Clinical Characteristics and Outcomes of Surgical Treatment of Solitary Osteochondromas in Children: A 11-Year Retrospective Study

Background: Osteochondroma is the most common benign bone tumor in childhood. Although most lesions are asymptomatic, surgical treatment is indicated in patients with pain, mechanical symptoms, cosmetic concerns, restricted range of motion, or neurovascular compression. This study evaluated the clinical characteristics and surgical outcomes of osteochondromas in children and adolescents treated at a single tertiary pediatric surgery center. Methods: This retrospective study included 75 pediatric patients who underwent surgical excision of osteochondroma between January 2015 and January 2026. Demographic, clinical, radiological, operative, histopathological, and follow-up data were analyzed. Lesion-related variables were assessed at the level of individual exostoses. The primary outcome was surgical treatment outcome, while secondary outcomes included lesion localization, symptoms, hospital stay, postoperative complications, recurrence, and associations between clinical and morphological variables. Results: A total of 75 patients with 76 solitary osteochondromas were included. The median age was 13 years, and 64.0% of patients were male. Most lesions were located distally (73.7%), with the femur being the most common site (48.7%), followed by the tibia (22.4%). Pain was the most frequent symptom, present in 63.2% of exostoses, followed by cosmetic concern in 32.9%. Standard radiography was used in nearly all cases (98.7%). Radiographic measurements significantly underestimated lesion size compared with intraoperative measurements, with median diameters of 3.0 cm and 4.0 cm, respectively (p < 0.001). A strong positive correlation was observed between radiographic and intraoperative lesion diameter (ρ = 0.77; p < 0.001), while symptom duration showed a weak but significant correlation with lesion diameter (ρ = 0.28; p = 0.013). No significant association was found between lesion diameter and symptomatic presentation, and logistic regression did not identify age, sex, lesion location, or diameter as significant predictors of symptoms. Postoperative outcomes were favorable: 94.6% of patients had no complications, wound infection and hematoma occurred in 2.7% each, and no recurrences or reoperations were recorded during a median follow-up of 63 months. Histopathological examination confirmed osteochondroma in all cases. Conclusions: Surgical excision of symptomatic pediatric osteochondromas was associated with favorable postoperative outcomes, a low complication rate, and no observed recurrence during follow-up. Standard radiography correlates well with intraoperative findings but may underestimate true lesion size, likely due to limited visualization of the cartilaginous cap. Symptom development appears multifactorial and cannot be reliably predicted by lesion size or location alone.