J Korean Orthop Assoc.  2008 Feb;43(1):122-126. 10.4055/jkoa.2008.43.1.122.

Synovial Osteochondroid Metaplasia of the Elbow Joint Mimicking a Fracture: A Case Report

• Yoo JH
• Yang BK
• Kim SW
• Zoo MH

• KMID: 2106427
• DOI: http://doi.org/10.4055/jkoa.2008.43.1.122

Abstract

We present here a case of synovial osteochondroid metaplasia of the elbow joint that was almost mistaken for a fracture. A 21-year-old military recruit complained of pain at the elbow after a minor direct injury. Since the imaging studies, including simple radiographs and CT scans, showed a small bony fragment, an operation was performed under the impression of fracture of the elbow joint. There was no evidence of acute injury such as bleeding or swelling, and excisional biopsy was done. The histopathological findings of osteochondroid metaplasia surrounded by fibrous tissue and synovium led to the pathologic diagnosis of synovial osteochondroid metaplasia. Clinicians should include this tumorous entity in differential diagnosis when a bony fragment is seen on the radiographs of an acutely injured subject.

Keyword

Elbow; Synovial osteochondroid metaplasia; Fracture

MeSH Terms

Biopsy
Diagnosis, Differential
Elbow
Elbow Joint
Hemorrhage
Humans
Metaplasia
Military Personnel
Synovial Membrane
Young Adult

Figure

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  Fig. 1 (A, B) The preoperative anteroposterior and lateral simple radiographs show a radio-opaque density around the radio-capitellar joint (white arrow). (C, D) The reconstructed 3-dimensional computed tomographic images reveal a bony fragment on the posterolateral side of the elbow joint.

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  Fig. 2 The operative findings. There was no bruise or evidence of intra-articular bleeding. The mass was encapsulated by the synovium (A) and the surrounding bony structures were intact, including the radial head and capitellum (B). The external surface of the lesion was covered by the joint capsule (C) and the inner surface was covered by the synovial and cartilaginous tissues (D).

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  Fig. 3 The bone scintigraphy taken 3 days after excision of the lesion. The absence of a hot spot on the anterior (A) and posterior (B) view implies that there is no acute fracture.

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  Fig. 4 (A, B) The histopathological findings. The osteochondroid tissue was surrounded by dense fibrous tissue without any evidence of acute hemorrhage (hematoxylin and eosin, ×40 for Fig. 4A and ×100 for Fig. 4B).

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