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Osteoid Osteoma and Your Everyday Practice n Review Article Instructions 1. Review the stated learning objectives at the beginning cme ARTICLE of the CME article and determine if these objectives match your individual learning needs. 2. Read the article carefully. Do not neglect the tables and other illustrative materials, as they have been selected to enhance your knowledge and understanding. 3. The following quiz questions have been designed to provide a useful link between the CME article in the issue Osteoid Osteoma and your everyday practice. Read each question, choose the correct answer, and record your answer on the CME Registration Form at the end of the quiz. Petros J. Boscainos, MD, FRCSEd; Gerard R. Cousins, MBChB, BSc(MedSci), MRCS; 4. Type or print your full name and address and your date of birth in the space provided on the CME Registration Form. Rajiv Kulshreshtha, MBBS, MRCS; T. Barry Oliver, MBChB, MRCP, FRCR; 5. Indicate the total time spent on the activity (reading article and completing quiz). Forms and quizzes cannot be Panayiotis J. Papagelopoulos, MD, DSc processed if this section is incomplete. All participants are required by the accreditation agency to attest to the time spent completing the activity. educational objectives 6. Complete the Evaluation portion of the CME Regi stration Form. Forms and quizzes cannot be processed if the Evaluation As a result of reading this article, physicians should be able to: portion is incomplete. The Evaluation portion of the CME Registration Form will be separated from the quiz upon receipt at ORTHOPEDICS. Your evaluation of this activity will in no way affect educational1. Discuss the clinical objectives presentation of and different imaging modality options the scoring of your quiz. for suspected osteoid osteomas. 7. Send the completed form, with your $15 payment (check or money order in US dollars drawn on a US bank, or credit card information) to: ORTHOPEDICS CME Quiz, PO Box 36, 2. Develop an insight into the histopathology and histochemistry of osteoid Thorofare, NJ 08086, OR take the quiz online. Visit www. Healio.com/EducationLab/Orthopedics for details. osteomas. 8. Your answers will be graded, and you will be advised whether you have passed or failed. Unanswered questions will be 3. Use diagnostic processes in the differential diagnosis of suspected osteoid considered incorrect. A score of at least 80% is required to pass. osteomas. If a passing score is achieved, Keck School of Medicine of USC will issue an AMA PRA Category 1™ certificate within 4-6 weeks. 9. Be sure to mail the CME Registration Form on or before 4. Apply current treatment depending on the location and accessibility of the deadline listed. After that date, the quiz will close. CME the lesion. Registration Forms received after the date listed will not be processed. CME ACCREDITATION This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through ABSTRACT osteomas have wide variations in presen- the joint sponsorship of Keck School of Medicine of USC and ORTHOPEDICS. Keck School of Medicine of USC is accredited Osteoid osteoma is the third most com- tation and tend to present in the second by the ACCME to provide continuing medical education for mon benign bone tumor. The authors decade of life, with pain that is worse at physicians. Keck School of Medicine of USC designates this Journal- describe the clinical presentation, diag- night and is relieved by salicylates. Plain based CME activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate nostic investigations, differential diagno- radiographs and computed tomography with the extent of their participation in the activity. sis, histopathology, and treatment options scans are the mainstay of imaging; how- This CME activity is primarily targeted to orthopedic surgeons, hand surgeons, head and neck surgeons, trauma for this condition, including a compre- ever, bone scintigraphy, single-photon surgeons, physical medicine specialists, and rheumatologists. There is no specific background requirement for participants hensive review of the literature. Osteoid emission computed tomography, magnet- taking this activity. FULL DISCLOSURE POLICY In accordance with the Accreditation Council for Continuing Medical Education’s Standards for Commercial Support, all CME providers are required to disclose to the activity audience The authors are from the Department of Trauma and Orthopaedic Surgery (PJB, GRC, RK), Perth the relevant financial relationships of the planners, teachers, Royal Infirmary, NHS Tayside, Perth, Scotland; Department of Radiology (TBO), Ninewells Hospital, and authors involved in the development of CME content. An NHS Tayside, Dundee, United Kingdom; and the Department of Orthopaedics (PJP), Athens University individual has a relevant financial relationship if he or she has a financial relationship in any amount occurring in the last Medical School, Athens, Greece. 12 months with a commercial interest whose products or The authors would like to thank Dr Elaine MacDuff, Western Infirmary, Glasgow, United Kingdom, services are discussed in the CME activity content over which for providing the image of the hematoxylin-eosin stain. the individual has control. The authors have no relevant financial relationships to The material presented in any Keck School of Medicine of USC continuing education activity does not disclose. Dr Aboulafia, CME Editor, has no relevant financial necessarily reflect the views and opinions of ORTHOPEDICS or Keck School of Medicine of USC. Neither relationships to disclose. Dr D’Ambrosia, Editor-in-Chief, has ORTHOPEDICS nor Keck School of Medicine of USC nor the authors endorse or recommend any techniques, no relevant financial relationships to disclose. The staff of ORTHOPEDICS have no relevant financial relationships to disclose. commercial products, or manufacturers. The authors may discuss the use of materials and/or products that UNLABELED AND INVESTIGATIONAL USAGE have not yet been approved by the US Food and Drug Administration. All readers and continuing education The audience is advised that this continuing medical participants should verify all information before treating patients or using any product. education activity may contain references to unlabeled uses Correspondence should be addressed to: Petros J. Boscainos, MD, FRCSEd, Department of Trauma of FDA-approved products or to products not approved by the FDA for use in the United States. The faculty members have and Orthopaedic Surgery, Perth Royal Infirmary, NHS Tayside, Taymount Terrace, Perth, United King- been made aware of their obligation to disclose such usage. dom, PH1 1NX ([email protected]). doi: 10.3928/01477447-20130920-10 792 ORTHOPEDICS | Healio.com/Orthopedics OSTEOID OSTEOMA | BOSCAINOS ET AL cme ARTICLE ic resonance imaging, and sonography predominantly the talar neck. Flat bones IMAGING are also used. Osteoid osteomas consist in the body and the skull are rarely af- Plain Radiographs of a nidus with surrounding sclerotic fected. Osteoid osteoma is usually local- Plain radiographs are the initial imaging bone. The differential diagnosis covers a ized within the bone cortex. Subcortical, study of choice. The osteoid osteoma ap- wide range of conditions due to the vari- intracortical, and intraperiosteal osteoid pears as a small, radiolucent nidus (usually able presentation of osteoid osteoma. The osteomas have been described. Osteoid less than 1 cm) surrounded by a variable natural history is for regression to occur osteomas of the spine account for ap- area of sclerotic bone or cortical thicken- within 6 to 15 years with no treatment; proximately 6% of cases and almost al- ing (Figure 1). The nidus can be difficult however, this can be reduced to 2 to 3 ways involve the posterior arch area close to detect when it is obscured by sclerotic years with the use of aspirin and non- to the pedicles.6,7 The lumbar spine is the cortical bone or in cases of intra-articular steroidal anti-inflammatory drugs. Com- most commonly affected region. Multiple lesions, where bone deposition from the in- puted tomography–guided percutaneous osteoid osteoma nidi in the same or dif- tracapsular periosteum is usually less.12,13 techniques, including trephine excision, ferent bones are rare.8,9 In addition, intramedullary-located oste- cryoablation, radiofrequency ablation, Pain is the most common clinical oid osteomas may not exhibit surrounding and laser thermocoagulation, are de- presentation. Its usual characteristics bone sclerosis.14 Indirect manifestations of scribed. are dull, unremitting, initially mild and synovial inflammation and joint effusion intermittent pain that increases in inten- may be evident, or symptoms that mimic steoid osteoma is a small, dis- sity and persistence over time. It tends osteoarthritis may be present.13,15 When tinctive, nonprogressive, be- to become increasingly severe at night treatment is delayed, secondary osteopenia Onign osteoblastic lesion that is and is usually relieved by salicylates and and changes in bone morphology may be usually accompanied by severe pain. nonsteroidal anti-inflammatory drugs observed.11 If the nidus is larger than 1.5 Jaffe1 was the first to report the iden- (NSAIDs). The indolent nature of early cm, the lesion is usually designated as an tification of this osteoblastic lesion in osteoid osteoma may result in delayed osteoblastoma.16,17 Osteoblastomas are 1935.
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