Ovim kliničkim zapažanjem želimo upozoriti na osteoid osteom kao mogući uzrok tegoba u području distalne falange prstiju šake. Ta iznimno rijetka lokalizacija osteoid osteoma predstavlja problem za prepoznavanje i zbog atipične prezentacije. Dvadesetogodišnji bolesnik se pet godina žalio na bol u području jagodice IV. prsta desne šake koja je bila praćena oteklinom i crvenilom jagodice prsta te deformacijom nokta. Na rendgenskim snimkama vidjela se osteoliza u području baze distalne falange. Magnetskom rezonancijom je postavljena sumnja na osteoid osteom, što je potvrđeno kompjuteriziranom tomografi jom. Nakon kirurškog liječenja tijekom kojeg je osteoid osteom ekskohleiran, dolazi do potpunog nestanka tegoba. Potpuni oporavak bolesnika pokazuje i rezultat DASH upitnika, koji je već tri mjeseca nakon zahvata pao sa 54,5 na 0 što je prema tom upitniku uredan nalaz. Na osteoid osteom se uvijek mora posumnjati ako je oteklina distalne falange prsta s deformacijom nokta praćena bolovima koji se smanjuju korištenjem NSAIL. Metoda izbora u dijagnostici je kompjuterizirana tomografi ja koja mora biti načinjena tako da slojevi ne budu deblji od 1 do 2 mm. Zbog
blizine neurovaskularnih struktura i tetiva najboljim oblikom liječenja osteoid osteoma u području distalne falange prstiju šake smatra se kirurška ekscizija ili ekskohleacija.With this clinical observation we would like to bring to mind osteoid osteoma as a possible cause of problems of distal phalanx of the fi ngers. Osteoid osteoma occurs rarely at this location and has atypical presentation. The main symptoms are swelling and redness of the fi ngertip with nail deformity, while typical night pain may not be present. Unusual clinical and x-ray presentation of tumor in this localization can make diagnosis of osteoid osteoma very difficult. A 20-year-old patient reported pain in the fi ngertip of his right ring finger persisting for fi ve years. Swelling and redness of the fi ngertip combined with nail deformity was also present. X-rays showed osteolysis in the base of distal phalanx. Magnetic resonance imaging showed suspicion of osteoid osteoma, which was confi rmed by computed tomography (CT). We performed surgical removal of osteoid osteoma in February 2014. The tumor was approached by longitudinal incision on the lateral side of the distal phalanx of the ring fi nger and the basal part of distal phalanx was cut with a small chisel to enable access to cystic change of the bone. Tumor removal with excochleation was performed and the material thus obtained was sent for histopathologic analysis. After surgery, the ring fi nger was immobilized in a plaster splint for a three-week period. After
removal of immobilization, the patient was referred to physical therapy consisting of individual exercises in order to obtain the full range of motion in all joints of the hands and strengthen hand and forearm muscles. After surgical removal of osteoid osteoma, all symptoms disappeared completely. Histopathologic findings confi rmed the diagnosis of osteoid osteoma. After physical therapy, he returned to daily activities without any problems. On regular follow ups at 3, 6 and 12 months after surgery, clinical fi ndings were normal and the patient had no pain or discomforts. Full recovery was shown by the result of the DASH questionnaire three months after the procedure. Preoperative DASH score 54.4 decreased to 0. Distal phalanx of the fi nger is a very rare localization of osteoid osteoma, and typical night pain may not be present. In addition, appearance on x-rays is not typical. Instead of central enlightenment surrounded with sclerosis, x-rays usually show a lytic lesion. For this reason, it may be diffi cult to make the diagnosis of osteoid osteoma. The main symptom is permanent pain, swelling
and redness of the fi nger, with nail deformity. The imaging method of choice is CT, which must be performed with thin layers of 1 to 2 mm. Furthermore, cooperation of surgeon and radiologist is extremely important to reach the accurate diagnosis. Many treatment options are described in the literature, such as CT-guided percutaneous thermocoagulation, destruction of lesions with alcohol, or CT-guided radiofrequency ablation. However, due to the proximity of neurovascular structures, tendons and joints, the best method for treatment osteoid osteoma in distal phalanx of the fi ngers is surgical excision or excochleation. Our conclusion is that one should always bear in mind that osteoid osteoma can be the cause of swelling of distal phalanx of the fi nger with nail deformity, and pain that alleviated with the use of non-steroidal anti-infl ammatory drugs. Surgical excision or excochleation is the best method for the treatment osteoid osteoma of distal phalanx of the finger
