En Bloc Resection of Coracoid Base Osteoid Osteoma in a Child: An Extremely Rare Case

BACKGROUND: Osteoid osteomas account for approximately 2- 3% of all primary bone neoplasm's sampled for biopsy. 50% of all of them occur in the long bones of the lower extremities, but osteoid osteoma of the coracoid process is rare. We have found only nine previously reported cases of coracoid osteoid osteoma in the international literature. We report a child with coracoid base osteoid osteoma. CASE PRESENTATION: A twelve-years-old boy with a persistent pain at the right shoulder since 9 months ago, were evaluated. His pain relatively responds to non-steroidal anti-inflammatory drugs (NSAIDs). Imaging studies showed foci of sclerosis at right coracoid base with increased uptake on the Technetium-99m study. Because proximity to the neurovascular bundle we couldn't use radiofrequency ablation technique, so the patient underwent open surgery with a mini- deltopectoral approach and two level osteotomies ; one proximal to coracoid tip and the other at the base of coracoid just distal to subcoracoidphyseal line. Then a segment of coracoid resected. Tip of coracoid securely reattached with a screw. CONCLUSIONS: To our knowledge in the literature up to now there are only nine reports of coracoid osteoid osteoma. These cases were treated with different approaches and different techniques. We used en-bloc resection via mini-anterior approach. Our patient 30 months after surgery (October 2012) have full range of motion and became pain free since wound healing with normal control imaging.Definite diagnosis of osteoid osteoma in the uncommon sites may be delayed. En bloc resection of tumor with two osteotomies by an anterior approach has been limited soft tissue injury and is a reliable method of treatment.