Case Report

By Dr. Sanjay S Deo , Dr. Ashwin A Deshmukh , Dr. Anil Salgia
Corresponding Author Dr. Sanjay S Deo
Dr. D.Y.Patil Medical College Pimpri Pune India 411018, 202, Bhairavi Apt ICS Colony, Bhoslenagar Shivajinagar - India 411007
Submitting Author Dr. Sanjay S Deo
Other Authors Dr. Ashwin A Deshmukh
Dr. D.Y.Patil Medical College Pimpri Pune India 411018, Department of Orthopaedics Dr. D.Y.Patil Medical college Pimpri Pune - India 411018

Dr. Anil Salgia
Dr. D.Y.Patil Medical College Pimpri Pune India 411018, Dept of Orthopedics Dr. D.Y. Patil Medical College Pimpri Pune - India 411018


Osteochondroma, Proximal femur, Sciatica.

Deo SS, Deshmukh AA, Salgia A. Sciatica due to Osteochondroma of Proximal Femur: A Case report. WebmedCentral ORTHOPAEDICS 2013;4(8):WMC004379
doi: 10.9754/journal.wmc.2013.004379

This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Submitted on: 24 Aug 2013 02:40:28 PM GMT
Published on: 26 Aug 2013 05:27:20 AM GMT


A 68 year old female patient presented with bony swelling on the proximal part of the posterior aspect of thigh from childhood, Since 6 months she started complaining tingling and numbness in distribution of sciatic nerve. The X ray and later the MRI confirmed it to be Osteochondroma. The surgical excision of the osteochondroma confirmed the diagnosis histopathologically. Post operatively patient was relieved of all symptoms and recovered uneventfully.


Osteochondroma is the most common benign bone tumor, accounting 35% of benign and 9% of all malignant tumors1. Most are asymptomatic but can occasionally cause mechanical symptoms depending on their location and size. An osteochondroma of proximal femur can present with limb length discrepancy2, increased femoral anteversion2, valgus angulation2 and acetabular dysplasia, bursal inflammation, pain and occasionally compression on the sciatic nerve1.

Case Report

A 68 year old female presented with complaints of radiating pain with paraesthesias in left lower limb since 5 to 6 months which were affecting her activities of daily living. Patient had no history of trauma, weight lifting or constitutional symptoms.

On examination a bony hard swelling was palpable on the supero lateral quadrant of left buttock.

Nerve stretch tests and Faber’s test were positive. No distal neurological deficit was found


X ray Pelvis with both hips showed pedunculated bony excrescence with well-defined margins at the greater trochanter(Fig. No. 1 & 2 )

MRI of left hip showed sessile bony excrescence from the proximal femur and greater trochanter, possibly Osteochondroma abutting and stretching the left sciatic nerve. (Fig. No 3)


In right lateral position, a posterior approach to the hip was taken with an incision of 12 cm incision centered over the swelling along the posterior border of greater trochanter.

Gluteus maximus and the short external rotators were split and Osteochondroma was exposed.

Fine Dissection was done and Sciatic Nerve was identified and was found under the tumor.

Neurolysis of the sciatic nerve was performed.(Fig. No. 4)

A firm lobulated sessile mass of 10 cms x 10 cms, encapsulated with fibrous tissue which is continuous with the periosteum of proximal femur was seen. On removal of fibrous capsule revealed a shiny smooth cartilaginous covering. Osteochondroma was excised extraperiosteally en block and the tumor bed was curetted out completely. The defect that was left was filled with methyl methacrylate cement. Haemostasis was achieved and the wound was closed over a suction drain.The tumor mass collected was sent for histopathology examination (Fig. No. 5)

Post operative care: Histopathology report revealed calcified bony fragments with underlined marrow. Focal areas of calcification were identified with no evidence of neoplastic activity.Intravenous antibiotics were continued for 5 days. Static quadriceps and Ankle toe movements were started on Day 2 post operative day after the drain was removed. Regular dressings were done on Day 2, 5, 8 and 12. Sutures were removed.

Patient is walking comfortably.

Post operative x rays show complete excision of osteochondroma with bone cement. (Fig. No. 6 & 7) 


Osteochondromas are cartilage capped bony growths produced by progressive enchondral ossification from aberrant growths plate cartilage rests. The cortex of an Osteochondroma is continuous with that of the bone from which it arises1 Osteochondromas can occur as solitary lesions with no known genetic predisposition whereas multiple lesions occur in hereditary multiple exostosis also Multiple osteochondromatosis (Diaphyseal aclasis)2. Incidence of malignant transformation in multiple osteochondroma is 10% against 1% in solitary osteochondroma; This patient is being presented as this is an unusual presentation at this age. We wanted to diagnose this case after ruling out any malignant change. Also that this presentation can mimic sciatica and/or lumbar canal stenosis so we wanted to confirm the pathology and offer a cure to this patient.

The common presenting feature of Osteochondromas is mechanical pain and nerve impingement2. This case represents an unusual type of sciatica due to pedunculated solitary femoral osteochondroma.

The differential diagnosis for sciatic nerve compression is substantial & can be divided into intraspinal, extraspinal, pelvic and extrapelvic categories of anatomical etiology3. Other potential sites include the hip joint , the pelvis as in impingement by obturator internus muscle, pelvic bone tumors such as Osteochondromas, as in this case4,5.Other less common causes of sciatic nerve compression are vascular malformations, infectious disease8 and tumors of bone & soft tissue2.  Paik et al5 reported a case of exostosis transformed to a chondrosarcoma. the patient has 2 surgeries first retroperitoneal approach for the mass & then posterior approach for chondrosarcoma. Turan et al7 reported a femoral neck osteochondroma with signs of sciatic nerve compression including weakness of toe & ankle dorsiflexion and diminished ankle reflex. They had a sessile growth unlike in our case which was pedunculated. In our patient there was no weakness in distribution of sciatic nerve. We protected the medial circumflex artery during the approach to the pedunculated mass6. We had no post operative weakness in sciatic nerve and the recovery was uneventful.


1. Sciatica: An uncommon Etiology D Paulsrud, W Samuelson - The Iowa Orthopaedic Journal, 1989
2. Extra spinal Bone and Soft-Tissue Tumors as a Cause of Sciatica: Clinical Diagnosis and Recommendations: Analysis of 32 Cases Bickels, Jacob MD*; Kahanovitz, Neil MD†; Rubert, Cynthia K. MD*; Henshaw, Robert M. MD*; Moss, David P. BA*; Meller, Isaac MD‡; Malawer, Martin M. MD*Spine:  August 1999 - Volume 24 - Issue 15 - p 1611
3. Kulcu DG, NaderiS. Differential diagnosis of intraspinal & extraspinal non-discogenic sciatica. J.Clin Neurosci. 2008; 15(11); 1246-1252
4.Siebenrock KA, Ganz R Osteochondroma of femoral neck Clinical Orth & related research 2002; (394), 211-218.
5. Paik NJ, Han TR Lim SJ, Multiple peripheral nerve compressions related to malignantly transformed hereditary multiple exostosis, Muscle nerve, 2000; 23(8); 1290-1294.
6. Osteochondroma of femoral neck A rare cause of Sciatic nerve compression page 5-7 30/05/2011
7. Turan Ilica A, Yasar E, Tuba Sanal H, Duran C, Guvenc I Sciatic nerve compression due to femoral neck osteochondroma: MDCT and MR findings. Clin Rheumatol. 2008; 27(3); 403-404
8. Al-Khodairy AW, Bovay P, Gobelet C. Sciatica in the female patient: anatomical considerations, etiology & review of literature. Eur spine J. 2007; 16(6); 403-404

Source(s) of Funding

No external or any other funding was needed neither taken from anybody.

Competing Interests

No competing intrests.


This article has been downloaded from WebmedCentral. With our unique author driven post publication peer review, contents posted on this web portal do not undergo any prepublication peer or editorial review. It is completely the responsibility of the authors to ensure not only scientific and ethical standards of the manuscript but also its grammatical accuracy. Authors must ensure that they obtain all the necessary permissions before submitting any information that requires obtaining a consent or approval from a third party. Authors should also ensure not to submit any information which they do not have the copyright of or of which they have transferred the copyrights to a third party.
Contents on WebmedCentral are purely for biomedical researchers and scientists. They are not meant to cater to the needs of an individual patient. The web portal or any content(s) therein is neither designed to support, nor replace, the relationship that exists between a patient/site visitor and his/her physician. Your use of the WebmedCentral site and its contents is entirely at your own risk. We do not take any responsibility for any harm that you may suffer or inflict on a third person by following the contents of this website.

1 review posted so far

Review on Sciatica due to Osteochondroma of Proximal Femur: A Case report
Posted by Anonymous Reviewer on 12 Sep 2013 06:10:02 PM GMT Reviewed by Author Invited Reviewers
This review will not be counted towards final review score for this article and for its inclusion into WebmedCentral Peer Reviewer articles because review was posted by an anonymous reviewer.

I would like to add the incidence of neurological entrapment/compressive neuropathy ... View more
Responded by Dr. Sanjay S Deo on 11 Oct 2013 07:36:42 AM GMT

0 comments posted so far

Please use this functionality to flag objectionable, inappropriate, inaccurate, and offensive content to WebmedCentral Team and the authors.


Author Comments
0 comments posted so far


What is article Popularity?

Article popularity is calculated by considering the scores: age of the article
Popularity = (P - 1) / (T + 2)^1.5
P : points is the sum of individual scores, which includes article Views, Downloads, Reviews, Comments and their weightage

Scores   Weightage
Views Points X 1
Download Points X 2
Comment Points X 5
Review Points X 10
Points= sum(Views Points + Download Points + Comment Points + Review Points)
T : time since submission in hours.
P is subtracted by 1 to negate submitter's vote.
Age factor is (time since submission in hours plus two) to the power of 1.5.factor.

How Article Quality Works?

For each article Authors/Readers, Reviewers and WMC Editors can review/rate the articles. These ratings are used to determine Feedback Scores.

In most cases, article receive ratings in the range of 0 to 10. We calculate average of all the ratings and consider it as article quality.

Quality=Average(Authors/Readers Ratings + Reviewers Ratings + WMC Editor Ratings)