From the Division of Orthopaedic Surgery and the Departmezt of Pathology,

Osteoid osteoma has been accepted as a distinct clinical and pathological entity since it was described by Heine (1927), Bergstrand (1930) and most clearly by Jaffe (1935). Its features are that of a central nidus of vascular connective tissue stroma in which is scattered osteoid and atypical bone. Curettage will often cure the lesion. The present article reports a patient in whom osteoid osteoma recurred after en bloc excision on two occasions and reviews the literature. CASE REPORT A man aged forty-five years complained of pain and swelling of his right hand for a few days after an injury at work. During the next eighteen months he complained of continued swelling over the dorsum of the hand aggravated by shaking hands. Radiographs showed Initial radiograph showing sclerosis of second meta-carpal. relative density of the second metacarpal shaft (Fig. 1). Examination showed a soft mass which was excised, and a diagnosis of ganglion was made. Six years later, in May 1965, he was readmitted to hospital with recurrent pain deep to the site of the previous operation. Radiographs showed an area of transradiancy with a central nidus of punctate radiodensity in the base of the right second metacarpal bone (Fig. 2). An en bloc excision was done (Fig. 3), the defect being filled by an autogenous cancellous bone graft. There was a cavity in the second metacarpal base with a central firm red nidus and surrounding loose vascular tissue, strongly suggesting a diagnosis of osteoid osteoma. Microscopically this diagnosis was confirmed (Fig. 4). Figure 2-Six years later an area of radiolucency with a central nidus of punctate radiodensity is seen in the base of the second metacarpal. Figure 3-Extent of first excision