Hereditary multiple exostoses

Hereditary multiple exostoses, also known as diaphyseal aclasis, is an autosomal dominant condition, characterised by the development of multiple osteochondromas.

Hereditary multiple exostoses demonstrates an autosomal dominant inheritance pattern, with incomplete penetrance in females. The number of exostoses, the degree and type of angular deformity, and even the rate of malignant transformation vary significantly, even within families.

Most patients are diagnosed by the age of 5 years, and virtually all are diagnosed by the age 12 years. Patients may be asymptomatic with a few small lesions or may be significantly deformed by multiple large osteochondromas. 

Except that they are multiple, imaging features are identical to solitary osteochondromas. The skeletal distribution of lesions can significantly vary, with some authors noting that the typical distribution is bilateral and symmetric, whereas others report a strong unilateral predominance.

Often associated with a broadened shaft at the end of long bones, hence the term diaphyseal aclasis. 

Are also similar or those of solitary osteochondroma and include

  • vascular impingement
  • neural impingement
  • fracture
  • bursitis
  • deformity
  • malignant transformation

Malignant transformation is more common than in sporadic cases, with transformation rates reported as high as 25% (lower rates of 3-5% have also been published) 3. The mnemonic GLAD PAST 1 lists the associations with sarcomatous transformation.

Refer to generic osteochondroma article for more information.

Bone tumours

The differential diagnosis for bone tumours is dependent on the age of the patient, with a very different set of differentials for the paediatric patient.

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Article Information

rID: 1445
Synonyms or Alternate Spellings:
  • Diaphyseal aclasis
  • Familial osteochondromatosis
  • Diaphyseal aclasia
  • Multiple hereditary exostosis
  • Hereditary multiple exostosis
  • Multiple hereditary exostoses
  • HME

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Cases and Figures

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    Figure 1: illustration - femoral osteochondroma
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    Case 1
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    Case 2
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    Forearm
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    Pelvis
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    Femurs
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    Tibia and fibula
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    Case 8: plain film and MRI
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