Management of Distal Tibial Interosseous Osteochondroma: A Case Series and Review of Literature

Document Type : CASE REPORT

Authors

1 Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

2 Department of Surgery, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran

Abstract

The interosseous part of the distal tibia is one of the regions in which osteochondroma can occur. 
Osteochondroma typically occurs among growing children and causes gradual ankle deformity by its 
pressure effect on the fibula. We presented six patients (Fi ve boys and one girl with median age of 13 
years old) with distal tibial interosseous osteochondroma. They were treated by a 18 0̊ fibular osteotomy 
around its longitudinal axis just proximal and distal to the lesion. All patients were treated without any 
complication except for one who developed non-union of the site of the fibular osteotomy. In the last 
follow-up, all the patients were pain-free, and no recurrence was reported. Various methods have been 
described for resecting interosseous osteochondroma of the distal tibia, with or without fibular 
osteotomy and with or without acute correction of ankle deformity during resection surgery. Still, there 
is no consensus over the best method for resecting such lesions.
 Level of evidence: VI

Keywords

Main Subjects


  1. Tepelenis K, Papathanakos G, Kitsouli A, et al. Osteochondromas: An updated review of epidemiology, pathogenesis, clinical presentation, radiological features and treatment options. in vivo. 2021; 35(2):681-691. doi: 10.21873/invivo.12308.
  2. Bailescu I, Popescu M, Sarafoleanu LR, et al. Diagnosis and evolution of the benign tumor osteochondroma. Exp Ther Med. 2022; 23(1):1-6. doi: 10.3892/etm.2021.11026.
  3. Singh CM, Magar MT, Sud AD. Osteochondroma of the Distal Tibia Leading to Deformity and Stress Fracture of the Fibula-A Case Report. Medical Journal of Shree Birendra Hospital. 2021; 20(2):173-176.
  4. 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(1):1-4. doi: 10.1186/1757-1626-2-115.
  5. Genc B, Solak A, Kalaycioğlu SK, Sahin N. Distal tibial osteochondroma causing fibular deformity and deep peroneal nerve entrapment neuropathy: a case report. Acta Orthop Traumatol Turc. 2014; 48(4):463-466. doi: 10.3944/AOTT.2014.2741.
  6. Tayara B, Uddin F, Al-Khateeb H. Distal tibial osteochondroma causing fibular deformation resected through a posterolateral approach: a case report and literature review. Current Orthopaedic Practice. 2016; 27(2):E12-E14.
  7. Danielsson LG, Ei-Haddad I, Quadros O. Distal tibial osteochondroma deforming the fibula. Acta Orthop Scand. 1990;61(5):469-470. doi: 10.3109/17453679008993566.
  8. Ismail BE, Kissel CG, Husain ZS, Entwistle T. Osteochondroma of the distal tibia in an adolescent: a case report. J Foot Ankle Surg. 2008; 47(6):554-558. doi: 10.1053/j.jfas.2008.07.004.
  9. Mehraj M, Shah I. Osteochondroma of distal tibia: A case series. International Journal of Orthopaedics. 2018; 4(1):665-666.
  10. John AM, Thomas V, Pillai MG, Theckanal JG, Sebastian JP. Solitary osteochondroma from interosseous border of distal tibia. Journal of Orthopaedic Association of South Indian States. 2021; 18(2):85.
  11. Panta S, Thapa SK, Paudel KP. Distal tibia interosseous osteochondroma with fibula deformity. Journal of Chitwan Medical College. 2021; 11(3):148-150.
  12. Mahajan NP, Wadia F, GS PK, Yadav AK, Narvekar M, Kondewar P. Segmental Fibulectomy to Excise the Adherent Distal Tibia Osteochondroma in a Case of Hereditary Multiple Exostosis–A Rare Case Report. J Orthop Case Rep. 2020;10(4):1. doi: 10.13107/jocr.2020.v10.i04.1780.
  13. Yang H, Shou K, Wei S, et al. A revised surgical strategy for the distal tibiofibular interosseous osteochondroma. Biomed Res Int.2020; 2020:6371456. doi: 10.1155/2020/6371456.
  14. 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(3):564-567. doi: 10.1053/j.jfas.2017.01.029.
  15. Gupte CM, DasGupta R, Beverly MC. The transfibular approach for distal tibial osteochondroma: an alternative technique for excision. J Foot Ankle Surg. 2003; 42(2):95-98. doi: 10.1016/s1067-2516(03)70008-8.
  16. Gil-Albarova J, Gil-Albarova R, Bregante-Baquero J. Fibular rotational osteotomy for the treatment of distal tibial osteochondroma: a technical modification for deformity correction and improved outcomes. J Foot Ankle Surg. 2007; 46(6):474-479. doi: 10.1053/j.jfas.2007.08.001.
  17. 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(2):115-118. doi: 10.1016/j.jcot.2012.09.003.
  18. Masoum, S. H. F., Moradi, A., & Ebrahimzadeh, M. H. (2014). Multiple rib exostoses in a boy: a rare case resulting in surgery secondary to cosmetic concerns. Arch Bone Jt Surg. 2014; 2(3), 243. doi: 10.22038/ABJS.2014.3357.
  19. Suranigi S, Rengasamy K, Najimudeen S, Gnanadoss J. Extensive osteochondroma of talus presenting as tarsal tunnel syndrome: report of a case and literature review. Arch Bone Jt Surg. 2016; 4(3):269. doi: 10.22038/ABJS.2016.4709.

18.              Takikawa K, Haga N, Tanaka H, Okada K. Characteristic 

factors of ankle valgus with multiple cartilaginous exostoses. J Pediatr Orthop. 2008; 28(7):761-765. doi: 10.1097/BPO.0b013e3181847511.

  1. Noonan KJ, Feinberg JR, Levenda A, Snead J, Wurtz LD. Natural history of multiple hereditary osteochondromatosis of the lower extremity and ankle. J Pediatr Orthop. 2002; 22(1):120-124.
  2. Herrera-Perez M, De Mendoza MA, De Bergua-Domingo JM, Pais-Brito JL. Osteochondromas around the ankle: report of a case and literature review. Int J Surg Case Rep. 2013; 4(11):1025-1027. doi: 10.1016/j.ijscr.2013.08.015.