Editing Hereditary multiple exostoses (section)

==Pathophysiology==
It is characterized by the growth of cartilage-capped benign [[bone tumour]]s around areas of active bone growth, particularly the [[metaphysis]] of the long bones. Typically five or six exostoses are found in upper and lower limbs. Image depicts adult regrowth after knee replacement. [[File:MHE example of regrowth after age 70.png|thumb|Skeleton of 92-year-old woman with MHE who had knee replacements at age 70. See FIRS [[Body farm#Colorado Mesa University|Colorado Mesa University]].]]

Most common locations are:<ref name=turek>{{cite book | vauthors = | chapter = Chapter 9: Idiopathic and Heritable Disorders: Defects in Tumor Suppressor Genes: Hereditary Multiple Exostoses | veditors = Buckwalter JA, Weinstein SL |title=Turek's orthopaedics principles and their application |year=2005 |publisher=Lippincott Williams & Wilkins |location=Philadelphia |isbn=9780781742986 |pages=263 |edition=6th}}</ref>
* [[Anatomical terms of location#Proximal and distal|Distal]] [[femur]] (70%)
* [[Anatomical terms of location#Proximal and distal|Proximal]] [[tibia]] (70%)
* [[Humerus]] (50%)
* Proximal [[fibula]] (30%)

HME can lead to the shortening and bowing of bones; affected individuals often have a short stature.  Depending on their location the exostoses can cause problems including: pain or numbness from nerve compression, vascular compromise, inequality of limb length, irritation of tendon and muscle, [[Madelung's deformity]]<ref name=who>{{cite book | vauthors = Davies AM, Pettersson H  | veditors = Pettersson H, Ostensen H |year=2002 |title=Radiography of the Musculoskeletal System |publisher=World Health Organization |location=Geneva |isbn=978-92-4-154555-6 |pages=177, 189 |url=http://whqlibdoc.who.int/publications/2002/9241545550_eng.pdf | archive-url = https://web.archive.org/web/20140211092822/http://whqlibdoc.who.int/publications/2002/9241545550_eng.pdf | archive-date = 11 February 2014 }}</ref>  as well as a limited range of motion at the joints upon which they encroach. A person with HME has an increased risk of developing a rare form of bone cancer called [[chondrosarcoma]] as an adult.<ref name=who /> Problems may be had in later life and these could include weak bones and nerve damage.<ref name="pmid14349947">{{cite journal | vauthors = Cannon JF | title = Hereditary multiple exostoses | journal = American Journal of Human Genetics | volume = 6 | issue = 4 | pages = 419–425 | date = December 1954 | pmid = 14349947 | pmc = 1716573 }}</ref><ref name="pmid3046271">{{cite journal | vauthors = McBride WZ | title = Hereditary multiple exostoses | journal = American Family Physician | volume = 38 | issue = 3 | pages = 191–192 | date = September 1988 | pmid = 3046271 }}</ref><ref name="pmid8027127">{{cite journal | vauthors = Schmale GA, Conrad EU, Raskind WH | title = The natural history of hereditary multiple exostoses | journal = The Journal of Bone and Joint Surgery. American Volume | volume = 76 | issue = 7 | pages = 986–992 | date = July 1994 | pmid = 8027127 | doi = 10.2106/00004623-199407000-00005 | url = http://www.jbjs.org/cgi/pmidlookup?view=long&pmid=8027127 | url-status = dead | archive-url = https://archive.today/20140920144109/http://www.jbjs.org/cgi/pmidlookup?view=long&pmid=8027127 | archive-date = 2014-09-20 | url-access = subscription }}</ref>  The reported rate of transformation ranges from as low as 0.57%<ref name="pmid9272707">{{cite journal | vauthors = Legeai-Mallet L, Munnich A, Maroteaux P, Le Merrer M | title = Incomplete penetrance and expressivity skewing in hereditary multiple exostoses | journal = Clinical Genetics | volume = 52 | issue = 1 | pages = 12–16 | date = July 1997 | pmid = 9272707 | doi = 10.1111/j.1399-0004.1997.tb02508.x | s2cid = 44423092 }}</ref> to as high as 8.3% of people with HME.<ref name="pmid10755438">{{cite journal | vauthors = Kivioja A, Ervasti H, Kinnunen J, Kaitila I, Wolf M, Böhling T | title = Chondrosarcoma in a family with multiple hereditary exostoses | journal = The Journal of Bone and Joint Surgery. British Volume | volume = 82 | issue = 2 | pages = 261–266 | date = March 2000 | pmid = 10755438 | doi = 10.1302/0301-620X.82B2.0820261 | doi-access = free }}</ref> Some authors have described an association between HME and the presence of popliteal pseudoaneurysms.<ref name="pmid34815824">{{cite journal | vauthors = Duarte OA, Neira JG, Herazo VD, Lara MF, Polanco AL, Omaña AF, Ortiz AF | title = Popliteal artery pseudoaneurysm caused by non-penetrating trauma in a patient with hereditary multiple osteochondromatosis | journal = Radiology Case Reports | volume = 17 | issue = 1 | pages = 185–189 | date = January 2022 | pmid = 34815824 | pmc = 8593258 | doi = 10.1016/j.radcr.2021.10.025 }}</ref>