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Intra- or periarticular osteoid osteoma (00) is uncommon, and therefore a diagnostic challenge. Symptoms are: chronic synovitis, decreased range of motion, joint effusion, and joint contracture. Radiographically, the classical perifocal sclerotic margin is often absent, which leads to a significant delay in diagnosis. The authors retrospectively studied 50 cases of intra- and peri-articular OO, treated with percutaneous destruction and alcoholisation. The mean follow-up period was 8.7 years (range, 1 to 15 years). The diagnosis was only made after +/-14 months (range, 8 to 18 months), due to atypical symptoms (nightly pain absent in 38%) and uselessness of plain radiographs (in 100%). CT-scan, contrast enhanced MRI and bone scan brought the solution. The technique was successful in 48 out of 50 cases (96%): incomplete excision occurred in 2 patients. The diagnosis of intra- or periarticular OO should be considered in case of unexplained joint pain where conservative treatment is inefficient.

Osteoid osteoma is a relatively frequent benign bone tumour, consisting of osteoid and woven bone, and surrounded by a halo of reactive sclerotic bone, with an average size of the nidus less than 1.5 cm. It is a condition of late childhood, adolescence and young adult age. It usually occurs in the appendicular skeleton and the spine, and is generally localised in or near the cortex. The lesion causes pain, especially at night, but can cause joint pain with synovitis and joint effusion if located in the vicinity of chondral structures, or painful scoliosis if located in the spine. Osteoid osteoma may have an unpredictable course, and may require treatment or resolve spontaneously. In some cases, the diagnostic approach is challenging; there are different treatment methods, some of which have been recently introduced, with promising results. We review the literature about the natural history, clinical presentation, diagnostic approach and classical or modern treatment modalities of osteoid osteoma.

Osteoid osteoma (OO) is a small, self-limiting, benign osteogenic tumour. Successful treatment of OO requires complete resection or destruction of the nidus. Surgery, which consists of en bloc excision of the nidus, followed by internal fixation, bone grafting, or both, is successful in almost all cases. In a small percentage of cases the nidus may be missed at surgery, resulting in a failed procedure. The aim of this study was to evaluate the results of percutaneous destruction and alcoholisation as a treatment of OO. Fifteen patients with an osteoid osteoma (10 males, 5 females) were treated in the Oncology Unit, Orthopaedic Department, Mansoura University Hospital. Three OOs were localised in the humerus, 5 in the femur, 6 in the tibia and fibula, and one in the talus. All patients underwent destruction of the nidus by determining the nidus by CT, drilling with a cannulated drill bit, curretting with a speed burr and injecting ethanol. The nidus completely disappeared on the postoperative CT-scan. The average follow-up period was 19 months (6-24 months). There were no postoperative complications. This technique for the treatment of OO is minimally invasive, safe, simple, and cost effective. It allows an early return to normal activities. The procedure is particularly useful for a lesion located deep in the skeleton, which would require an extensive approach with conventional surgery.