Osteoid osteoma following fracture of the distal tibia: A case report and literature review

Osteoid osteoma is a benign bone-forming lesion, characterised by its small size, its clearly demarcated outline and by the usual presence of a surrounding zone of reactive bone formation. It often poses a diagnostic challenge due to its ambiguous presentation. The aetiology of osteoid osteoma is poorly understood. The previous suggestion that osteoid osteoma was not associated with trauma or infection has been challenged by more recent literature raising the possibility that it could be a reactive or healing response or a phenomenon associated with the revascularisation process. This case report describes an unusual presentation of a post-traumatic osteoid osteoma. Two years following a tibial fracture treated non-operatively, the patient developed new pain at the previous fracture site. The pain was constant, relieved by non-steroidal analgesia and not associated with systemic upset. It was initially attributed to other more likely diagnoses such as osteomyelitis and neuropathic pain. Multiple investigations and interventions were undertaken prior to the diagnosis being obtained by surgical excision of the lesion and histological studies 3 years following the initiation of the discomfort. This case report should raise the index of clinical suspicion of osteoid osteoma occurring post fracture.