; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D034941:Upper Extremity / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D055815:Young Adult