Surgical treatment for osteochondromas in pediatric digits

Osteochondromas in pediatric digits occasionally require surgical treatment due to restricted finger motion and/or angulatory deformity. However, the patients are growing children, and the indication for surgical treatment is controversial. We reviewed our cases in order to clarify characteristics of tumors and to report surgical outcomes.

We performed surgeries on 17 osteochondromas in the digits of 16 patients. The average age at surgery was 3.6 years. Ten of 16 patients had solitary osteochondroma, and 6 patients had been diagnosed with multiple osteochondromatosis. We classified osteochondroma into 3 types, according to their locations. Type A is located at the nonepiphyseal metaphysis of the bone (9 lesions), type B in the metaphysis on the epiphyseal plate side (5 lesions), and type C in the diaphysis (3 lesions). Surgery was indicated for either or both restricted motion and angulatory deformity. Simple excision of the tumor was performed in 14 lesions, wedge osteotomy in 2 fingers, and osteotomy with excision of tumor in 1 finger. The average follow-up period was 49 months (range, 14-155 mo).

Surgical outcomes in types B and C were all good, the deformities were well corrected, and range of motion was improved. On the other hand, in type A, 2 cases still had more than 30° of restricted motion at the final follow-up, and another 2 cases showed more than 10° of angulatory deformity.

For type A, early surgical treatment is recommended to prevent the progress of the finger deformity and to improve motion. When the tumors are oriented more laterally and include less than a third of the joint surface, we recommend sufficient tumor excision, which can include part of the articular surface.