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Thumb Distal Phalanx Enchondroma: Expanding the Surgical Corridor Through a Modified Volar Lateral Technique - A Case
M Harshith1, V S Sumukha1, Sachin C Nair2
1Department of Orthopaedic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Introduction:
Enchondromas are the most common benign bone tumors of the hand, but distal phalanx involvement of the thumb is exceedingly rare (<4%). Surgical management is challenging due to limited exposure and risk to vital structures.
Case Report:
A 19-year-old female presented with a painful swelling of the right thumb. Imaging revealed a lytic lesion in the distal phalanx consistent with enchondroma. Surgery was performed using a modified volar-lateral approach that combined the skin incision of the modified volar technique with a deep plane between the flexor pollicis longus tendon and the lateral border of the distal phalanx, preserving pulp septae and avoiding tendon splitting. Curettage and iliac crest bone grafting were performed.
Conclusion:
This modified approach provided better exposure for curettage, preserved sensory and tendon integrity, and achieved complete graft incorporation with full motion and no recurrence, offering a safe, functional technique for rare thumb distal phalanx enchondromas.