Surgical management of ventral scapular osteochondroma in a pediatric patient with multiple hereditary exostoses: a case report

Abstract

Multiple hereditary exostoses (MHE) is a rare autosomal dominant disorder caused by EXT1/EXT2 gene mutations, characterized by multiple osteochondromas arising from the metaphyses of long and flat bones. Scapular osteochondromas are uncommon, representing only 3-4.6% of all cases, and ventral (subscapular) lesions are exceedingly rare with limited surgical literature. A 12-year-old male with no family history of MHE presented with a one-year history of progressive, hard swelling over the right scapular region along with bilateral wrist, foot, and right arm swellings. He reported pain on overhead activities and scapular movement, with normal scapulohumeral rhythm and no neurological deficits on examination. Imaging confirmed a pedunculated osteochondroma on the ventral surface of the right scapula and multiple additional lesions consistent with MHE. He underwent complete surgical excision via a posterior approach through the triangle of auscultation, with rhomboid muscle splitting. Histopathology confirmed benign osteochondroma. At 1-year follow-up, the patient was completely asymptomatic with full shoulder range of motion and a QuickDASH score of 0. No recurrence was detected on follow-up imaging. This case demonstrates that symptomatic ventral scapular osteochondromas in MHE can be successfully managed via a posterior approach, with excellent functional outcomes.