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| CASE REPORT |
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| Year : 2014 | Volume
: 14
| Issue : 2 | Page : 158-160 |
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Femoral neck osteochondroma in an athlete: A case report and literature review
Abdullah D Alqarni
Department of Emergency Medicine, King Khaled University Hospital, King Saud University, Riyadh 11324, Saudi Arabia
| Date of Web Publication | 9-Oct-2014 |
Correspondence Address:
Abdullah D Alqarni
Department of Emergency Medicine, King Khaled University Hospital, King Saud University, P. O. Box 226638, Riyadh 11324
Saudi Arabia
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1319-6308.142375
Osteochondroma is a common primary bone tumor that is most often occurring around the knee. Osteochondromas are usually asymptomatic; however, they might cause a variety of symptoms depending on their size and location. Solitary osteochondroma of the femoral neck is an exceedingly rare condition. We are describing a rare cause of groin pain and hip stiffness in an athlete. Clinical and radiological evaluation revealed that the symptoms were due to a solitary osteochondroma of the femoral neck. To the best of our knowledge, this is the only report that describing a groin pain in an athlete due to a femoral neck osteochondroma. Osteochondroma of the femoral neck should be included in the differential diagnosis of groin pain in athletes. Sport-medicine physician's awareness of these lesions together with a high index of suspicion is crucial for diagnosis. يعد العرن العظمي من أكثر الأورام العظمية الأولية شيوعا والتي غالبا ما يحدث حول الركبة. لا يؤدي العرن العظمي عادة إلى أعراض ولكنه قد يسبب أحيانا مجموعة متنوعة من الأعراض اعتمادا على حجمه وموقعه.
العرن العظمي الانفرادي لعنق الفخذ هو حالة نادرة جدا. نصف في هذا التقرير سببا نادرا للألم وتيبس الورك لدى أحد الرياضين. كشف التقييم السريري والإشعاعي أن الأعراض كانت نتيجة لعرن عظمي انفرادي من عنق الفخذ. هذا هو التقرير الوحيد- بحسب علمنا- الذي يصف ألم الورك في أحد الرياضيين بسبب العرن العظمي لعنق الفخذ.
ينبغي أن يدرج العرن العظمي لعنق الفخذ في التشخيص التفريقي للألم الورك في الرياضيين. إن وعي طبيب الطب الرياضي لهذه الآفات مع ارتفاع حالة الاشتباه بها أمر حاسم لتشخيص المرض.
Keywords: Athlete, exostosis, femoral neck, osteochondroma
How to cite this article:
Alqarni AD. Femoral neck osteochondroma in an athlete: A case report and literature review. Saudi J Sports Med 2014;14:158-60 |
| Introduction | |  |
Osteochondroma is the most common primary bone tumor. It is a benign tumor containing both bone and cartilage, and usually occurring near the end of a long bone. It is usually an extra-articular lesion arising from the metaphysis of long bone and seen most commonly at the knee, forearm, and ankle. [1]
Osteochondromas are generally asymptomatic, however; depending on their size and location, they may cause neurovascular compression symptoms or pain due to bursal inflammation or impingement on an overlying structure. In addition, concern exists about their malignant degeneration.
Osteochondroma can present as solitary or multiple lesions that is pedunculated or sessile. Hereditary multiple exostoses, also known as osteochondromatosis, is a rare, autosomally dominant inherited condition that causes multiple bony lesions.
We are describing a rare cause of groin pain and hip stiffness in an athlete which turned out to be a solitary osteochondroma of the femoral neck. The patient was agreed that date concerning his case would be submitted for publication and was approved by the institutional review board. To the best of our knowledge, this is the first report that describing a groin pain in an athlete due to a femoral neck osteochondroma.
| Case report | | |
A 28-year-old athlete patient presented with right groin pain and stiffness. The pain started 2 months prior to the presentation without history of antecedent trauma. It was insidious, initially mild and became progressively severe with time, and radiating to the medial side of the thigh. The pain interfered with daily activities of the patient and led to the discontinuation of his sport performance. The patient also noticed an ipsilateral hip stiffness following the onset of pain, which also was progressive and interfered with his activities.
The patient was initially assessed by the general practitioner who prescribed him analgesia and advised modification of daily activities; however, no further radiological imaging was performed. Clinical examination upon presentation revealed a right hip tenderness with the restricted and painful range of motion of the affected hip. The internal and external rotation particularly was severely limited.
In view of the persistent patient symptoms and failure of medical treatment, we proceeded to radiological investigations. Radiographs of the right hip showed a large mass at the inferior surface of the right femoral neck [Figure 1]. To further delineate the mass, a computed tomography scan with three-dimensional reconstruction was ordered. It revealed an ill-defined 31 × 29 mm bony expansion at the region of the right femoral neck with low attenuation cystic areas and undulating cortical contour [Figure 2]. It was suggestive of a sessile osteochondrma (exostosis). Magnetic resonance imaging (MRI) was also performed to assess the soft-tissue part of this tumor, especially the cartilage cap thickness and to exclude malignancy. MRI demonstrated a sessile, broad-based osseous protuberance with cortical and medullary continuity with the parent bone at the medial aspect of right femoral neck confirming the diagnosis of a sessile osteochondroma. Cartilage cap was normal in thickness measuring <1 cm, with no evidence of soft-tissue mass or cartilage irregularity to suggest malignant transformation [Figure 3]. | Figure 1: Anteroposterior and lateral views of both hips radiographs showing the osteochondroma of the femoral neck on the right side (arrow)
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 | Figure 2: Coronal and axial computed tomography scan views with three-dimensional reconstruction view demonstrating the osteochondroma (arrow)
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 | Figure 3: Coronal and axial magnetic resonance imaging views demonstrating the sessile osteochondroma lesion with the classic cartilage cap (arrow)
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The patient was referred to the orthopedic surgeon and planned for surgical excision of the lesion.
| Discussion | | |
The differential diagnosis of groin pain in athletes is broad and includes conditions of the hip, lower back, and pelvis. It is estimated that hip and groin injuries accounted for 6% of all adult athletic injuries. They also cause a significant morbidity in athletes. [2] Conditions such as athletic pubalgia (or sports hernia), piriformis syndrome, stress fractures, strains and snapping hip are established, well reported causes of such athletic injuries.
Osteochondroma of the femoral neck is relatively rare. It is atypical as it represents an intra-articular lesion. It has been described in association with trochanteric bursitis, sciatic nerve compression, [3],[4] a snapping hip, [5] femoroacetabular impingement, [6],[7] a fracture at its pedicle, [8],[9] or symptomatic nonunion of such a fracture. [10],[11] In our patient; it was associated with groin pain and restricted hip range of motion.
Osteochondroma of the femoral neck may lead to pain and mechanical restriction of hip motion. Mechanical block occurs if there is a direct contact of the enlarged femoral neck against the ischium or the acetabulum. [7] Neurovascular compression is rare and occurs in <1% of all cases of osteochondromas. [12] In the current case, we speculate that groin pain and stiffness was due to an impingement between the enlarged osteochondroma lesion and the ischium. However; an element of bursitis as a cause of pain cannot be ruled out.
Based on a literature search, only one case of solitary osteochondroma of the femoral neck has been reported. [3] In that report, it caused a sciatic nerve compression. This contrasted with the osteochondroma presented here, which caused a groin pain and stiffness. Reports similar to the current case; describing a femoral neck osteochondroma that caused pain and restricted range of motion; have been reported, however; in these reports, there were multiple osteochondromas rather than a solitary lesion. [4],[8]
| Conclusion | | |
Osteochondroma of the femoral neck is a rare cause of groin pain and hip stiffness in athletes. Physicians taking care of athletic individuals should be aware of the possibility of this lesion in patients with unexplained symptoms. Sufficient radiological investigation is crucial for diagnosis, and physicians should be more liberal in requesting them.
| References | | |
| 1. | Peterson HA. Multiple hereditary osteochondromata. Clin Orthop Relat Res 1989; 329:222-30.  |
| 2. | Keogh MJ, Batt ME. A review of femoroacetabular impingement in athletes. Sports Med 2008;38:863-78. |
| 3. | Yu K, Meehan JP, Fritz A, Jamali AA. Osteochondroma of the femoral neck: A rare cause of sciatic nerve compression. Orthopedics 2010;33:625-26 . |
| 4. | Turan Ilica A, Yasar E, Tuba Sanal H, Duran C, Guvenc I. Sciatic nerve compression due to femoral neck osteochondroma: MDCT and MR findings. Clin Rheumatol 2008;27:403-4. |
| 5. | Inoue S, Noguchi Y, Mae T, Rikimaru S, Hotokezaka S. An external snapping hip caused by osteochondroma of the proximal femur. Mod Rheumatol 2005;15:432-4. |
| 6. | Hussain W, Avedian R, Terry M, Peabody T. Solitary osteochondroma of the proximal femur and femoral acetabular impingement. Orthopedics 2010;33:51. |
| 7. | Siebenrock KA, Ganz R. Osteochondroma of the femoral neck. Clin Orthop Relat Res 2002; 394:211-8. |
| 8. | Robbins MM, Kuo S, Epstein R. Non-traumatic fracture of an osteochondroma mimicking malignant degeneration in an adult with hereditary multiple exostoses. Radiol Case Rep 2008;3:99. |
| 9. | Carpintero P, León F, Zafra M, Montero M, Berral FJ. Fractures of osteochondroma during physical exercise. Am J Sports Med 2003;31:1003-6. |
| 10. | Alonso-Torres A, Bernabéu D, López-Barea F, Martín-Hervás C, González-López JM. Growth and fracture of an osteochondroma in an adult patient. Eur Radiol 2004;14:2366-7. |
| 11. | Davids JR, Glancy GL, Eilert RE. Fracture through the stalk of pedunculated osteochondromas. A report of three cases. Clin Orthop Relat Res 1991; 271:258-64. |
| 12. | Paik NJ, Han TR, Lim SJ. Multiple peripheral nerve compressions related to malignantly transformed hereditary multiple exostoses. Muscle Nerve 2000;23:1290-4. |
[Figure 1], [Figure 2], [Figure 3]
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