When Should You Be Wary Of Hypertrophic Bone Formation?

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Note this AP X-ray showing prominent but well organized hypertrophic bone formation at the site of prior partial 1st ray amputation. The patient, in question, is a 51-year-old male with diabetes.
Here is an AP X-ray showing the immediate postoperative result from resection of the hypertrophic 1st metatarsal stump.  The DPM used a power sagittal saw and stripped the periosteum 1 cm proximal to the resection. The surgical incision site healed uneven
Here is an AP X-ray of the same foot six months later.  As you can see, there is recurrence of the hypertrophic bone formation at the 1st metatarsal stump.  Note the poorly organized and irregular bone formation to the site. Accommodative shoe gear is suf
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Author(s): 
By Pamela M. Jensen, DPM

Final Notes
In conclusion, hypertrophic bone formation can lead to reulceration in diabetic neuropathic patients and can be the cause of complication in elective surgical procedures. Evidence shows that manual instrumentation for osteotomies in metaphyseal bone results in increased trauma to the periosteum and thus increases the risk of over-stimulation of fibroblasts to form hypertrophic bone. You should reserve treatment only for symptomatic cases and hold off on attempting further bone resection until the exostosis is fully matured in order to prevent reoccurrence and further revisional procedures.

Dr. Jensen is a first-year resident at the University of Texas Health Science Center at San Antonio.
Dr. Steinberg (pictured) is an Assistant Professor in the Department of Orthopaedics/Podiatry Service at the University of Texas Health Science Center.

Clarification: The Diabetes Watch column in the April issue was written by Chih Yen, DPM. Dr. Yen is a first-year resident at the University of Texas Health Science Center at San Antonio.




References:

1. Armstrong DG, Hadi S, Nguyen HC, Harkless LB, Factors Associated with Bony Regrowth Following Diabetes-Related Partial Foot Amputation, Journal of Bone and Joint Surgery American, 81(11) 1561-5.
2. Conner JM and Evans DP, Fibrodysplasia ossificans progressiva. Journal of Bone and Joint Surgery 64B: 76-83, 1982.
3. Resnick D, and Niwayama G (eds.) Diagnosis of Bone and Joint Disorders, pp. 2042-2085, 2412-2413, 2997, W. B. Saunders, Philadelphia, 1981.
4. Shollenberger BS, and Mandracchia VJ, Exuberant Bony Proliferation Following Foot Surgery, The Journal of Foot Surgery, Vol. 27, N. 5, pp. 433-439 1988.
5. Hellstadius A, An investigation, by experiments on animals, of the role played by the epiphysial cartilage in longitudinal growth. Acta Chir. Scand. 95:156,1947.
6. Speer DP, The Pathogenesis of Amputation Stump Overgrowth, Clinical Orthopedics and Related Research, No. 159, pp.284-306, September 1981.
7. Turek SL (ed.) Orthopaedics: Principles and their Applications, pp. 744, 1173, J.B. Lippincott, Philadelphia, 1984.
8. Edmonson AS, and Crenshaw AH (ed) Campbell’s Operative Orthopedics, pp. 530, 2372-2375, C.V. Mosby, St. Louis.

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