Chondroblastoma: A Detailed Explanation

Introduction

Chondroblastoma is a rare, benign (non-cancerous) bone tumour that primarily arises in the epiphysis (end part) of long bones. It predominantly affects adolescents and young adults, typically between the ages of 10 and 25 years. Despite being benign, chondroblastoma can cause significant discomfort and functional impairment if not diagnosed and managed appropriately.

Pathology and Cause

The term “chondroblastoma” refers to the tumour’s origin from chondroblasts, which are immature cartilage-producing cells. The exact cause of chondroblastoma is not well understood, but it is believed to arise from abnormal proliferation of these cells within the growing ends of bones. It is not associated with inherited genetic factors or environmental causes in most cases.

Common Sites

Chondroblastoma most frequently develops in the following locations:

• Proximal humerus (upper arm near the shoulder)
• Proximal femur (upper leg near the hip)
• Distal femur (lower end of the thigh bone near the knee)
• Proximal tibia (upper part of the shinbone near the knee)

Rarely, it may occur in flat bones such as the pelvis or bones of the foot.

Clinical Presentation

Patients with chondroblastoma typically present with:

• Pain: Localised pain at the tumour site, which may worsen with activity.
• Swelling: Mild swelling or a palpable lump may be felt near the affected joint.
• Restricted movement: Joint stiffness or reduced range of motion, especially if the tumour is close to a joint.
• Limping: If the tumour affects the lower limb, a limp may develop.

Diagnosis

Diagnosis of chondroblastoma is based on a combination of clinical evaluation, imaging studies, and histopathological examination.

• X-ray: Shows a well-defined, lytic (bone-destroying) lesion with possible calcification in the epiphyseal region.
• MRI/CT scan: Provides detailed information about the extent of the tumour and its relation to surrounding tissues.
• Biopsy: A sample of the tumour is examined under a microscope to confirm the diagnosis and rule out other conditions.

Differential Diagnosis

Other conditions that may resemble chondroblastoma on imaging and clinical features include:

• Giant cell tumour of bone
• Aneurysmal bone cyst
• Clear cell chondrosarcoma (a rare malignant tumour)
• Osteomyelitis (bone infection)

Treatment

The mainstay of treatment for chondroblastoma is surgical removal. The most common procedure is curettage, where the tumour is scraped out from the bone. This may be followed by filling the cavity with bone graft or bone cement to restore structural integrity. In rare cases, more extensive surgery may be needed if the tumour recurs or affects vital structures.

Additional treatments may include:

• Adjuvant therapies: Use of chemicals, cryotherapy (freezing), or radiofrequency ablation to destroy residual tumour cells.
• Rehabilitation: Physiotherapy to restore joint function and mobility post-surgery.

Prognosis and Follow-up

Chondroblastoma generally has an excellent prognosis after complete surgical removal. However, there is a risk of recurrence in about 10–20% of cases, particularly if the tumour is not entirely excised. Rarely, the tumour may metastasise (spread) to the lungs, but this is extremely uncommon.

Regular follow-up with imaging is recommended to monitor for recurrence, especially within the first two years post-treatment.

Nursing Care of Patients with Chondroblastoma

While the primary treatment is surgical excision, nursing care plays a pivotal role in ensuring optimal recovery, minimizing complications, and providing holistic patient support. This document presents a thorough overview of nursing care for patients diagnosed with chondroblastoma, from preoperative preparation to long-term follow-up.

Preoperative Nursing Management

Assessment

• Comprehensive Health History: Assess the onset, duration, intensity, and nature of pain; history of trauma; previous medical or orthopedic conditions; and family history of bone disorders.
• Physical Examination: Inspect the affected limb for swelling, deformity, tenderness, and limited range of motion. Assess gait, posture, and any compensatory movements.

Pain Management

• Administer prescribed analgesics, including NSAIDs or acetaminophen, as needed.
• Monitor pain levels using standardized pain scales (e.g., Wong-Baker FACES, Numeric Rating Scale).
• Educate patients and caregivers about non-pharmacological pain relief methods, such as ice application, rest, and elevation.

Psychosocial Support

• Address anxiety and fear related to diagnosis, possible surgery, and prognosis.
• Provide age-appropriate explanations about the disease and treatment plan.
• Offer access to counseling services if needed.

Preoperative Preparation

• Ensure preoperative investigations (blood tests, imaging) are completed.
• Educate patients and families regarding surgical procedure, anesthesia, and expected postoperative course.
• Assess for allergies, especially to anesthesia or antibiotics.
• Obtain informed consent and coordinate with the surgical team for preoperative briefings.
• Maintain NPO (nothing by mouth) status as per hospital protocol before surgery.

Postoperative Nursing Care

Immediate Postoperative Care

• Monitor vital signs closely—particularly for signs of shock, bleeding, or infection.
• Assess the surgical site for bleeding, hematoma, swelling, and dressing integrity.
• Monitor neurovascular status of the affected limb: check color, temperature, pulse, capillary refill, sensation, and movement.

Pain and Comfort Management

• Administer prescribed analgesics on schedule and as needed for breakthrough pain.
• Encourage use of non-pharmacologic pain relief: repositioning, supportive pillows, relaxation techniques.

Prevention of Complications

• Regularly assess for signs of infection: fever, redness, discharge, or unusual swelling at the surgical site.
• Monitor for signs of deep vein thrombosis, especially with reduced mobility.
• Encourage gentle movement and range-of-motion exercises as advised by the healthcare provider or physiotherapist.
• Observe for neurovascular compromise and report changes immediately.
• Educate the patient and family about warning signs demanding prompt medical attention.

Wound and Limb Care

• Maintain clean, dry dressings; change dressings per protocol or as directed by the surgeon.
• Observe for abnormal drainage and document the characteristics (color, amount, odor).
• Support the affected limb with splints or immobilizers if prescribed.
• Promote elevation of the limb to reduce swelling.

Rehabilitation and Mobilization

• Coordinate with the physiotherapy team for early rehabilitation plans to restore function.
• Teach and assist with safe ambulation devices (crutches, walkers) if necessary.
• Encourage progressive weight-bearing as advised by the orthopedic surgeon.
• Monitor and document improvements in mobility, strength, and range of motion.

Psychosocial and Emotional Support

• Provide continual emotional support, especially for young patients coping with immobility or changes in self-image.
• Facilitate communication between the patient, family, and multidisciplinary team members.
• Offer referral to psychological or social services when indicated.

Long-Term Nursing Management

Follow-Up Care

• Emphasize the importance of regular clinical and radiological follow-up to detect recurrence early.
• Schedule and remind patients of follow-up visits.
• Monitor for late complications—growth disturbances, joint stiffness, secondary osteoarthritis.

Patient and Family Education

• Instruct on wound care and signs of infection.
• Educate about activity restrictions and gradual return to normal activities.
• Discuss the importance of adherence to medication and physiotherapy.
• Provide written materials and reliable resources for further reading.

Reintegration and Quality of Life

• Assist with transitioning back to school, work, or social activities.
• Encourage participation in support groups for bone tumor survivors if available.
• Monitor for emotional changes, depression, or anxiety and refer as needed.

Special Considerations

Pediatric and Adolescent Care

• Use age-appropriate communication techniques.
• Engage families as active participants in care and rehabilitation.
• Consider the impact of the disease and surgery on growth, development, and schooling; coordinate with school counselors as needed.

Care for Surgical Complications

• Be vigilant for local recurrence of the tumor, which may require further surgery.
• Monitor for joint dysfunction and refer to orthopedic specialists as necessary.
• Support limb-sparing techniques and prosthetic or orthotic interventions if amputation or structural support is required.

Interdisciplinary Collaboration

• Work closely with orthopedic surgeons, radiologists, physiotherapists, occupational therapists, pain specialists, and social workers.
• Ensure coordinated care plans and regular interdisciplinary meetings.

Documentation and Legal/Ethical Aspects

• Maintain accurate, up-to-date documentation of all assessments, interventions, patient responses, and communications.
• Respect patient autonomy, privacy, and confidentiality in all aspects of care.
• Uphold informed consent, especially for surgical and invasive procedures.

REFERENCES

1. Merck Manual. Benign Bone Tumors and Cysts. https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/tumors-of-bones-and-joints/benign-bone-tumors-and-cysts#v41359083.
2. Pediatric Orthopaedic Society of North America. Chondroblastoma. https://posna.org/Physician-Education/Study-Guide/Chondroblastoma.
3. Limaiem F, Tafti D, Rawla P. Chondroblastoma. [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536947/
4. Soheili A, Momeni M, & Tehranzadeh J. Tumors. In: Basic Musculoskeletal Imaging. https://accessmedicine-mhmedical-com.ccmain.ohionet.org/content.aspx?bookid=3075&sectionid=255922038. 2nd ed. New York, NY: McGraw Hill; 2021.
5. Limaiem F, Tafti D, Rawla P. Chondroblastoma. [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/sites/books/NBK536947/
6. Wells R. G. Musculoskeletal Tumors. In: Diagnostic Imaging of Infants and Children. https://accesspediatrics-mhmedical-com.ccmain.ohionet.org/content.aspx?bookid=1429&sectionid=84708143. New York, NY: McGraw Hill; 2013.
7. Chen W, DiFrancesco LM. Chondroblastoma: An Update. Arch Pathol Lab Med. 2017 Jun;141(6):867-871. doi: 10.5858/arpa.2016-0281-RS. PMID: 28557595.

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