Clinical Example: Osteochondromas of the Distal Phalanx

Osteochondromas are the most common benign bone tumors. They are believed to arise as a local perichondrial growth abnormality. They usually arise within the first two decades of life and stop growing with skeletal maturity.
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Case 1. This young woman presented with a painless distal phalanx and nailbed deformity which developed slowly during her teens
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Plain Xrays show continuity of abnormal bone the with the medullary bone of the distal phalanx.
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The tumor was accessed through an eponychial splitting lateral incision.
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Te dorsal subungual bone was recontoured.
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Specimen.
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Eponychial fold reconstruction.
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Case 2. Osteochondroma presenting as a pulp mass. The patient believed that they had a splinter or foreign body in the finger from a forgotten incident.
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Excision through a midline longitudinal incision.l
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Case 3. Mass and progressive nail plate contour deformity developed over the last several years in this 42 year old woman.
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The nail plate is actually folded against itself in an acute angle.
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On plain radiographs, The mass has a central ossification. The lateral border of the distal phalanx has remodelled with traction exostoses at the attachments of the intraosseous ligament.
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The tumor shelled out with  a small proximal attachment. Pathology was interpreted as Nora's lesion: bizarre parosteal osteochondromatous proliferation (BPOP), which is histologically distinct variant of osteochondroma. BPOP has a later age of onset , more rapid growth and more variability than simple osteochondroma.
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Late result, with normalization of the nail plate contour.
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