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Osteochondromatosis in the Hip-joint: Report of a Case

Case A446938. A boy, aged thirteen years, was brought to the Clinic November 9, 1923, complaining of disability and pain in the left hip. Two and one-half years before, he had fallen fifteen feet; after the fall he complained of his foot, but not his hip. Six months after the fall he began to limp, but had no pain. Later an injury from skiing and another from a fall caused pain and disability in the hip for a time. Four weeks prior to examination, while riding a bicycle, he had a sudden locking in the hipjoint which lasted about ten minutes. Physical examination, except for a slight limp, was essentially negative. The X-ray revealed multiple osteocartilaginous bodies within the hip-joint. At operation, November 13, the left hipjoint was explored through a Smith-Peterson incision, and a lobulated osteocartilaginous growth was detached from the bone along the line of the reflection of the synovial membrane from the anterior intertrochanteric line. Thirty other loose bodies were removed from the cavity of the joint. The bodies varied in size from 4 mm. to 1.5 em. They were not all removed at this operation, as some were deeply placed and could only have been reached by a posterior incision, and it was not thought wise to prolong the operation unduly because of the danger of infection. The patient and his family were told of the remaining loose bodies, so that they might return if further trouble arose. Convalescence was uneventful, and motion in the hip-joint was free at the time of dismissal. Jones, of the Section on Orthopedic Surgery of the Clinic, in a careful review of the literature, found only one other similar case reported. This report was made by Eden, in 1914. While loose osteocartilaginous bodies have been found in practically all the large joints, the most common situations are in the knee and elbow, the next being the shoulder-joint. Henderson has defined osteochondromatosis as a condition in which the synovial membrane becomes hypertrophied, the redundant tags become cartilaginous on the tip as they grow, and, becom- Fig. 1. Loose bodies distributed throughout the joint cavity. Note that the contour of the joint is intact. ing heavier, break off and become free osteocartilaginous bodies. In an article published in the American Journal of Orthopedic Surgery, in December, 1918, he tabulated similar conditions, such as (1) loose bodies originating from direct trauma (in reality, a fracture), (2) bodies originating from a pathologic condition in the joint surfaces, making them more brittle than they should be (osteochondritis dissecans), in which pieces desiccate and readily chip off, (3) bodies originating by the breaking off of marginal osteophytes resulting f rom hypertrophic arthritis, and (4) those originating as a part of a general process, such as Charcot joint. The characteristic feature of osteochondromatosis in the roentgenogram is that of an intact outline of the joint surfaces. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Radiology Radiological Society of North America, Inc.

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