Limp in an 11-Year-Old Male

Article Outline

• Diagnosis
  • Osteochondroma
• References
• Copyright

An 11-year-old Hispanic boy presented with left leg pain after a friend fell on top of him while they were wrestling. He reported pain with flexion and full extension of the left knee but was able to bear some weight on the injured extremity. Physical examination demonstrated no gross deformity or swelling. Palpation of the popliteal fossa and posterior thigh elicited pain. A firm, mobile mass and crepitus were also palpated in this area. The patient was able to walk, though not without significant pain. Radiographs of the affected leg are pictured above (Figure 1, Figure 2, Figure 3).

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• Figure 1. 

  Anterior-posterior radiograph.

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• Figure 2. 

  Oblique radiograph.

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• Figure 3. 

  Lateral radiograph. Used with permission of Blaine Hannafin, MD, Chandler Regional Medical Center, Department of Emergency Medicine, Chandler, AZ.

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Diagnosis 

Osteochondroma 

Osteochondromas are benign bony growths with a cartilage cap that usually originate from long bones. They are typically oriented nearly parallel with their neighboring long bone, with their axis pointing away from the nearest joint. New growth extends from the tumor's cartilage cap. Because the cartilage cap is radiolucent, the lesion typically appears smaller on radiography than on physical examination.¹

Most osteochondromas are diagnosed incidentally, but some may become symptomatic as they place pressure on adjacent muscles, bursae, or nerves. Less than 1% of these growths become malignant. Management is typically conservative. Surgery is reserved for those patients who have significant pain or restriction of joint mobility.² In children, radiographs of other areas of the body may be indicated to exclude osteochondromatosis, an autosomal dominant condition resulting in multiple osteocondromas, and an increased risk of malignant change. In this case, the patient's fractured osteochondroma (best seen in Figure 3) was treated with crutches, analgesics, and orthopedic follow-up.

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References 

1. Grainger R, Allison D. Grainger& Allison's Diagnostic Radiology: A Textbook of Medical Imaging. 4th ed.. Philadelphia: Elsevier Churchill Livingstone; 2001;
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2. Canale S, Beaty J. Campbell's Operative Orthopaedics. 10th ed.. Philadelphia: Mosby Elsevier; 2003;
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