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ABSTRACT ID: IRIA - 1061.  Osteoid osteoma is a common entity with male predilection, male to female ratio – 4:1  Most of the effected are young individuals.

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Presentation on theme: "ABSTRACT ID: IRIA - 1061.  Osteoid osteoma is a common entity with male predilection, male to female ratio – 4:1  Most of the effected are young individuals."— Presentation transcript:

1 ABSTRACT ID: IRIA

2  Osteoid osteoma is a common entity with male predilection, male to female ratio – 4:1  Most of the effected are young individuals in second decade of life.  Dull aching deep bone pain - worsening in the nights, relieved by analgesics.  On physical examination tenderness is present.  Signs of inflammation including erythema, warmth are almost always absent

3  The treatment options available are Surgery and Radio Frequency Ablation.  Due to the prolonged hospital stay, complications and incomplete removal of the nidus leading to recurrence; surgery is a less desired option.  Radio Frequency Ablation has proved to be quick, safe and minimally invasive method of management.

4  A 17 year old Indian male patient complaints of 8 months deep bone pain over left hip.  Pain was worsening at night with sleep disturbance, aggravated on walking and relieved on rest.  H/o trauma 2 years back- slip and fall from height of 10 meters.  No H/o recent fever. No H/o pain over small joints or early morning stiffness.  N/K/C/O DM/BA/TB/Jaundice

5 INSPECTION:  Muscle wasting was evident over the thigh and calf regions.  Scarpa triangle fullness is seen in the left hip.  Left anterior superior iliac spine is inferior compared to right side(pelvic tilt)  No limb length discrepancy or gluteal muscle wasting PALPATION:  Scarpa triangle tenderness present.  Greater trochanter tenderness present.  No mass palpable.  Flexion and internal rotation movements of left hip joint were restricted.  Trendenlenburg test: Positive  Femoral and distal pulses felt.  Active toe movements present.  Sensation intact.

6  The patient was then admitted and all the baseline investigations were done.  All the baseline investigations were found to be within normal limits.  The patient was then subjected for Radiological investigations.

7 Image A : (Shows)  Oval lytic lesion (nidus) at the medial cortex of the left femoral neck near the lesser trochanter with surrounding sclerosis and adjacent cortical thickening.  Nidus measured 2.0 x 1.2 cm (Cc x Tr) with internal calcific foci. Image A

8 Oval lytic lesion (nidus) 2.0 x 1.2 cm at the medial cortex of the left femoral neck near the lesser trochanter with surrounding sclerosis and adjacent cortical thickening.

9  Radio Frequency Ablation was planned after radiological confirmation of the diagnosis of Osteoid osteoma.  Prothrombin time and international normalized ratio (INR) were tested and found within normal limits.  Anaesthetist’s evaluation was carried out.  Prophylactic antibiotic (Cefotaxime 1 gm ) was administered immediately before the procedure.

10 Lesion localization done with 128 multi detector row CT to confirm accurate needle position within the nidus.  (Image on the (L): Scout image confirming the needle position with gonadal pads  Image (R)Red arrow – Bone biopsy cannula. Yellow arrow – tip of the electrode)  Under CT guidance and spinal anaesthesia, percutaneous entry into the osteoma nidus was made using osteocyte bone biopsy cannula (13 G) with a drill and Kirchner wire.

11  Aspiration of the nidus content was done and sent for histo pathological examination – diagnosis of osteoid osteoma was confirmed.  Nidus was ablated in two locations(cranial and caudal) by two bone tracts. Calories ablated were 1.27 Kcal and 1.6 Kcal respectively for 5 minutes each.  Injection lignocaine 2 ml was injected into the nidus at the end of the procedure.  The duration of the procedure was 120 minutes.

12 The image above is a post procedural x ray showing needle tracts. Image above shows needle tracts taken during Radio Frequency Ablation(coronal). Above images show needle tracts in various sections

13  The patient reported to have immense pain relief without any analgesics the very next day.  Complaining of pain only at skin entry site.  Normal sleep in the night.  Patient was advised to avoid vigorous activities, sports such as jumping long distance running for a month.  This was the first Radio frequency Ablation procedure done in the Pondicherry territory.

14  A follow up X ray of pelvis was done after 30 days – needle tracts were evident.  No fresh complaints from the patient.  Bone pain relieved.  No other delayed complications were reported.  The post procedural period was uneventful

15  An Osteoid osteoma is a benign skeletal tumour usually less than 1.5 cm in diameter.  Composed of woven bone and an osteoid and more located in the appendicular bone.  Focal pain at the tumour site.  Pain worsens in the night and increases with activity and is relieved with analgesics and inflammatory medications.

16  The pain is presumed to be a result of local vasodilatation resulting from elevated levels of PGE2 at the site of the tumour.  Spinal osteoid osteoma may in addition lead to scoliosis.  These tumours usually regress spontaneously, the mechanism probably being bone infarction.

17  Difficulty in lesion localization, consequences of extensive dissection and need for prolonged recuperation and risk of incomplete removal and therefore recurrence of the lesion make surgery a less desired option.  Radio Frequency Ablation is proved to be safe, quick and minimally invasive method of management.  We were able to achieve a high technical and clinical success without any complications. Percutaneous Radio Frequency Ablation should be the method of choice for treating extra spinal osteoid osteoma.

18  Cartnell CP,O Byrne J, Eusrac 3 Radio frequency ablation of osteoid osteoma with cooled probes and impedance control energy delivery, AJR AM J Roentgenol 2006; 186 (5 suppl) S 244- S248 (cross ref J E medicine)  Rosanthal DI, Marota JJA, Hornicok FJ osteoid osteoma :elevation of respiratory and cardiac rates at the biopsy needle entry into the tumour in 10 patients, Radiology 2003,226: (abstract medicine)  Resnik D, Kyariakos M, Guerdn D, Greenway bone and joint imaging, 3 rd ed, Elsevier Saunders;2005 Tumours and tumour like lesions of bone:Imaging pathology of specific lesions;pp  Kitsoulis P, Mantellos G, Vlychou M, Osateoid osteoma,Acta Orthop Belg.2006; (PubMed)  Solav SV, lack of hypervascularity on three phase bone scan:osteoid osteoma revisited.World J Nucl Med. 2006;5:1


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