A 25-year-old woman presents with a 3-year history of night pain in the right femoral neck relieved completely by aspirin/NSAIDs. Thin-cut CT scan shows a small (<2 cm) lucent nidus with surrounding cortical sclerosis. The most appropriate treatment is:

• A En-bloc surgical excision with wide margins
• B Long-term NSAID therapy as the only management
• C CT-guided radiofrequency ablation (RFA) of the nidus ✓
• D Bisphosphonate infusion to arrest cortical sclerosis

Explanation

The clinical and radiological description (night pain relieved by NSAIDs, lucent nidus <2 cm with reactive sclerosis) is pathognomonic of osteoid osteoma. CT-guided radiofrequency ablation (RFA) is now the gold standard treatment, achieving >90% success rate with minimal morbidity, shorter recovery, and outpatient procedure. It delivers heat (70-90°C) to ablate the nidus under CT guidance. Surgical excision was previously standard but carries higher morbidity and risk of structural compromise (especially for femoral neck location). NSAIDs control pain but do not cure the lesion and carry GI side effects with long-term use.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.