Leave alone lesions - skeletal

Last revised by Daniel MacManus on 18 Feb 2025

Skeletal leave alone lesions, also called “don't touch” or "do-not-touch" lesions, are so characteristic radiographically that further diagnostic tests such as a biopsy are unnecessary and can be frankly misleading and lead to additional unnecessary surgery. Thus, a radiologic diagnosis should be made without a list of differential possibilities.

These lesions can be divided into three categories - post-traumatic lesions, normal variants, and lesions that are real but obviously benign.

Post-traumatic lesions

Initially described by the renowned musculoskeletal radiologist Clyde Helms in the chapter of his book entitled "don't touch lesions" 1, 12.

Cases and figures

  • Case 1: sclerotic non-ossifying fibroma
  • Case 2: osteopoikilosis
  • Case 3: tug lesion - soleal line
  • Case 4: cortical desmoid
  • Case 5: synovial herniation pit
  • Case 6: pelvic digit
  • Case 7: tug lesion- soleal line
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