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| CASE REPORT |
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| Year : 2016 | Volume
: 5
| Issue : 8 | Page : 64-65 |
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Turret exostosis of proximal phalanx of thumb
Ganesh Singh Dharmshaktu1, Tanuja Pangtey2
1 Department of Orthopaedics, Government Medical College, Haldwani, Uttarakhand, India
2 Department oPathology, Government Medical College, Haldwani, Uttarakhand, India
| Date of Web Publication | 3-Jan-2017 |
Correspondence Address:
Ganesh Singh Dharmshaktu
Department of Orthopaedics, Government Medical College, Haldwani - 263 139, Uttarakhand
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2250-9658.197441
The osteochondromatous lesion of the skeleton is common occurrences and may have many variants, the knowledge of which is crucial for identification and treatment. Acquired osteochondroma, also known as Turret exostosis is one such lesion. The clinico-radiological picture often mimics that of a solitary osteocartilagenous exostosis, but the history of minor trauma as triggering event and histopathological correlation concludes the ubiquitous diagnosis. We present a case of Turret exostosis of thumb proximal phalanx on medial aspect with appropriate management. Keywords: Complication, injury, metacarpal, osteochondroma, thumb, treatment, turret exostosis
How to cite this article:
Dharmshaktu GS, Pangtey T. Turret exostosis of proximal phalanx of thumb. N Niger J Clin Res 2016;5:64-5 |
| Introduction | |  |
Turret exostosis, also called as acquired osteochondroma, is a unique and uncommon disorder described sporadically as case reports in the clinical literature. Originally postulated to be a result of ossification of subperiosteal hematoma, the entity was first described by Wissinger et al. [1],[2] The minor injury to the affected site, predominantly phalanges, is the precedent condition. [3] Growing mass, cosmetic deformity or limitation of function with or without pain are usual presenting features. [3],[4] The dorsum aspect and very rarely the palmar aspect of phalanges or metacarpal is a common site of involvement with exceptions of thumb lesions which usually have palmar involvement. [3],[5]
| Case Report | | |
We present a case of a 29-year-old male patient who presented to us with a hard swelling over left thumb that was starting to interfere with his activities of daily living lately. There was a history of mild injury to his thumb 8 months back that presented with pain and swelling but subsided on rest and medications for 4 weeks. For the last 4 months, he witnessed a bony hard swelling over proximal phalanx of left thumb medially that was increased in size over the period and was bony hard in consistency, well defined and with little pain on deep palpation. The swelling was immobile and appeared fixed to bone on palpation with a well-defined extent [Figure 1]. The overlying temperature was normal, and no fixity of skin was found. The radiograph brought by patient showed a bony like growth over thumb proximal phalanx [Figure 2]a and b. The radiological picture resembled a sessile variant of osteochondroma. The computed tomography scan was refused by the patient and an excision biopsy was planned after informed consent and aseptic preparation. The swelling was removed and sent for histopathological assessment. The report suggested a diagnosis of osteochondroma-like picture and considering the history was labeled as an acquired variety of it. The patient had an uneventful recovery and achieved normal functions after 6 weeks of treatment [Figure 2]c. | Figure 1: The clinical picture of the thumb with a nodular, bony hard swelling over medial aspect. There was mild limitation of movement with little pain
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 | Figure 2: The radiograph of the lesion over thumb proximal phalanx of thumb (a and b) and that of hand without the lesion (c)
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| Discussion | | |
Like solitary osteochondroma, the clinical picture may range from asymptomatic profile to pain or functional limitation. Pressure symptoms on vital structures may also arise as per the occurrence in a vulnerable location. Rarely, adjacent tendon rupture can be associated with the lesion and requires appropriate treatment. [6] Our patient had mild pain due to size of the swelling and minimal limitation due to its presence on medial aspect. The dorsum aspect, which is commoner site at thumb, might interfere extensor tendon functioning.
The clinical profile and radiology coupled with biopsy reports had typical features of that of a solitary osteochondroma but the absence of any lesion previously, and the emergence of it postinjury made the diagnosis in favor of Turret exostosis. Other similar conditions that involve reactive bone formation include florid reactive periostitis and Nora's lesion (benign proliferative osteochondromatous proliferation). Experts believe all mentioned variants may be stages of similar pathologic entity. The treatment, however, follows the same as any problematic growth and excision is a mainstay to restore normalcy. Recurrence, however, is a potential complication and must be explained to the patient. [7]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Wissinger HA, McClain EJ, Boyes JH. Turret exostosis. Ossifying hematoma of the phalanges. J Bone Joint Surg Am 1966;48:105-10.  |
| 2. | Kontogeorgakos VA, Lykissas MG, Mavrodontidis AN, Sioros V, Papachristou D, Batistatou AK, et al. Turret exostosis of the hallux. J Foot Ankle Surg 2007;46:130-2. |
| 3. | Stahl S, Schapir D, Nahir AM. Turrets exostosis of the phalanges presenting as limited motion of the finger. Eur J Plast Surg 2000;23:82-4. |
| 4. | Murphey MD, Choi JJ, Kransdorf MJ, Flemming DJ, Gannon FH. Imaging of osteochondroma: Variants and complications with radiologic-pathologic correlation. Radiographics 2000;20:1407-34. |
| 5. | Mohanna PN, Moiemen NS, Frame JD. Turret exostosis of the thumb. Br J Plast Surg 2000;53:629-31. |
| 6. | Yoo JH, Kim JH, Chang JH. Turret exostosis of the phalanx with tendon rupture: A case report. J Korean Soc Surg Hand 2009;14:85-8. |
| 7. | Bourguignon RL. Recurrent turret exostoses - Case report. J Hand Surg Am 1981;6:578-82. |
[Figure 1], [Figure 2]
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