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Outcome of surgical interventions for solitary enchondromas of the hand : Controversial issues
Ismail Tawfeek Badr1, Mehmet Ali Tokgöz2, Coşkun Ulucaköy3
1Department of Orthopedic Surgery, Menoufia University Faculty of Medicine, 32511, Shebin El-Kom, Menoufia, Egypt. ismail.badr@med.menofia.edu.eg.
Background:
Enchondromas are the most common primary bone tumors of the hand and are benign cartilaginous tumors. This study evaluated the clinical and radiologic results of patients who underwent surgical interventions for isolated hand enchondromas with a minimum follow-up of 1 year and focused on controversial issues.
Methods:
A retrospective study included 66 patients with solitary hand enchondromas with follow-up >12 months who underwent surgical interventions between January 2014 and July 2020. Patients with multiple enchondromas, low-grade chondrosarcoma, or who missed follow-up were excluded. All patients underwent thorough curettage with or without filling. Follow-up visits were done at 6 weeks, 3 months, 6 months, and annually. Demographic characteristics, clinical presentation, surgical details, final histologic examination, rehabilitation program, complications, and recurrences were recorded. The range of movement of the affected hand was compared to the contralateral one. Radiological evaluation of defect filling using the modified Neer classification was done.
Results:
Of the patients 25 were male and 41 were female (38 right hand affection, 28 left hand affection), the mean age was 30.4 ± 11.9 years. Indications for surgery were local pain, swelling, and pathological fractures. The mean follow-up period was 28.8 ± 12.9 months (range 12-67 months). The mean MSTS score was 28.73 ± 1.6 (range 24-30). The middle finger was most frequently affected (18 cases, 27.3%) and the proximal phalanx was the most common location (37 cases, 56.1%). The mean length of lesions was 18.9 ± 6.67 mm and the mean width was 12.3 ± 4.1 mm. According to the modified Neer classification, 50 cases were classified as grade 1 (healed), 16 cases as grade 2 (healed with defects), and no case presented as persistent or recurrent lesions.
Conclusion:
Solitary hand enchondroma can be effectively treated with adequate curettage, with or without autologous bone grafting, with positive functional and radiological outcomes. When compared to grafting from the iliac crest, harvesting bone from the distal radius provides a shorter hospital stay and reduced complication rates.
