Osteoid osteoma: The results of conventional open excision

Background: Conventional (en bloc) open excision was the standard treatment for osteoid osteoma. With the advancement of radiological techniques, percutaneous procedures with less morbidity have been introduced. The clinical outcomes and risk for complications of the conventional (en bloc) open excision will be discussed. Patients and methods: Twenty-one patients with osteoid osteoma were prospectively treated with conventional (en bloc) open excision between January 2012 and June 2017. The clinical findings and radiological investigations as well as the operative data for all patients were recorded. Radiological assessment was based mainly on plain X-rays. CT scan was performed in seven patients and a bone scan in three patients. Their mean age was 17.7 years (range 15-25) and mean follow-up was 2.2 years (range 1-3). All were males. Osteoid osteoma was located in the lower limb in 20 patients, and in the upper limb in one patient. In all patients, plain X-rays were used intraoperatively before closure to confirm complete excision. The removed bone was routinely sent for histological examination. Results: Improvement of pain intensity was documented in 16 patients during the first week postoperatively. In five patients, improvement came gradually during the first 6 months postoperatively. That was attributed to the extensive bone curettage rather than the remaining nidus. Three patients had increased pain in the anterior superior iliac spine from the bone-graft harvesting area. One patient developed a partial foot drop. The tumor was in the proximal fibula and neurapraxia of the lateral popliteal nerve developed due to compression by postoperative hematoma and was successfully treated conservatively. No patient developed tumor recurrence. No pathological fracture or wound infection occurred. Conclusions: Open en bloc excision of osteoid osteoma has the risk of increased morbidity and complications. It is recommended when hospital facilities and equipment are unavailable to perform percutaneous excision.