En Bloc Resection of Coracoid Base Osteoid Osteoma in a Child: An Extremely Rare Case

Abstract

Background:Osteoid osteomas account for approximately 2- 3% of all primary bone neoplasm's sampled for biopsy. 50% of all of them occur in the long bones of the lower extremities, but osteoid osteoma of the coracoid process is rare. We have found only nine previously reported cases of coracoid osteoid osteoma in the international literature. We report a child with coracoid base osteoid osteoma.Case presentation:A twelve-years-old boy with a persistent pain at the right shoulder since 9 months ago, were evaluated. His pain relatively responds to non-steroidal anti-inflammatory drugs (NSAIDs). Imaging studies showed foci of sclerosis at right coracoid base with increased uptake on the Technetium-99m study. Because proximity to the neurovascular bundle we couldn't use radiofrequency ablation technique, so the patient underwent open surgery with a mini- deltopectoral approach and two level osteotomies ; one proximal to coracoid tip and the other at the base of coracoid just distal to subcoracoidphyseal line. Then a segment of coracoid resected. Tip of coracoid securely reattached with a screw.Conclusions:To our knowledge in the literature up to now there are only nine reports of coracoid osteoid osteoma. These cases were treated with different approaches and different techniques. We used en-bloc resection via mini-anterior approach. Our patient 30 months after surgery (October 2012) have full range of motion and became pain free since wound healing with normal control imaging.Definite diagnosis of osteoid osteoma in the uncommon sites may be delayed. En bloc resection of tumor with two osteotomies by an anterior approach has been limited soft tissue injury and is a reliable method of treatment.

Osteoid osteoma of the base of the coracoid process – A case report

“…[9] Therefore, management was based accordingly with attempts at analgesia [6,8,9,[11], [12], [13]], physiotherapy [9,12], intra-articular steroid injections [12], and arthroscopic exploration [5,8] without resolution of symptoms. In all cases, the initial X-ray did not reveal any abnormalities, therefore subsequent CT [[6], [7], [8], [9], [10],12,13], MRI [5,[8], [9], [10], [11], [12]], bone scan [7,8], or Technetium-99 m [10,13] were done which ultimately revealed a clear nidus confirming the diagnosis of “OO”. Most cases underwent definitive treatment via an open surgical method [6,7,[9], [10], [11],13] whilst a minority was done via an arthroscopic approach [5,8,12].…”

“…In all cases, the initial X-ray did not reveal any abnormalities, therefore subsequent CT [[6], [7], [8], [9], [10],12,13], MRI [5,[8], [9], [10], [11], [12]], bone scan [7,8], or Technetium-99 m [10,13] were done which ultimately revealed a clear nidus confirming the diagnosis of “OO”. Most cases underwent definitive treatment via an open surgical method [6,7,[9], [10], [11],13] whilst a minority was done via an arthroscopic approach [5,8,12].…”

Osteoid Osteoma of the Coracoid Process: Case Report With Literature Review

“…Later on, several other open surgical techniques have also been described in the literature, and in most of the cases, anterior approach was used and coracoid osteotomy was performed, followed by OO excision and reattachment of the CP using a screw 13,[19][20][21] . Although all of these reports showed excellent results after follow up period of 2-30 months, we have to be aware that osteosynthetic material remains present after the methods where CP reattachment using a screw was performed 13,[19][20][21] . In such cases, an additional surgery may be required to remove any metal components that would interfere with CT or MRI.…”

“…A great number of methods have been described in the treatment of OO including a wide spectrum ranging from seldom-used conservative approach with NSAIDs over minimally invasive percutaneous treatments (mechanical, chemical or thermal ablation) to open surgical methods (en bloc resections and curettage techniques) [9][10][11][12][13][14][15][16][17][18][19][20][21] . Th erapeutic approach merely depends on numerous factors, among which anatomical localization is one of the most important factors in decision-making.…”

Radiofrequency ablation of osteoid osteoma at the base of the coracoid process: Report of two cases

“…Following nidus excision, the sclerosis zone gradually disappears, indicating a secondary, reversible alteration. 6 Patients with OOs typically report generalized pain at the site of their benign tumors, and their pain can be more severe and frequent at night. Non‐steroidal anti‐inflammatory drugs (NSAID) and salicylates are commonly used to manage pain.…”