Fracture of an Osteochondroma of the Femoral Neck Caused by Impingement Against the Ischium

Abstract

This article describes 2 cases of osteochondroma emanating from the posterior aspect of the femoral neck with a fracture at the base of its stalk caused by impingement between the tumor and the ischium. A 44-year-old man and a 57-year-old man presented with left hip pain. Radiographs revealed a mass at the posterior aspect of the femoral neck. Computed tomography and magnetic resonance imaging revealed that the mass was fractured at the stalk. The relationship between the tumor and the ischium was examined with an image intensifier. The tumor impinged on the ischium with slight flexion and external rotation of the hip joint. In both patients, the tumor was excised, and the pathological report was osteochondroma. At follow-up, the patients had full hip joint range of motion, and lateral radiographs of the left hip joint showed complete resection of the tumor without recurrence. To the authors' knowledge, the current cases are the first reports of fracture of an osteochondroma with confirmed impingement using an image intensifier pre- and intraoperatively. Both patients had histories of restricted hip range of motion and a sudden onset of pain. After excision, the patients recovered to activities of daily living with no complications. An osteochondroma at the posterior aspect of the femoral neck can impinge on the ischium and fracture at its base with a sudden onset of pain. Awareness of this mechanism of impingement may lead to a better understanding of patient symptoms caused by osteochondroma of the femoral neck.

A Huge Capital Drop with Compression of Femoral Vessels Associated with Hip Osteoarthritis

“…Several reports of osteochondroma have described an appearance similar to that in our case, presenting as an osseous mass around the femoral neck [ 6 – 11 ]. Osteochondroma is the most common benign bone tumor, with most cases being a solitary lesion.…”

Surgical hip dislocation according to Ganz for excision of osteochondromas in patients with multiple hereditary exostoses

“…Of the 61 cases reported in English literature, 24 cases involved patients with MHE 15,24-32 and 13 cases consisted of patients with a solitary osteochondroma. 15,[33][34][35][36][37][38][39][40][41] The remaining 24 cases were not classified. 17,26,42,43 The difference between the incidence of osteochondromas around the hip joint and the number of patients who are treated surgically is possibly explained by the fact that these deep-seated osteochondromas are not as symptomatic as more superficial lesions.…”

Intra-articular osteochondroma of the posteroinferior femoral neck associated with hip joint osteochondromatosis: A case report

“…Osteochondroma of the femoral neck is rare. It has been described in patients with bursitis, sciatic nerve compression, femoroacetabular impingement, and fracture at the stalk of the tumor (2)(3)(4)(5). Determining the optimal treatment may be difficult due to the high risk of avascular necrosis (AVN) following surgical excision due to the lesion's location.…”