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[Diagnostics and treatment of osteoid osteoma].

Der Orthopäde 2017 June
BACKGROUND: Osteoid osteoma is the third most common benign bone tumor and typically induces pain that is worse at night.

OBJECTIVE: To identify the epidemiological, pathogenetic, histological and radiological characteristics of osteoid osteoma and to present the broad variety of treatment options.

MATERIAL AND METHODS: This review article summarizes relevant clinical studies and meta-analyses on this topic.

RESULTS: Osteoid osteoma is characterized by a central nidus smaller than 1.5 cm in diameter with surrounding bone sclerosis. In the majority of cases, the tumor occurs in the long bones of the lower extremities and is predominantly manifested in patients aged between 5 and 25 years. Pain is mediated by prostaglandins, which stimulate afferent peripheral nerve fibers. Besides plain radiographs, thin-section computed tomography represents the gold standard of diagnostics but should be complemented by magnetic resonance or nuclear medicine imaging modalities. The conservative treatment consists of long-term therapy with non-steroidal anti-inflammatory drugs. Minimally invasive radiofrequency ablation of the nidus is the current operative treatment of choice.

CONCLUSION: Success rates of radiofrequency ablation and other minimally invasive procedures are high while treatment costs and length of hospital stay are low. Thus, open surgical curettage is reserved for rare indications and en bloc excision of the nidus should only be performed in cases of recurrent lesions.

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