Recurrent Metacarpal Enchondroma Treated With Strut Allograft: 14-year Follow-up

Enchondroma of the hand is a common lesion with a recurrence rate of up to 13.3% after curettage and bone grafting. Pathologic fractures often occur. Although allograft bone chips are widely used in the surgical treatment of enchondroma, the use of structural allograft bone has not been reported before. This case report presents a recurrent enchondroma of the fifth metacarpal with pathologic fracture in a 13-year-old girl who had 2 previous interventions and 2 more interventions for other enchondromas in the same hand. These interventions consisted of curettage and autogenous iliac crest bone grafting. The metacarpal diaphysis was resected and reconstructed with an intercalary freeze-dried strut allograft fibular bone segment to avoid further donor graft site morbidity. At 14 years of follow-up, the patient had full range of motion of the hand, with no symptoms, and the allograft bone had been incorporated completely, with no recurrence of the tumor. With strut allograft bone, healing occurs by creeping substitution at its ends that is limited to a few millimeters. Limited vascularization also occurs on the allograft surface, leaving most of the allograft segment devoid of vascularity and leading to the complications seen in massive bone allografts. However, because of their thin cortices and decreased total volume, smaller bone allografts show higher rates of osteointegration and revascularization. In selected cases, a strut allograft bone may be considered a suitable material for long-term reconstruction of the hand after enchondroma excision, especially in young patients, who have increased healing potential compared with older patients.