Atypical Presentation of Synovial Osteochondromatosis At the Subtalar Joint Mimicking A Fracture Following Trauma: A Case Report
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2019, Vol 13, Issue 1
Abstract
Synovial osteo chondromatosis (SOC) are benign tumors arising from metaplastic synovial tissue of joints, bursae or tendon sheath. These tumors are most commonly found in the knee joint and rarely presents in the foot and ankle region. We report a case of a middle age gentleman with primary SOC and was misdiagnosed as an acute neck of talus fracture following trauma. He presented with pain one week after a fall and examination revealed a 4x4 cm bony hard swelling over the anterolateral aspect of the right ankle joint. Radiograph showed a possible neck of talus fracture but Computer Tomographic (CT) scan revealed no fracture but bony mass within the sinus tarsi and extending to the lateral aspect of the ankle joint. Excision biopsy confirmed SOC and patient recovered fully without any pain and no sign of recurrence after 1-year follow-up. This case highlights the rarity of SOC in the foot and ankle region, which mimicked a fracture of the neck of talus.Synovial osteo chondromatosis (SOC) are benign tumors arising from synovial tissue of joints, bursae or tendon sheath. These synovial tissues undergo metaplasia to form cartilaginous or osteocartilaginous bodies which may break off from the synovial surface, causing pain or mechanical blockage to the joint [1]. Involvement is usually monoarticular, with the large joints being most frequently affected. The knee joint is involved in 60 to 70% of cases; the shoulder, elbow, and hip are the next most frequently involved joint. It rarely involves the joints of the foot and ankle region [2]. Here we report an atypical presentation of primary SOC of the right subtalar joint in a middle age gentleman, who presented with pain of the right ankle and was misdiagnosed as a right talus fracture, after a traumatic fall in his workplace.A 40-year-old male was referred to our Orthopedic Department with a history of trivial fall one week ago in his workplace and was diagnosed as a right neck of talus fracture. It is associated with pain and limited range motion of the affected ankle especially on eversion and inversion of ankle. He denied any pain or swelling over the ankle region prior to the above injury. On examination, there is a localized swelling just anterior to the lateral malleolus. On palpation it was tender and firm in consistency. The pain was aggravated with passive inversion and eversion of the subtalar joint. The ankle was otherwise stable. All bloods investigations were normal. Radiographs of the right ankle showed a large calcified mass that contained multiple radiopaque bodies, lateral to the subtalar joint. From the lateral view, there appeared to be a suspicious fracture line traversing the neck of talus (Figure 1). As we were unable to rule out a fracture, we proceeded with a CT scan of the right ankle that reported no obvious fracture but revealed a large bony mass measuring 5x4x4 cm within the sinus tarsi and extending to the lateral aspect of the ankle joint (Figure 2). In view of the benign presentation of the tumor an excision biopsy was performed. The surgery was done through anterolateral approach to the talus, exposing the whitish bony hard mass that was sitting in the region of the sinus tarsi. Intraoperative findings showed a solitary whitish bony tumor measuring about 5x4x4 cm in size (Figure 3a), which was encased by hypertrophied synovium. The disease was noted to have eroded the adjacent plantar surface of the talar neck. The tumor was removed as a whole and sent for histopathology examination (HPE). The section showed few chondorocytes arranged in lobules within the synovial which was consistent with synovial chondromatosis. No nuclear atypia was seen, ruling out malignancy (Figure 3b).
Authors and Affiliations
Azammuddin A, Tan JA, Othman MS, Hanif KAA, Halim MAHA, Leong JF
Keywords
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- EP ID EP594397
- DOI 10.26717/BJSTR.2019.13.002341
- Views 164
- Downloads 0
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