Open Journal of Me di cal Imaging, 2011, 1, 50-52
doi:10.4236/ojmi.2011.12008 Published Online December 2011 (
Copyright © 2011 SciRes. OJMI
Osteoid Osteoma of Proximal Phalan x o f t h e I nd ex Fi nger
of the Right Hand
Seyed Abdolhossein Mehdi Nasab1, Mohammad Pipelzadeh2
1Department of Orthopedic Surgery, Imam Khomeini Hospital, Jundishapur University of Medical Sciences,
Ahvaz, Iran
2Clinical Research Center, Jundishapur University of Medical Sciences, Ahvaz, Iran
E-mail: {hmehdinasab, mpipel}
Received October 3, 2011; revised December 1, 2011; accepted Dece mb er 11, 2011
Osteoid osteoma is a benign bone forming tumor of the growing skeleton that is most often seen in young
men. It represents by pain and radiologic appearance of anidus surrounded by osteosclerosisthat occurs
mostly in long bones of the lower extremity. Occurrence of this tumor in the hand is an uncommon condition.
We present a 23-year-old man with an osteoid osteoma in the proximal phalanx of the right index finger. The
radiological examination showed a lytic lesion with irregular border with a central sclerotic nidus and also
sclerotic changes around the lytic lesion and bone expansion in the proximal phalanx of the right index finger.
He was suffering from a history of pain and swelling of his finger since 8 months. The pain disappeared after
surgical excision of nidus. The patient was pain-free and there was no evidence of recurrence at 15 months
follow up.
Keywords: Osteoid Osteoma, Phalanx, Hand
1. Introduction
Osteoid osteoma is a benign osteoblastic tumor first de-
scribed by Jaffe in 1835. It accounts for about 11% of
benign tumors and 3% of all primary bone tumors with
6% to 13% of all cases occurring in the hand [1]. This
tumor usually affects children, adolescents and young
adults, but 90% of cases occur in patients younger than
25 years old. Male-female ratio for osteoid osteoma is
2:1. Pain, worse at night and relieved by oral non-ster-
oidal anti-inflammatory medications is the most typical
symptom [2]. This tumor is most frequently seen in the
metaphysis or diaphysis of long bones with half the cases
involving the femur or tibia but it can affect the posterior
element of the spine (10%), hands or feet (12%) [2]. Ra-
diograph of the affected long bone shows a lucent area
less than 1.5 cm in diameter called nidus surrounded by a
zone of reactive bone formation in the cortical or me-
dullary canal [3]. Osteoid osteomas of the hand areun-
common, most commonly seen in the phalanges, and
often result in atypical clinical and radiologic findings.
So, long delay in diagnosis is common since clinical
findings may mimic a variety of diseases in differential
2. Case History
A 23 years old man was referred with a history of pain at
proximal phalanx of index finger of his right hand since
8 months. No previous trauma was mentioned. He re-
ported mild pain which progressively increased at night
and responded partially with analgesic drugs. He had
been treated with antibiotic as a case of infection, but the
pain was unrelieved. Physical examination revealed ten-
derness and swelling at proximal phalanx of index finger.
Some limitation in PIP joint was noted. The radiological
examination showed a lytic lesion with irregular border
with a central sclerotic nidus and also sclerotic changes
around the lytic lesion and bone expansion in the proxi-
mal phalanx of the right index finger (Figure 1) and CT
scan of fingers revealed a sclerotic expansile lesion in the
proximal phalanx of the right index finger (Fig u re 2).
General condition and blood examination was normal.
The patient underwent surgery under general anesthesia.
Using a dorsolateral approach the cortex of proximal
phalanx was opened and a soft reddish mass with central
lesion was resected with a curette and sent for histopa-
thologic examination. After high speed burr of the lesion
the resulting bone defect was filled with autogenouscan-
Figure 1. Anteroposterior radiograph of the right hand.
The radiological examination showed a lytic lesion (arrow
head) with irregular border with a central sclerotic nidus
and also sclerotic changes around the lytic lesion and bone
expansion in the proximal phalanx of the right index finger.
Figure 2. CT scan of fingers revealed a sclerotic expansile
lesion (arrow head) in the proximal phalanx of the right
index finger.
celous bone graft taken from theiliac crest. Histopa-
thologic study revealed irregular trabeculae, immature
osteoid, vascular connective tissue consisting of osteoid
osteoma diagnosis. The pain was decreased in first day
post operation and complete relief of pain was reported
at one week after surgery. At final follow up 15 month-
spost-surgery the patient was pain free with no sign of
3. Discussion
Occurrence of osteoid osteoma in the hand is unusual
and in order of frequency, proximal, distal and middle
phalanx are the most frequent site. Diagno sis is based on
clinical and plain radiography, in particular when the
tumor occurs in its frequent site of proximal femur or
tibia which has characteristic radiologic findings. Al-
though the manifestatio ns of osteoid osteoma in a typ ical
patient are usually diagnostic, those occurring in pha-
langes of the handare frequently misdiagnosed [4,5]. This
is partly because of their rarity in the hand and atypical
manifestations [6].Plain radiography is usually sufficient
to make the diagno sis but CT scan is th e best modality to
identify nidus and confirm the correct diagnosis [3,6].
Bone scans though nonspecific, can show a hot spot be-
cause of vascular character of this tumor. Meng et al.
reported the most common appearance of osteoid os-
teoma of the hand is of an eccentric lesion with soft-tis-
sue swelling and a relative absence of sclerosis, suggest-
ing osteomyelitis [6]. Most of the hand osteoid osteoma-
sare diagnosed late because of atypical radiologic or
clinical findings. This tumor may be misdiagnosed with
conditions such as subacute osteomelitis, Brodie’s ab-
scess, tuberculosis, tenosynovitis. Patients with osteoid
osteomain the small bones of hand may present without
pain or without anidus or bone forming reaction and this
is the reason for delay in diagnosis. Although this tumor
may regress spontaneou sly after a long time, but surgery
is usually indicated in symptomatic patients not respon-
sive to medical treatment. A variety of treatment options
including medication, wide excision of the nidus and
curettage of the lesion, CT-guided core drill excision,
radionuclide-guided excision, percutaneous radiofre-
quency ablation, injection of ethanol, or interstitial laser
photocoagulation (ILP) have been used for this tumor
[3,7-11]. Percutaneous CT-guided ablations with laser or
radiofrequency have now widely replaced surgery as the
treatment of choice for osteoid osteoma. However, sur-
gical excision still plays a major role for the lesions in
the hands and feet owing to the close relationship of the
small bones with the neurovascular structures [12,13].
4. Conclusions
In patients with pain, swelling and abnormal radio-
graphic findings in the hand, osteoid osteoma should be
considered in the differential diagnosis. Surgery is still
the treatment of choice for phalangeal osteoid osteoma
Copyright © 2011 SciRes. OJMI
Copyright © 2011 SciRes. OJMI
because of their close relationship with the neurovascular
5. References
[1] G. Rubin, A. Wolovelsky, M. Rinott, and N. Rozen, “Os-
teoid Osteoma of the Hamate: An Unusual Cause of Ul-
nar-Sided Wrist Pain,” Orthopedics, Vol. 33, No. 7, 2010,
p. 513.
[2] B. Galdi, J. T. Capo, A. Nourbakhsh and F. Patterson,
“Osteoid Osteoma of the Thumb: A Case Report,” Hand,
Vo l. 5, N o. 4 , 2010, pp. 423-426.
[3] R. K. Heck, “Benign Bone Tumors and Non Neoplastic
Condition Simulation Bone Tumors,” In: S. Terrycanale,
J. H. Beaty, Eds., Campbells Operative Orthopedics, Mosby,
Philadelphia, 2008, pp. 855-857.
[4] S. S. Bilgin, Y. Yildiz, B. Güçlü and Y. Saglik, “Osteoid
Osteoma in the Hand: An Evaluation of Eight Patients,”
Acta Orthopaedica et Traumatologica Turcica, Vol. 38,
No . 3, 2004, pp. 20 6-211 .
[5] S. Agarwala and B. S. Rajput, “Osteoid Osteoma-Pu-
zzling Presentation & Effective Management—A Case
Report,” Indian Journal of Orthopaedics, Vol. 38, No. 3,
2004, pp. 183-184.
[6] Q. Meng and L. Watt, “Phalangeal Osteoid Osteoma,”
British Journal of Radiology, Vol. 62, No. 736, 1989, pp.
321-325. doi:10.1259/0007-1285-62-736-321
[7] P. Goswami, N. Medhi, P. K. Sarma, H. S. Das and P.
Hazarika, “Imaging Features of Osteoid Osteoma in Plain
Radiograph, CT and MR: A Case Report and Review of
Literatures,” Indian Journal of Radiology and Imaging,
Vo l. 15, No. 4, 2005, pp. 481-48 4.
[8] C. Maynou, H. Baudson, A. Cotten and H. Mestdagh,
“Osteoid Osteoma of the Radial Bicipital Tuberosity:
Report of 2 Cases,” Revue de Chirurgie Orthopedique et
Reparatrice de Lappareil Moteur, Vol. 87, No. 6, 2001,
pp. 606-609.
[9] A. A. Essi, N. Hattoma, A. Grane, N. Adnane, M. Rafai,
A. Largab and M. Trafeh, “Badly-Known Osteoid Os-
teoma of the Phalanx (Case Report),” The Pan Arab
Journal of Orthopaedics and Trauma, Vol. 8, No. 1, 2004,
pp. 91-93
[10] I. Ghanem, “The Management of Osteoid Osteoma: Up-
dates and Controversies,” Current Opinion in Pediatrics,
Vol. 18, No. 1, 2006, pp. 36-41.
[11] J. M. Soler, G. Piza and F. Aliaga, “Special Characteris-
tics of Osteoid Osteoma in the Proximal Phalanx,” Jour-
nal of Hand Surgery, Vol. 22, No. 6, 1997, pp. 793-797.
[12] M. Soong, J. Jupiter and D. Rosenthal, “Radio Frequency
Ablation of Osteoid Osteoma in the Upper Extremity,”
Journal of Hand Surgery, Vol. 31, No. 2, 2006, pp. 279-
283. doi:10.1016/j.jhsa.2005.10.012
[13] C. C. Harrod, R. E. Boykin and J. B. Jupiter, “Pain and
Swelling after Radiofrequency Treatment of Proximal
Phalanx Osteoid Oste oma: Case Report,” Journal of Hand
Surgery, Vol . 35 , No. 6, 20 10, pp. 990-994 .