Curettage Using Soft-wire for Enchondroma in the Hand: A Technical Note

Enchondromas are benign bone cartilaginous lesions predominantly seen in the hand, possibly leading to a pathological fracture. When the lesion expands to the whole phalanx, curettage through a small fenestration is difficult. To overcome the problem, soft-wire (cerclage wire) was used as a curette. Soft-wire is commonly used for a tension band wiring method for patellar or olecranon fractures.

Two representative cases are presented: one is a 43-year-old male with enchondroma in the middle phalanx of the left index finger, and the other is a 28-year-old female with enchondroma in the distal phalanx of the right thumb. Surgery was performed in both cases under general anesthesia. The cortex adjacent to the lesion was approached dorsally, splitting the extensor tendon (the index finger case), or laterally (the thumb case). Fenestration of the cortex was performed with a 3.2-4 mm diameter surgical air drill. A bent and looped soft-wire of 0.7 or 0.9 mm diameter was threaded through the fenestration and used as a curette. Consequently, β-tricalcium phosphate particles were implanted. Bone incorporation was observed.

This easy technique of curettage is a minimally invasive procedure for enchondroma. Moreover, the length of the skin incision and the size of the cortical fenestration are the same regardless of the size of the lesion.