Surgical treatment of osteochondroma of the proximal humerus: Radiographic and early clinical results

摘要

Background: Symptomatic osteochondromas (OCEs) of the proximal humerus present a number of challenges, based upon their location and proximity to neurovascular structures. The purpose of this investigation was to evaluate the characteristics of these lesions and report the early results of surgical excision in children. Methods: This is a retrospective case series of 31 pediatric patients with proximal humeral OCE treated with surgical excision. Radiographs and medical records were reviewed to evaluate tumor characteristics, treatment, and clinical results. The mean patient age was 13 (SD, 4) years, and the median follow-up was 11 months (range, 1 to 78 mo). Results: From 1995 to 2009, 31 patients with proximal humeral OCE underwent surgical excision. Indications for surgery included pain in 25 (81%) and limited range of motion in 8 (26%). The OCE were most commonly posterolateral (23%) and posteromedial (16%). The site of OCE significantly influenced the extent of mass excision. OCEs located anteriorly, laterally, and posterolaterally had an average of 92% of mass excised (range, 69% to 100%), whereas those located posteromedially had an average of 68% of mass removed (range, 30% to 82%; P=0.02). Two patients (6%) had persistent postoperative pain, and 2 had recurrence. The deltopectoral approach was most commonly utilized (61%). For the posteromedial lesions, the direct medial approach led to more complete excision (79% vs. 51%). There were no neurovascular complications. Conclusions: Surgical excision of proximal humerus OCE led to favorable results, though persistent postoperative pain was seen with inadequate excision. Despite risks of neurovascular injury, a direct medial approach should be considered for posteromedial lesions. Level of evidence: Level IV - retrospective study.