Exostosis

exostosis
Exostosis of the back surface of the femur (radiograph).

Exostosis is benign thorn bone and cartilage formation on the surface of the bone (Fig.). There are single or multiple, have the form of a thorn, mushrooms, cauliflower and other Etiology of exostosis - dysplasia growth zones. The disease often wears a family of hereditary character.
The development of exostosis may occur after injury (incorrect healing of fractures on the former site of hemorrhage, if the injury was damaged periosteum). The value of exostosis can be from a few centimeters up to ten and more centimeters.
Exostosis detected, usually in childhood and adolescence. Single exostosis often formed in the distal metaphase hips, proximal tibial metaphysis, less often on the upper extremities. Multiple exostosis (sometimes up to several tens) are located symmetrically in the field of metamizol long bones, ribs, clavicle.
The growth of exostosis slow, during the whole period of development of the skeleton. Often exostosis long time asymptomatic. When multiple exostosis there are various skeletal deformities caused by a disorder of bone growth (varus or congenital curvature tibia fractures of the femoral head, radial bone, the curvature of the forearm from elbow side, lateral movement of a brush and others). With the rapid growth of exostosis should think about the degeneration of it.
Diagnosis of exostosis is put upon examination, palpation and chest x-ray of the affected limb segments.
Treatment of single exostosis operational, with multiple exostosis are surgically removed only exostosis that constrict the blood vessels, nerves, or cause the occurrence of any deformations.

Exostosis (from the Greek. exostosis - growth on bone) - bone outgrowths on a surface of bones, consisting of sponge and compact bone.
The clinical significance of different exostosis is not the same. Some of them, there are no symptoms, others cause pain, others limit the mobility of limbs, the fourth sometimes undergo a transformation into a true tumor and may even be subjected to malignancy.
The term "exostosis" refers to a pathological condition of the bones, which complicate various diseases, and only the so-called multiple cartilage exostosis are certain independent form of the disease. The origin of exostosis is different. They can occur as a manifestation of the regeneration process after injury, chronic inflammatory diseases of the bones, inflammation of the mucous bags and fibrositis. They can occur as a side complication benign tumors, as a consequence of aseptic necrosis and other chronic joint diseases, after surgery, congenital anomalies and deformities of the bones, when chondromatosis bones.
The etiology of multiple cartilage exostosis is unclear, but the mechanism of their development is connected, of course, disruption encontrarnos of ossification. Often possible to observe the family nature of this disease. There are exostosis of unknown origin.
Clinical recognition of all these pathological States difficult. Most clinical interest are the so-called subungual and multiple cartilage exostosis. Clinical picture in subungual the exostosis phalanxes of the foot is characterized by sharp pain, ottaviana free edge up, the advent of inflammatory changes from constant pressure shoes on the nail and granulation development under the nail.
Cartilage exostosis located superficially in the field of metamizol, felt how tight formation, and in distinct cases when they can be observed deformations of bones in the form of varus and valgus deformities of lower limbs, combined sometimes with a delay of growth. Cartilage call them, first, by their origin (from metaepitome cartilage), and secondly, because to stop the growth of the skeleton they are on the surface of the cartilage hat (that is why the x-ray image sizes are always less true).
Recognize different kinds of exostosis using x-ray studies. X-ray symptoms of exostosis is usually easy to explain in comparison with clinical data. In the process of the research the need arises evidence available communication bone of these formations with the underlying bone. This mapping is required because of the possible similarities with exostosis of calcification and bones in the soft tissues adjacent to the bone, but not associated with it (for example, with references for additional information myositis and interstitial calcification). The size, shape and location of exostosis determined by their origin.
As a consequence of the trauma they can be formed from incorrectly located splinter of bone (Fig. 1) or ossification hemorrhage (Fig. 2). At break of articulation exostosis can occur at the site of attachment cords to the bone surface (for example, on pubic bones, at break pubic joint childbirth or when you break any other articulation) (Fig. 3). Exostosis to arise, osteomyelitis in the form of a ledge at the side of the soft tissues in the place of the break of the periosteum, and also as a result of inflammation in the soft tissues adjacent to the bone that occurs when bursitis.
The most significant subungual exostosis at the distal end of the nail phalanxes on the back I toe (Fig. 4) and multiple cartilage exostosis.
Multiple cartilage exostosis, situated in places encontrarnos bone growth comes in the form of protrusions on the narrow foot or on a broad basis. The tip of the exostosis is aimed in the opposite direction of the joint. In addition to a multiple there are the same kind of single exostosis that in those cases when they have broad-based gain a significant similarity with spongiform osteomas. However osteoma has a smoother surface and proper shape. Sometimes to spend differential diagnosis between them is practically impossible. Accurate diagnosis determines medical tactics. Cartilage exostosis when going to osteochondroma necessarily require radical removal within healthy bone tissue. The long existence of osteochondroma may result, although very rare, turn to osteochondroma (Fig. 5). The need for surgery sometimes occurs when some bone outgrowths, impeding the normal locomotor function of the leg.

Fig. 1. Post-traumatic exostosis.
Fig. 2. Exostosis on the former site of hemorrhage.
Fig. 3. Exostosis after breaking clavicle-beaked ligaments.
Fig. 4. Exostosis nail phalanxes - subungual exostosis.
Fig. 5. The malignancy cartilage exostosis.