Clinical Examples: Phalangeal head exostosis variations

Rarely, periarticular bone growth involves the interphalangeal joints of the fingers. These cases demonstrate some of the variations.

 
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Case 1. 14 year old boy with radial prominence and ulnar deviation of the middle finger proximal interphalangeal joint. Painless, no history of trauma.
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Radiographs showing well circumscribed calcification at the  proximal phalanx collateral ligament origin, 10 degrees of lateral angulation. 
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This was treated with simple excision. Pathology was consistent with mature bone.
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Case 2. Mass developing after a lateral dislocation of the proximal  interphalangeal joint of a 34 year old woman. 
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Radiographs were consistent with either a united collateral ligament avulsion fracture or ossiification of a parosteal hematoma.
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This was treated with simple excision and collateral ligament repair to local tissues.
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Late result.
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Case 3. 21 year old woman with pain developing in a congenitally angulated thumb.
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Radiographs show a juxtaarticular ossification with  subchondral cyst formation of the bone interface with the lateral phalangeal head and lateral angulation of the proximal phalanx articular surface.
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This was treated with excision of the mass and corrective closing wedge osteotomy of the proximal phalanx.
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There was no articular cartilage on the pseudojoint, with  arthritic type reactive changes.
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Corrected alignment
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Intraoperative fluoroscopy. The mass:
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Osteotomy planning: proximal pin parallel to the proximal joint line, distal pin parallel to the distal joint line: 
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Pins were used as saw blade alignment guides:
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Osteotomy closed:
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Intraosseous wire passed through pin tracts, interfragmentary pin:
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Late result:
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articular phalanx exostosis
phalanx osteotomy

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