Tumours of the hand presenting as pathological fractures

Tumours represent one of the important differential diagnoses that need to be considered while investigating fractures of the small bones of the hand, as this can sometimes be the sole or the first presenting complaint. We conducted a retrospective study of the Scottish Bone Tumour Registry, analysing the records of patients with hand tumours which primarily presented as pathological fractures. The registry held records of 233 patients with tumours involving the bones of the hand, of which 53 (22.7%) had pathological fractures as the first presenting complaint. The average age at presentation was 36.9 yrs. The proximal phalanx was the most common bone involved (50.9%). The distal phalanx rarely developed pathological fractures due to tumours (5.3%). Most of the lesions affected the fifth ray (43.9%) Chondroma was the most common tumour seen (43 patients). Malignant lesions were an infrequent cause of pathological fractures (7 chondrosarcomas and 1 Ewing's sarcoma). Tumours are less commonly seen as a cause of fractures in the hand with most such fractures initially treated as minor injuries with buddy strapping and early mobilisation. A carefully obtained history and study of radiographs is essential to diagnose these lesions.