Few people know about exostosis, despite the fact that this disease is not rare. The disease can develop in both a child and an adult. However, most often a person does not even suspect about the disease, since it does not cause any discomfort and is asymptomatic.

Causes of the disease

Exostosis is a bone or osteochondral growth on the surface of the bone. This is a benign tumor several millimeters thick, consisting of cartilage tissue. But as the tumor grows, it hardens and turns into a bone growth. The disease can develop even in a young child, but, as a rule, it does not manifest itself until 7–8 years of age.

In most cases, it is diagnosed during adolescence during an examination. The danger of osteochondral exostosis is that it may not appear for a very long time, growing to enormous sizes. Although it is quite simple to diagnose: the growth can be felt under the skin. New growths are also visible on x-ray.

The causes of the disease are as follows:

• injuries and damage in childhood and adolescence, when intensive tissue growth occurs;
• chronic diseases of the skeletal system;
• complications after inflammatory processes in the body;
• congenital skeletal anomalies;
• excess calcium in the body, deposited on the bones;
• heredity.

With exostosis, several growths can be observed at once. Sometimes their number reaches several dozen. They may be different sizes and forms. There are growths in the form of a ball, an inverted bowl, and even in the shape of a flower.

Classification and diagnosis

Typically, neoplasms are noticed during an X-ray examination. However, only the ossified part of the growth is visible in the image, and the cartilage “cap” covering the growth remains invisible. Therefore, the real size of tumors is always larger than what is visible on an x-ray. But x-ray examination perfectly shows the number, shape and stage of development of tumors.

Exostosis manifests itself in different ways. Most often, the disease can develop for years until it is detected by a doctor. But there are cases when the tumor puts pressure on nerve endings and blood vessels. Then the person experiences pain when pressing on certain areas of the body or feels numbness.

If the growth is located near a joint, it limits the movement of the limbs. Sometimes exostosis is accompanied by dizziness. In such cases, the patient undergoes additional examinations. If the disease develops with complications, and the growth itself grows rapidly, then there is a risk of transformation of the neoplasm into a malignant tumor. Then a biopsy is performed with tissue collection to better study the development of the disease.

The disease is divided into 2 types:

1. Solitary exostosis, manifested in the form of a single growth.
2. Multiple, characterized by several neoplasms. Multiple growths appear in several areas at once. This type of disease is hereditary.

Most often, exostosis is diagnosed on the following parts of the body:

• collarbone;
• hip joint;
• shoulder joint;
• tibia;
• edge;
• spatula

In half of the cases exostosis is diagnosed femur And tibia.

One of the most severe types The disease is spinal exostosis. A tumor on the spine can affect spinal cord, leading to disruptions in its operation. Marginal exostoses vertebral bodies interfere with their normal mobility. In addition, vertebral growths often develop into malignant formations.

Exostosis is no less dangerous knee joint. A growing tumor causes inflammation and leads to deformation of the joint, impairing its function.

The hands and feet are least commonly affected. Usually, hereditary exostosis of the calcaneus and metatarsal bones are detected.

Uninitiated people mistakenly call a heel growth a “spur,” confusing it with another disease.

Treatment methods

Exostosis is treated in only one way - surgery. However, some patients may not require surgery. Usually the operation is prescribed for children who have reached adulthood. Until this time, the growth may shrink and completely resolve. This is how, for example, rib exostosis behaves, which is detected in children 8–18 years old. In most cases, it is a complication of various diseases and resolves spontaneously over time. If the bone growth does not grow and does not cause any discomfort, then some people live with it all their lives, seeing a doctor from time to time.

Indications for removal of exostoses are:

• significant tumor size or rapid growth;
• the risk of transformation of growths into malignant neoplasms;
• painful sensations due to the pressure of growths on blood vessels and nerve endings;
• various cosmetic defects.

As a rule, surgery to remove tumors does not require special preparation. The tumors are removed along with the periosteum adjacent to the tumor to avoid relapse. Operations are carried out as under general anesthesia, and under local anesthesia, if the case is simple. Even after surgery on the hip or foot area, the patient returns to full life in just a few weeks.

When the affected area of ​​the body should be protected, after the operation it is immobilized for some time with a plaster splint. The patient then undergoes a course of restorative procedures. If all medical recommendations are followed, the patient recovers quickly. Only in in rare cases Complications are possible when the disease relapses. The growth appears again and is a harbinger malignant neoplasms. Most often, a malignant tumor affects the vertebrae, hip and pelvic bones, as well as the shoulder blades.

Traditional methods

Despite the fact that exostosis is a disease that requires surgical intervention, many people try to cure the bone growth at home. Some turn to traditional healers, others take information from the Internet, looking at dubious photos of treatment and using unverified recipes. Unfortunately, self-medication often only complicates the situation.

As a rule, patients begin treatment with folk remedies when the bone growth causes severe discomfort. To relieve pain, many people do herbal compresses and lotions. Such methods do not cause harm to health, but they do not cure exostosis.

Having failed to achieve results using herbal recipes, patients turn to radical drugs - painkillers and various ointments. However, such methods are already fraught with complications.

1. Firstly, thoughtless use of painkillers negatively affects internal organs such as the liver, kidneys and stomach.
2. Secondly, a benign tumor can develop into malignancy, and medications used without prescription only accelerate this dangerous process.

Still traditional methods are not so harmful in the treatment of exostosis if they are preventive in nature. First of all, this concerns lifestyle.

Normal nutrition, strengthening the immune system, playing sports - all this protects against the development of exostosis even after injury.

Some diseases internal organs can also cause tumors to appear on the bones. To prevent this from happening, you need to carefully monitor your health and treat various ailments in a timely manner.

To prevent exostosis from affecting your legs, you should give them rest more often. It is important to distribute the load on the feet evenly, and for this it is useful to wear comfortable shoes and orthopedic insoles.

Doctors often prescribe various compresses and baths to patients to reduce pain syndrome or relieve swelling. Home methods can also be used after surgery, but no prescription should be used without consulting your doctor.

It appears to be a benign neoplasm that develops from bone tissue.

It is characterized by slow growth, it never becomes malignant and does not metastasize to nearby tissues.

Osteoma is typical for patients of childhood and young age (from 5 years to 21 years). Osteomas are mainly localized on outer surface bones and on flat cranial bones, and can also appear on the walls of the ethmoid, frontal, sphenoid and maxillary sinuses and on the femur, humerus and tibia. Possible damage to the bones of the spine. Osteomas are usually single, but can also be multiple (Gardner's disease).

All types of such diseases can only be treated surgically. Male patients are more at risk of this disease than women (they get sick about 2 times more often). However, osteomas of the facial bones are more common in women (3 times more often than in male patients).

The process of development of this type of neoplasm can occur either without symptoms at all (and for quite a long time), or be accompanied by external signs, depending on the location.

Osteoma frontal sinus on x-ray

If the osteoma reaches a significant size and compresses neighboring areas (for example, blood vessels, nerves, etc.), this can cause the manifestation of corresponding symptoms and, if the functioning of the compressed areas or organs is impaired, requires surgical removal. In other cases, osteoma is removed for cosmetic reasons.

Classification

Depending on the origin, experts distinguish two types of osteomas:

• hyperplastic osteomas are tumors that develop from bone tissue. This group includes the osteomas themselves and the so-called osteoid osteomas (synonym: osteoid osteomas);
• heteroplastic osteomas – neoplasms arising from connective tissue. In another way, such osteomas are called osteophytes.

Osteoid osteoma

This is a bone tumor with high differentiation, but, unlike osteoma itself, its structure differs from the structure of normal bone tissue. It consists of vascular-rich areas of the so-called osteogenic tissue, chaotically scattered bone beams and zones of bone tissue destruction (osteolysis). Typically, osteoid osteomas are rarely larger than 1 centimeter in diameter. This is a fairly common disease. Her share in total number benign bone tumors - approximately 12 percent.

It can be localized on any bones of the body, except the bones of the skull and sternum. More common in men. The course of this disease is characterized by gradually increasing pain. On early stage As the disease develops, these sensations are similar to muscle pain. Over time, the pain intensifies and occurs spontaneously. Sometimes lameness appears.

If a tumor occurs in the area of ​​the articular part of the bone (epiphysis), fluid may accumulate in the joint.

If the neoplasm is located in the area of ​​the growth plate, it stimulates bone growth, as a result of which patients childhood Skeletal asymmetry may develop. If osteoid osteoma is localized in the spine, scoliosis is possible. With such a location of osteoid osteoma, there is a risk of compression of peripheral nerves.

Exostosis of the nail phalanx

Most often, orthopedic surgeons or traumatologists treat osteoid osteoma, and only surgically. After surgery, relapses are extremely rare.

Osteophytes (endo- and exostoses)

There are two types of osteophytes:

1. internal osteophytes (in other words, endostoses) grow into the canal bone marrow, As a rule, they are isolated, but there is an exception - hereditary disease, known as osteopoikilosis. In this case, multiple endostoses are observed. The course of the disease in the majority of cases is not accompanied by severe symptoms. Often diagnosed incidentally during X-ray examination;
2. external osteophytes (in other words, exostoses). As their name suggests, they form on the surface of the bone. The cause of the appearance of exostoses can be various pathological processes, but their occurrence is possible without any visible reasons. Exostoses are most often found on the bones of the face, skull and pelvis. There may be no manifestations of the development of these osteophytes at all, or they manifest themselves as a cosmetic defect, or, in the case of compression of nearby areas, they manifest themselves with corresponding external signs. There are cases where the development of exostosis was accompanied by bone deformation and fracture of the pedicle of the external osteophyte.

Since exostoses are more common than endostoses, let’s consider them in more detail.

What is exostosis?

Often, when patients hear a diagnosis of “exostosis” at a doctor’s appointment, they get scared. How serious is this disease? Where does it come from?

Exostosis is nothing more than a growth on the bone surface.

Such neoplasms have various shapes and sizes. For example, there are exostoses in the form of a mushroom or cauliflower. The structure of this formation is a compact spongy compact tissue.

There are cases when growths are formed from cartilage. It should be noted that the use of the term "cartilaginous exostosis" is a bit of a misnomer. The neoplasm, although it appears from cartilaginous elements, subsequently ossifies and turns into spongy tissue. And its surface is covered with hyaline cartilage, which is the growth zone of exostosis.

When formed on the long tubular bones of the extremities, the growths are most often localized on the femurs. The second most common case is the tibia, and the third is the humerus.

Reasons for appearance

The reasons for the occurrence of this type of growth are different. Basically, it appears at the site of bone injury as a result of excess tissue growth.

This is often observed with cracks, fractures, surgical intervention and so on.

However, there are other risk factors. According to statistics, the problem of exostosis in most cases is faced by patients of childhood and adolescence. This is often associated with the intensity of growth. In addition, there is often a hereditary connection.

The causes of this disease also include various kinds chronic inflammatory bone diseases. In some cases, exostoses can form against the background of inflammation of the mucous bursae and fibrositis. Aseptic necrosis and bone chondromatosis can provoke the appearance of growths. Exostoses often appear in patients with congenital skeletal anomalies.

It should be said that quite often specialists are not able to explain the origin of the disease.

Main symptoms

Most often, these growths do not cause any discomfort. The disease occurs without pronounced symptoms and is diagnosed completely accidentally during a routine examination.

However, in some cases there are signs that help make the diagnosis of exostosis. What are these signs?

In the first place are pain during movement, physical activity and pressure on the bone, as well as some discomfort.

As the disease progresses and exostosis grows, these symptoms become more pronounced. If the growth is localized in close proximity to the joint, it can severely limit the range of motion. Often this neoplasm can be palpated, in some cases even independently.

Bone pain due to exostosis

Diagnostic methods

Currently, this disease is relatively easy to diagnose. The doctor may suspect exostosis at the stage of examining the patient (in some parts of the body the growth can be easily felt under the skin). Of course important role Symptoms and medical history play a role in making a diagnosis. To ensure the correct diagnosis, an x-ray examination is prescribed.

Exostosis is clearly visible on x-ray.

It should be said that the actual size of the growth is often several millimeters larger than in the picture, since cartilage tissue is not visible on the radiograph. Sometimes additional examinations are necessary. This is especially true for cases in which the tumor rapidly increases in size. In these cases, a tissue biopsy is prescribed, followed by cytological examination in the laboratory.

Treatment methods

Currently, there is only one method of treating this disease - surgical removal.

Of course, such intervention is not always necessary, since in most cases exostoses are not dangerous to health, and the disease itself is generally asymptomatic.

Surgery is necessary when the growth grows to large sizes or growing too fast. Surgery is also indicated if the patient has severe pain and problems with movement. Some patients voluntarily undergo surgery in cases where the growth causes a serious cosmetic defect.

Existing in at the moment techniques allow you to get rid of exostosis in short term. The bone growth is removed through an incision one to two centimeters long. Such intervention does not require special training, long stay in hospital and long-term rehabilitation. In most cases, after removal of exostosis, the patient begins to return to normal life already after a few days.

Osteochondral exostosis of the fibula

Possible complications

In some cases, even exostosis is not large size can cause a lot of problems and seriously affect the quality of life.

There are also some complications that the growth can lead to. First of all, it should be said that large exostoses often rest against neighboring bones, which causes their gradual deformation.

One of possible complications is a fracture of the exostosis leg (however, such cases are extremely rare). However, the most big threat the risk of malignancy remains. There are cases where the appearance of such a growth was a harbinger of the formation of a tumor - most often cancer of the pelvic bones and femur, as well as the shoulder blades and vertebrae.

Exostoses are benign spiny-shaped osteochondral formations on the surface of the bone (Fig.). They can be single or multiple, have the shape of a thorn, mushroom, cauliflower, etc. The etiology of exostoses is dysplasia of growth zones. The disease is often familial and hereditary.

The development of exostosis can be observed after injury (improper healing of fractures at the site of former hemorrhage, if the periosteum was damaged during injury). The size of exostosis can range from several centimeters to ten or more centimeters.

Exostoses are usually detected in childhood and adolescence. Single exostoses are more often formed in the distal metaphysis of the femur, proximal metaphysis of the tibia, less often on upper limb. Multiple exostoses (sometimes up to several dozen) are localized symmetrically in the area of ​​the metaphyses of long tubular bones, on the ribs, and the clavicle.

The growth of exostosis is slow throughout the entire development period. Exostoses often remain asymptomatic for a long time. With multiple exostoses, various skeletal deformations occur due to bone growth disorders (varus or valgus curvature of the tibia, dislocation of the femoral head, radius, curvature of the forearm towards the ulnar side, lateral displacement of the hand, etc.). With the rapid growth of exostosis, one should think about its malignant degeneration.

The diagnosis of exostosis is made by examination, palpation and x-ray examination affected limb segments.

Treatment of single exostoses is surgical; in case of multiple exostoses, only those exostoses that compress vessels, nerves or cause the formation of some deformations are surgically eliminated.

Exostoses (from the Greek exostosis - growth on bone) are bone outgrowths on the surface of bones, consisting of spongy and compact bone tissue.

The clinical significance of various exostoses varies. Some of them exist asymptomatically, others cause pain, others limit the mobility of the limb, and others sometimes undergo transformation into a true tumor and can even undergo malignancy.

The term “exostosis” refers to pathological conditions of bones that complicate various diseases, and only the so-called multiple cartilaginous exostoses are a certain independent form of the disease. The origin of exostoses is different. They can occur as a manifestation of the regenerative process after injury, chronic inflammatory bone diseases, inflammation of the mucous bursae and fibrositis. They can occur as a concomitant complication of a benign tumor, as a consequence aseptic necrosis and other chronic joint diseases, after surgery, with congenital anomalies and skeletal deformities, with chondromatosis of the bones.

The etiology of multiple cartilaginous exostoses is unclear, but the mechanism of their development is undoubtedly associated with a disruption of the normal course of enchondral ossification. It is often possible to observe the familial nature of this disease. There are also exostoses of unknown origin.

Clinical recognition of all these pathological conditions difficult. The so-called subungual and multiple cartilaginous exostoses are of greatest clinical interest. Clinical picture with subungual exostosis of the phalanges of the foot, it is characterized by severe pain, pressing of the free edge of the nail upward, the appearance of inflammatory changes from the constant pressure of shoes on the nail and the development of granulations under the nail.

Cartilaginous exostoses, located superficially in the area of ​​the metaphyses, are palpated as dense formations, and in severe cases, bone deformations in the form of varus and valgus curvature can be observed. lower limbs, sometimes combined with growth retardation. They are called cartilaginous, firstly, by their origin (from metaepiphyseal cartilages), and secondly, because before the skeletal growth stops, they have a cartilaginous cap on the surface (therefore, in the X-ray image their sizes are always smaller than the true ones).

Recognized various types exostoses using x-ray examination. X-ray symptoms exostosis are usually easily explained when compared with clinical data. During the research process itself, there is a need to prove the existing connection between the bone mass of these formations and the underlying bone. Such a comparison is necessary due to the possible similarity with exostosis of calcifications and ossifications in soft tissues adjacent to the bone, but not associated with it (for example, with myositis ossificans and interstitial calcification). The size, shape and location of exostoses are determined by their origin.

As a consequence of injury, they can form from an incorrectly located bone fragment (Fig. 1) or during ossification of hemorrhage (Fig. 2). When a joint ruptures, exostoses may occur at the site of attachment of the ligament to the bone surface (for example, on pubic bones, when the symphysis pubis is ruptured during childbirth or when any other joint is ruptured) (Fig. 3). Exostoses can form during osteomyelitis in the form of a protrusion towards the soft tissues at the site of a periosteal rupture, as well as as a result of inflammation in the soft tissues adjacent to the bone, which is observed with bursitis.

The most indicative subungual exostoses are at the distal end of the nail phalanx on back side I toe (Fig. 4) and multiple cartilaginous exostoses.

Multiple cartilaginous exostoses, located in places of enchondral bone growth, look like protrusions on a narrow stalk or on a wide base. The apex of the exostosis is directed in the opposite direction from the joint. In addition to multiple ones, there are single exostoses of the same kind, which, in cases where they have a wide base, acquire a significant resemblance to spongy osteoma. However, osteoma has a smoother surface and regular shape. Sometimes spend differential diagnosis between them is almost impossible. Accurate diagnosis defines medical tactics. Cartilaginous exostoses, when transforming into osteochondroma, require radical removal within healthy bone tissue. Long-term existence of osteochondroma can lead, although very rarely, to transformation into osteochondrosarcoma (Fig. 5). The need for surgery sometimes occurs when some bone growths interfere with normal musculoskeletal function limbs.

Rice. 1. Post-traumatic exostosis.
Rice. 2. Exostosis at the site of a former hemorrhage.
Rice. 3. Exostosis after rupture of the coracoid ligament.
Rice. 4. Exostosis of the nail phalanx - subungual exostosis.
Rice. 5. Malignancy of cartilaginous exostosis.

Osteochondroma, (synonymous with cartilaginous exostosis) is a single benign tumor that consists partly of cartilage and partly of bone. Osteochondromas are common and may develop spontaneously after a blow or bruise or may be hereditary. If the growth on the bone does not interfere with everyday life, then no treatment is required, otherwise it can be removed surgically. A single osteochondroma in adults becomes malignant quite rarely, in this case it leads to the development of chondrosarcoma.

Osteochondromatosis(synonym: hereditary multiple exostosis) is a relatively common disorder of skeletal development in children who have bone spurs develop on long bones, ribs and vertebrae. If the lesions are severe, they can stop bone growth, leading to dwarfism. Pressure on the tendons blood vessels or nerves may cause other problems. Typically, such growths stop growing at the end of puberty; in rare cases, regrowth in adulthood may indicate malignant changes.

Exostosis

What is exostosis?

Exostosis is a bone or bone and cartilaginous growth of a non-tumor type on the surface of bones (a type of linear, spherical and other formation). Exostosis in its structure consists of cartilaginous tissue (ossified in similarity to normal cartilaginous tissue) and therefore the name “ cartilaginous"Exostosis does not accurately show the essence of the entire process.

The process of ossification during exostosis is usually accompanied by transformation into spongy bone, enclosed on the outside in a thin and dense bone shell. Surface bone exostosis- This is a layer covered with hyaline cartilage, the thickness of which is only a few millimeters. From such a cartilaginous head the growth of the entire exostosis subsequently results.

According to M.V. Volkov (1974), this disease accounts for 27% of all primary tumors and tumor-like skeletal dysplasias in children, and according to Adler (1983), osteochondral exostosis among benign tumors bones are found in 40% of cases.

The disease occurs in two forms: multiple exostotic chondrodysplasia and solitary osteochondral exostosis. Both solitary and multiple osteochondral exostoses can affect any bone. The favorite localization is the metaphyses of long tubular bones. In 48% of all osteochondral exostoses, lesions are detected in the distal metaphysis of the femur, proximal metaphyses of the humerus and tibia. The disease is usually detected in childhood and adolescence.

Clinical symptoms depend on the form of the disease, location, size of exostoses, their shape and relationship with surrounding organs and tissues.

With solitary lesions, as a rule, bone density is detected, motionless in relation to the bone, various sizes and forms of tumor-like formations; the skin over them is usually not changed. Large osteochondral exostoses can put pressure on blood vessels or nerve trunks, causing pain. The location of exostoses in the spine with their growth towards the spinal canal can cause compression of the spinal cord.

At plural form With exostotic chondrodysplasia, symptoms such as short stature, club-handedness, and deformity of the knee joints often come to the fore. Large exostoses are often the cause of severe deformities caused by bulging of the exostosis beyond the bone, its pressure on the adjacent bone and its curvature, disruption of the epiphyseal growth zone and underdevelopment of the epiphysis. The latter often leads to the development of radial or ulnar clubhand (with underdevelopment of the epiphysis of the radius or ulna), valgus or varus deformity.

X-ray picture. At the beginning of their development, exostoses are located in close proximity to the epiphyseal cartilaginous plate on the side of the metaphysis. As the bone grows, moving away from the epiphysis, exostosis can be located in the diaphyseal part of the bone. By the distance of exostosis from the epiphysis, one can judge how long ago it appeared. Form of exostosis The growth of exostosis usually continues during the period of bone growth, but sometimes an increase in its size is noted after the closure of the growth zones.

One of the serious complications of osteochondral exostoses is their malignancy. According to different authors, such complications occur in 3-25% of cases. The cartilaginous coverings of exostosis undergo degeneration, pronounced proliferation and massive growths of cartilaginous tissue occur. Malignancy is more often observed in adult patients. Degenerating exostoses are localized mainly on the pelvic bones, tibia, femur and humerus.

Treatment of osteochondral exostoses is only surgical. depends on their location.

Causes of exostosis

The reasons for the formation of exostosis may be inflammatory process, bruise, incarceration, abnormalities of the periosteum and cartilage, such infectious diseases like syphilis, lack of function endocrine system or its individual glands. Exostosis is presented, in general, as a persistent formation, however, there are cases when the process of formation of exostosis decreases over time and the exostosis disappears forever.

Often, slowly increasing and not causing pain, exostosis is not observed clinical symptoms, remaining invisible to both the patient and the doctor. Exostosis is detected by X-ray examination, or by palpation of seals that are already visible during examination.

Large quantity scientific works devoted to elucidating the causes of exostosis, their attention is directed to the study of heredity in this disease. However, even the presence in certain cases of family exostoses, which are inherited, does not yet provide any basis for explaining the occurrence of this disease.

Osteochondral exostosis

Osteochondral exostosis can continue to go unnoticed for a long time, since the growth of osteochondral exostosis is very often not accompanied by symptoms. Exostosis can be detected randomly, for example, during an X-ray examination or when growths or indurations are identified.

Often bone growths do not appear until the age of 8, however, during active skeletal growth in the period from 8 to 16 years, activation may occur and exostosis may develop. Accelerated development of osteochondral exostosis is observed during puberty and is found on the fibula and tibia, as well as in the lower part of the thigh, on the scapula and clavicle.

Osteochondral exostosis affects the hands and feet much less frequently and never affects the skull area. The number of growths with osteochondral exostosis can vary - from a few to dozens; the situation is similar with sizes - from a pea to a large orange. It is not always possible to palpate exostoses during research, so for precise definition their quantities apply radiography. This is the only way to obtain data on the size, shape and structure of osteochondral exostosis.

There are two types of osteochondral exostosis: solitary osteochondral exostosis And multiple exostotic chondrodysplasia. Both types of exostoses can affect any bone. The favorite localization is the metaphyses of the long tubular bone. 50% of all osteochondral exostoses are marked by damage to the femur and proximal metaphysis shoulder joint and tibia. Osteochondral exostosis usually manifests itself in adolescence and childhood.

Diagnostic methods

The clinical picture of osteochondral exostosis depends on the form of the disease, its localization, size of exostoses, shape and connection with nearby tissues and organs. Exostoses of enormous size can affect nerve trunks and blood vessels, causing pain. Osteochondral exostosis in the spinal region, with further growth into the spinal canal region, can lead to compression of the spinal cord.

Diagnosis of exostoses is impossible without radiographic examination. Since in most cases, it is not possible to detect the formed growth upon palpation. X-ray imaging allows you to get an idea of ​​the number of exostoses, the shape of the growths, their size, structure and development. It should be taken into account that the cartilaginous cover covering the growth from the outside is not visible on the x-ray. That is, true dimensions There is always more exostosis than is visible in the picture. This circumstance is especially pronounced in children, since in them the size of the upper cartilaginous growth often reaches 8-10 mm.

Treatment

There are no methods conservative treatment exostosis. It is only possible to carry out surgical operation. In what case is it necessary to perform surgery: If there is a rapid growth of exostoses. If the growths put pressure on nerves or blood vessels. If the growth is so large that it appears visually. They try not to perform operations on children before they reach the age of 18, since they often experience spontaneous resolution of exostoses. However, if the growths cause discomfort or increase in size very quickly, then surgery is necessary. Surgical treatment exostosis can be performed under general or local anesthesia. The choice of pain relief method depends on the location of the growth and its size. The surgical technique involves removing the bone growth using a chisel. After which the bone is smoothed. In most cases, the operation is performed through a small incision. The rehabilitation period after surgery to remove exostosis takes no more than 14 days. If a single growth is removed, the patient can begin to stand up on the day of surgery. At the first stage after surgery, a gentle motor regimen is recommended. Then, after the swelling has reduced, a recovery-training regimen is prescribed. Needs to be restored muscle strength, amplitude of movement. It is very important that movements during training do not cause pain. At the first stage, training is carried out under the guidance of a physical therapy methodologist, then continues independently.

Treatment of exostosis with surgery

Treatment of exostoses is only surgical. In the case of the formation of multiple exostoses, the first step is to remove overgrown areas of bone tissue that compress nerves and blood vessels. Treatment of exostosis with surgery is carried out by orthopedic traumatologists under general or local anesthesia, depending on the size of the growths on the bone surface and their location. During the operation, overgrown areas of bone tissue are removed, followed by smoothing.

When treating exostosis in our center of traumatology and orthopedics, an operation is performed with minimal tissue trauma and the use of modern technology, as well as with the application of internal cosmetic stitches, which allows you to return to active image life in the shortest possible time. Timely methods for diagnosing exostosis with further effective treatment (if necessary) help to avoid subsequent complications of this disease.

Complications of exostosis

At large exostoses they may put pressure on neighboring bones, and bone defects and deformation of the bones of the extremities are sometimes observed. In very rare cases, fractures of the exostosis stalk are observed. The most serious complication is the transformation of exostosis into a malignant tumor. Most often, malignant transition occurs with exostoses of the hip, scapula, pelvis, and vertebrae; Histologically, such osteogenic sarcoma can have the structure of chondrosarcoma, chondromyxosarcoma and spindle cell sarcoma, i.e., a malignant tumor of a very different morphological structure.

Prevention

The only prevention of exostosis is regular examination, preventive examination. It is especially important to carry it out among children, since the formation of exostosis can cause abnormal development skeleton and will cause a lot of trouble in the future.

Ministry of Education and Science of the Russian Federation

Federal State Budgetary Educational Institution of Higher Professional Education

in physical education

on the topic: Exostotic disease

Completed:

Art. gr. B445 Kan A. R.

Checked:

Batueva D.V.

In the concept of many people, tumors are always some kind of round formations consisting of soft tissue. But the formation of any outgrowth on the bones does not fit into such a concept at all. Although, according to all internal and external signs, these formations are tumors with a benign course. This means that over time the neoplasm does not have a tendency to rapid growth and distribution throughout the body.

If the growth forms on the outer surface of the bone, then it is medical practice called "exostosis". It can consist of almost any tissue that is involved in the formation of the musculoskeletal system. The peculiarity of such a tumor is that it is practically asymptomatic - most patients know about its existence, but extremely rarely seek help from a doctor. Bone growths become a cause for concern only when they are accompanied by pain or discomfort.

Limiting usual activities or discomfort immediately force patients to begin treatment for the tumor. In mild cases, conservative methods that bring an analgesic effect are sufficient. If such treatment is ineffective, the issue of surgery is decided in order to radically eliminate exostosis, which is the cause of mechanical irritation of surrounding tissues. But in children, the methods of assistance are slightly different, which is due to the incomplete processes of growth and development of the body.

Species

The outcome of this disease is always a small protrusion that forms in a certain area of ​​the bone. But what causes excess tissue growth? There are three main mechanisms by which osteochondral outgrowths develop:

• The first option is more typical for childhood, and is due to congenital and hereditary factors. If one of the parents had multiple exostoses, then the likelihood of their occurrence in the child is extremely high. This is due to initial defects in the formation of bone tissue, which leads to the development of single or multiple benign tumors.
• The second option is more often observed in adult patients - it is based on a long-term mechanical effect on the bone. Features of professional activity or habits cause constant pressure on the tissue. For protection purposes, the body forms a small growth in such an area.
• The third option is intermediate - it is more often observed in young people and adolescents. In this case, osteochondral exostosis forms in the area of ​​attachment of muscles or ligaments to the bone. Excessive physical activity can lead to the development of chronic damage there, in place of which a bone outgrowth forms over time.

Osteochondral exostosis, depending on the location, can develop in two main types, in each of which one of the tissues predominates in the tumor.

Bone

Such a tumor usually forms in areas of tissue that are significantly removed from the joints. Exostosis almost completely repeats the structure of the underlying bone on which it was formed. This is due to disturbances in growth processes - in a certain area, cells initially began to divide incorrectly, which ultimately led to the formation of a growth.

To the touch, these dense protrusions seem the same, but there are their varieties. They are based on pathological processes that are absolutely opposite in nature:

1. A tumor consisting of bone cell elements usually forms in the skull or pelvis. This feature is due to the long maturation of these parts of the skeleton, which consist of several individual bones at once. Therefore, exostosis sometimes develops in the area of ​​their sutures due to impaired growth processes.
2. Frequent and prolonged microtraumas - tears at the attachment points of ligaments, lead to the development chronic inflammation. It leads to the proliferation of connective tissue, which is gradually replaced by bone, forming a small, noticeable protrusion.
3. Fractures also do not always go away without a trace - if the bone tissue was not matched accurately, then a rough callus forms in this area. To the touch, such a formation also represents an exostosis - a motionless and very dense nodule.

Pure bone growths require specific and immediate treatment only for persistent symptoms or signs of growth of the formation.

Mixed

If a protrusion forms in the joint area, then it is high probability will consist of several fabrics at once. Such osteochondral exostosis can seriously affect mobility, being a mechanical obstacle. Moreover, changes are most often observed in the knee joint, which is due to it. Therefore, the following pathologies are observed in adults:

• Exostosis of the knee joint can be congenital, when one of its constituent bones initially has a soft growth. TO adolescence, it thickens significantly, after which it begins to cause discomfort to a person when moving and even during normal standing.
• Another option is a predisposition to the development of exostosis, due to the special structure of cartilage tissue. Typically, changes are observed in the area of ​​the patella, at the upper or lower end of which a dense process gradually forms.
• There is a traumatic nature here too - regular damage to the tendon of the hip extensor muscles triggers the processes of bone tissue growth. Therefore, over time, exostoses may appear in the area kneecap and under it.

Without treatment, the listed conditions will inevitably lead to the development of arthrosis - irreversible changes in the joint, accompanied by a decrease in mobility in it.

Treatment

If the pathological growth is not accompanied by manifestations, then it still needs to be carefully monitored. Its size needs to be assessed regularly to assess its growth rate. A rapid increase in formations is characteristic of malignant tumors, which require immediate treatment.

If exostosis does not increase, then it is most likely of benign origin. In this case, only preventive measures:

• Constant mechanical irritation of the growth should be avoided - during physical activity, work, rest. To do this, you need to choose clothes and shoes well, as well as properly organize your labor process.
• Exposure to sudden temperature changes, which can provoke pain in the protrusion area, is not recommended.
• Regular moderate physical activity strengthens muscle tissue, which does not allow the bone spine to further increase in size.

Much depends on the location of the growth - if it is located in an area of ​​​​constant friction or pressure, then manifestations will inevitably arise.

Conservative

If the formation gives a person slight or periodic discomfort, then it can be “hidden” with the help of medications and physical therapy methods. The following purposes are used:

1. Non-steroidal anti-inflammatory drugs are the standard of treatment - they are used in any form (injections, tablets,). They allow you to eliminate signs of inflammation in the area of ​​growth associated with irritation of surrounding tissues.
2. If they are ineffective, a blockade is performed with Diprospan - a small amount of the product is injected into the area of ​​exostosis using a syringe. It provides a long-lasting analgesic effect.
3. Additionally, physiotherapy methods are used - gymnastics, massage, electrophoresis with painkillers or enzymes. They can significantly improve metabolic processes that were disrupted due to prolonged pressure of the tumor on surrounding tissues.

The effectiveness of conservative treatment is assessed within several weeks - the absence of positive changes becomes an indication for radical removal of exostosis.

Surgical

Surgery always seems to be the best way to solve the problem - but after it more serious mobility problems can develop. Therefore, intervention is always the most extreme treatment option. Currently, growths are removed in the following ways:

• Traditional option- This is the destruction of a protrusion through a cut in the skin. After dissecting the surrounding soft tissue, the bone spine is completely removed within the healthy tissue. But such intervention is possible only with a single exostosis located in an accessible place.
• A more modern method is shock wave destruction of the build-up, which is carried out using special devices. They are fixed over the affected area, after which the tumor is mechanically crushed through the skin. But here, too, the localization of the formation matters - there should not be any important structures of the body nearby.

Surgical treatment always carries a risk for preserving the function of the musculoskeletal system. Therefore, even after successful removal of exostosis, the function of the joints or the entire limb may be completely or partially lost.

In a child

For children, the appearance of a pathological growth on one or more bones usually has tumor origin. This is due to the fact that they usually do not have other causes of its occurrence - constant mechanical impact or chronic injury. Therefore, neoplasms, often of a congenital nature, are more typical for a child:

• consist only of bone tissue, and are usually localized in the area of ​​long tubular bones. The disease is usually asymptomatic, so its detection occurs by chance. While playing or washing, children develop a dense, immovable nodule, as if fused to bone tissue.
• Osteochondromas are of a mixed nature, manifested by the formation of exostoses in the joint area. Since in children the ossification processes are still in progress, manifestations may be absent. But in some cases, you can notice deformation associated with the formation of a tumor. When palpated, it is softer than osteoma and can also be mobile.

These diseases are quite rare, so if you find any growth on the bone in a child, it is better to show it to the doctor. Most often, these “tumors” are normal skeletal formations that will not affect the further growth and development of the baby.

Treatment

If the pathological origin of exostosis is nevertheless confirmed, then regular medical supervision is established for the child. It is not recommended to perform surgery at this age, as it may affect further bone formation. Therefore, treatment consists of the following stages:

1. The baby is regularly examined by a doctor, assessing the size of the tumor, as well as its growth rate.
2. If the tumor practically does not grow, then its removal can be waited until the baby’s skeleton has time to fully form. For this period special events not required - the child grows in normal conditions.
3. If the formation begins to actively grow, then the operation can radically solve the problem. In this case, intervention cannot be delayed in order to avoid complete destruction normal bone tissue by tumor.

Medicines and methods of physiotherapy in the treatment of such pathology are only auxiliary in nature, helping to eliminate unpleasant manifestations. The basis of assistance is the radical removal of the tumor, which at any moment can manifest itself as rapid and malignant growth.