TITLE:
Hereditary Multiple Exostoses (HME) with Peroneal Nerve Compresion: A Case Report
AUTHORS:
Onarisa Ayu, Muhammad Iqbal
KEYWORDS:
Osteochondroma, Hereditary Multiple Exostosis (HME), Peroneal Nerve Compression
JOURNAL NAME:
International Journal of Medical Physics, Clinical Engineering and Radiation Oncology,
Vol.12 No.2,
May
17,
2023
ABSTRACT: Introduction: Hereditary multiple exostosis (HME) is a
hereditary disorder characterized by multiple osteochondromas. Clinical
symptoms can result from compression of adjacent structures such as peripheral
nerves. In Indonesia, HME with nerve compression cases have rarely reported. Presentation of Case: An
eleven-year-old female with complaining of left knee joint pain and progressive
masses in left lower leg since 6 years ago. This complains followed by numbness
and difficulty to dorso flexion motion on left ankle joint since four months
ago. Physical examination showed of the bony masses was detected at the left
lateral upper third lower leg with measuring about six into eight centimeters.
Range of motion of left ankle joint patient had difficult to dorso flexion.
X-ray imaging viewed demonstrates multiple exostosis appearance involving distal femoral, proximal
fibula, proximal tibia and distal fibula bone. MR Imaging revealed cartilage
cap of head fibula is thin less 1.5 cm and the axially specimen showed peroneal nerve compression. The
patient underwent left head fibula wide resection. Intraoperative findings
peripheral nerve peroneal compression and was decompression. Medical
rehabilitation for physiotherapy was advised. The results of the follow-up
after 2 years, no pain feels and the patient was able to dorso flexion of left
ankle joint and no additional bumps in other areas of the body. These lesions may arise from any bone which
was pre-formed in the cartilage. Nerve compression syndromes are the neurological complex symptom caused
by the mechanical or dynamic compression of a specific single segment. MRI was
excellent demonstration of blood vessels compromise and represents choices with
peripheral nerves structures and to measuring cartilage cap thickness for
criterion of osteochondromas differentiation and exostotic grade. Complete
resection was importance of the cartilaginous cap to prevent recurrence. The decompressing the peroneal nerve that
pressured by the masses and vascular problems occured. Conclusion: Hereditary multiple exostosis is an
inherited disorder characterized by multiple osteochondromas. It is important
to monitor all cases of HME especially if the patient complains of pain or
growth of an osteochondroma. The surgical excision, with complete resection of
the cartilaginous cap of the tumor, is important in preventing recurrence.