What is your diagnosis?

Osteochondroma: Image 1 shows a solitary, pedunculated mass arising from the medial cortex of the distal femur at the meta-diaphyseal junction without any bony lucency or cortical destruction. 

Image 2. Case courtesy of Dr Aditya Shetty, Radiopaedia.org, rID: 27292. Labels by Author

• Pearl: Osteochondromas slowly develop in early childhood and stop growing after reaching skeletal maturity. They are usually found on long bones (Femur 30%, Tibia 10-20%, Humerus 10-20%) [1].

What is your treatment in the ED?

Osteochondromas are benign bone tumors and are usually incidental findings. They often do not cause symptoms and therefore no treatment is necessary. If osteochondromas are causing pain or growing past skeletal maturity, there may be concern for malignant transformation or occult fracture of the tumor [2].

• Pearl: If there is no family history of hereditary osteochondromatous syndromes, the likelihood of malignant transformation to chondrosarcoma is <1% [3].

What is your disposition?

Patients can be safely discharged with follow-up with orthopaedics only as needed. Orthopedic consultation in the ED is not necessary. Asymptomatic osteochondromas are routinely just observed. However, painful or cosmetically unappealing osteochondromas can be surgically resected as an outpatient. 

Do I need to consult orthopaedics?

Yes.