Surgical Treatment of Solitary Enchondromas of the Hand

Atypical Location of Enchondroma and its Management - A Case Report

Introduction

Enchondromas are most commonly found in the bones of the hand and feet. Although the location in the feet is not uncommon the enchondroma of the calcaneus is a rare finding.

Case Report

In this case report, we present a 45-year-old male patient who was diagnosed with enchondroma of the calcaneum. The power burr was used to perform an extended curettage, and the harvested cortico-cancellus bone from the iliac crest was used to fill the cavity; following which the calcaneal plate was applied. At the end of the 1-year follow-up, the patient was asymptomatic, and there was no evidence of recurrence.

Conclusion

Enchondroma of the calcaneum is a rare but treatable condition that should be considered in patients presenting with heel pain and well-defined radiolucent lesions on radiographs.

Endoscopic Curettage and Bone Grafting of Enchondroma of Proximal Phalanx of Finger

An enchondroma is a benign tumor in the medullary cavity of bone, which is composed of mature hyaline cartilage. It has a predilection for the ulnar-sided tubular bones of the hand and occurs most commonly in the proximal phalanx, and less commonly in the middle phalanx and metacarpals, and rarely in the distal phalanx. The treatment options for enchondromas include conservative regular follow-up or surgery. Operation is indicated in symptomatic enchondroma or lesions larger than 3 to 4 cm. The purpose of this Technical Note is to report the technical details of endoscopic curettage and bone grafting of enchondroma of proximal phalanx of finger. This minimally invasive approach can preserve the cortical integrity and periosteum of the involved phalanx.

Benign cartilaginous tumors of the hand, a five-year retrospective study

Benign and malignant cartilaginous bone tumors of the hand are rare findings, however representing a particular pathology due to the capacity to induce significant functional impairment. Even though a large proportion of tumors of the hand and wrist are benign, these may present destructive characteristics, deforming adjacent structures until compromising function. The most appropriate surgical approach for most benign tumors is intralesional lesion resection. Malignant tumors often require wide excision, up to segment amputation to obtain tumor control. A five-year retrospective study was performed on patients admitted in our Clinic with benign cartilaginous tumors of the hand, in which 15 patients were admitted within this period, 10 presenting with enchondroma, four presenting with osteochondroma, and lastly one with chondromatosis. After clinical and imaging evaluation, all the aforementioned tumors were surgically removed. Definitive diagnosis for all bone tumors, either benign or malignant, was established by tissue biopsy and histopathological examination, dictating therapeutic strategy.

Comparison of Distal Radius Autograft Technique with Iliac Crest Autograft Technique in Solitary Finger Enchondromas

OBJECTIVES

The purpose of the study was to compare clinical and radiological outcomes of autografts obtained from the iliac crest (IC) and distal radius (DR) and to evaluate their superiority for surgical treatment of solitary finger enchondromas.

METHODS

Twenty-five patients for whom curettage and autografting were carried out for finger enchondroma were retrospectively analyzed. DR autograft was used in eight patients and IC autograft was used in 17 patients. Data on pre-operative total active motion (TAM), disabilities of the arm, shoulder, and hand (DASH) score, and pain visual analog scale (VAS) scores of the involved finger, duration of surgery, amount of bleeding during the operation, length of hospital stay, presence of complications related to anesthesia, and post-operative donor site morbidity were obtained. Pre-operative and post-operative 12^th month radiographies were evaluated for pre-operative tumor volume, post-operative remnant volume, and Tordai radiologic evaluation grade.

RESULTS

No statistically significant difference could be identified between post-operative TAM (p=0.154), DASH (p=0.458), pain VAS scores (p=0.571), remnant volume (p=0.496), Tordai radiologic evaluation grade (p=0.522), duration of surgery (p=0.288), and amount of bleeding (p=0.114) between DR and IC groups. However, mean hospital stay duration was shorter for the DR group (p=0.0001). Recurrence was observed in one patient in the DR group and three patients in the IC group (p=0.996).

CONCLUSION

The clinical and radiological outcomes of grafting from the DR and IC were similar in the treatment of hand enchondromas. However, grafting from the DR may result in shorter hospital stay compared to IC grafting.

Ollier Disease: A Case Series and Literature Review

SUMMARY BACKGROUND

Ollier disease is the most common nonhereditary type of enchondromatosis. Enchondromas are common, usually benign intraosseous cartilaginous tumors that form near the growth plate cartilage predominantly unilaterally in the metaphyses and diaphyses of tubular bones. They usually affect the long bones of the hand, the humerus, and the tibia, followed by flat bones, such as the pelvis. The estimated prevalence of Ollier disease is 1 in 100,000 and while it is linked with somatic heterozygous mutations in IDH1 or IDH2 genes, exact etiology is unknown. The risk of malignant transformation towards chondrosarcoma is up to 30-35% and it is clinically suspected when pain and a rapid increase in the size of the lesions is seen.

CASE PRESENTATIONS

We report two clinical cases of patients diagnosed with Ollier disease. In both cases transformation to chondrosarcoma was observed.

CONCLUSIONS

Ollier disease is a rare disorder, defined by the presence of multiple enchondromas and an asymmetric distribution of the cartilage lesions that can be extremely variable in terms of size, location, age, gender. Constant monitoring of patients is important due to the high risk of malignancy. Because the disease is very rare and the manifestations vary widely, each patient's case must be evaluated, and the treatment strategy adopted individually.