Manejo expectante de osteocondroma solitario interóseo de la tibia distal: reporte de un caso y revisión de la literatura

Resumen

La localización del osteocondroma en la tibia distal es poco frecuente y su crecimiento con compromiso y deformidad del peroné distal es aún más raro, haciéndolo una condición más sintomática que en otras ubicaciones. Factores como la severidad de los síntomas, deformidad progresiva del tobillo, complicaciones sindesmóticas, riesgo de fractura patológica o transformación maligna, junto con nuevas y mejores técnicas quirúrgicas, han llevado a que el manejo expectante de esas lesiones sea excepcional y escasamente reportado. Presentamos el caso de un joven de 17 años con osteocondroma solitario interóseo tibio distal sintomático y compromiso fibular, que fue exitosamente manejado en forma expectante. A los 5 años de seguimiento clínico-radiológico no presenta complicaciones y la lesión se mantiene estable.

Abstract

Osteochondromas located in the distal tibia are a rare condition, and the involvement of the distal fibula with deformity is even more uncommon. Factors such as the severity of symptoms, progressive deformity of the ankle, syndesmotic complications, the risk of pathological fracture or malignant transformation, together with new and safer surgical techniques, have led to scarce reports of non-surgical management. We present a case report of a 17-year-old male with a symptomatic interosseous solitary osteochondroma in the distal tibia with fibular involvement, which was successfully managed non surgically. After 5 years of clinical and radiological follow-up, he has no complications, and the lesion remains stable.

Palabras clave

osteocondroma - tibia distal - manejo expectante - reporte de caso

Keywords

osteochondroma - distal tibia - non-surgical management - case report

Fuente de Financiación

Este estudio no recibió financiamiento.

• Bibliografía

• 1 Thakur GB, Jain M, Bihari AJ, Sriramka B. Transfibular excision of distal tibial interosseous osteochondroma with reconstruction of fibula using Sofield's technique - A case report. J Clin Orthop Trauma 2012; 3 (02) 115-118 . Doi: 10.1016/j.jcot.2012.09.003
• 2 Galasso O, Mariconda M, Milano C. An enlarging distal tibia osteochondroma in the adult patient. J Am Podiatr Med Assoc 2009; 99 (02) 157-161
• 3 Matsumoto K, Sumi H, Shimizu K. Tibial osteochondroma causing foot pain mimicking tarsal tunnel syndrome: a case report. J Foot Ankle Surg 2005; 44 (02) 159-162 . Doi: 10.1053/j.jfas.2005.01.007
• 4 Chin KR, Kharrazi FD, Miller BS, Mankin HJ, Gebhardt MC. Osteochondromas of the distal aspect of the tibia or fibula. Natural history and treatment. J Bone Joint Surg Am 2000; 82 (09) 1269-1278
• 5 Spatz DK, Guille JT, Kumar SJ. Distal tibiofibular diastasis secondary to osteochondroma in a child. Clin Orthop Relat Res 1997; (345) 195-197
• 6 Kose O, Ertas A, Celiktas M, Kisin B. Fracture of an osteochondroma treated successfully with total excision: two case reports. Cases J 2009; 2: 8062 . Doi: 10.4076/1757-1626-2-8062
• 7 Bernard SA, Murphey MD, Flemming DJ, Kransdorf MJ. Improved differentiation of benign osteochondromas from secondary chondrosarcomas with standardized measurement of cartilage cap at CT and MR imaging. Radiology 2010; 255 (03) 857-865 . Doi: 10.1148/radiol.10082120
• 8 Gupte CM, Dasgupta R, Beverly MC. The transfibular approach for distal tibial osteochondroma: an alternative technique for excision. J Foot Ankle Surg 2003; 42 (02) 95-98 . Doi: 10.1053/jfas.2003.50010
• 9 Appy-Fedida B, Krief E, Deroussen F. , et al. Mitigating Risk of Ankle Valgus From Ankle Osteochondroma Resection Using a Transfibular Approach: A Retrospective Study With Six Years of Follow-Up. J Foot Ankle Surg 2017; 56 (03) 564-567 . Doi: 10.1053/j.jfas.2017.01.029
• 10 Kitsoulis P, Galani V, Stefanaki K. , et al. Osteochondromas: review of the clinical, radiological and pathological features. In Vivo 2008; 22 (05) 633-646
• 11 Wani IH, Sharma S, Malik FH, Singh M, Shiekh I, Salaria AQ. Distal tibial interosseous osteochondroma with impending fracture of fibula - a case report and review of literature. Cases J 2009; 2 (01) 115 . Doi: 10.1186/1757-1626-2-115
• 12 Ciampolini J, Gargan MF, Newman JH. Arthrodesis of the distal tibiofibular joint for a large osteochondroma in an adult. Foot Ankle Int 1999; 20 (10) 657-658 . Doi: 10.1177/107110079902001008
• 13 Dekker AP, Grimer RJ. Transformation of solitary osteochondroma to dedifferentiated chondrosarcoma arising in the distal radius: a case report. Musculoskelet Surg 2013; 97 (01) 89-92 . Doi: 10.1007/s12306-012-0226-z
• 14 Garrison RC, Unni KK, McLeod RA, Pritchard DJ, Dahlin DC. Chondrosarcoma arising in osteochondroma. Cancer 1982; 49 (09) 1890-1897
• 15 Kim YC, Ahn JH, Lee JW. Osteochondroma of the distal tibia complicated by a tibialis posterior tendon tear. J Foot Ankle Surg 2012; 51 (05) 660-663 . Doi: 10.1053/j.jfas.2012.05.010
• 16 Genç B, Solak A, Kalaycıoğlu S, Şahin N. Distal tibial osteochondroma causing fibular deformity and deep peroneal nerve entrapment neuropathy: a case report. Acta Orthop Traumatol Turc 2014; 48 (04) 463-466 . Doi: 10.3944/AOTT.2014.2741
• 17 Minami S, Nakatani N, Miyazaki N, Watanuki A, Honda T, Yoshida M. Spontaneous regression of a solitary osteochondroma of the distal tibia. J Orthop Sci 2009; 14 (05) 669-671 . Doi: 10.1007/s00776-009-1362-7