Abstract
Enchondroma of the hand is a common benign tumour composed of mature cartilage; it is usually asymptomatic and found accidentally or after pathologic fractures. Malignant transformation may occur, though only very rarely. The age of the patients varies widely. The small bones of the hand are the most frequent anatomic site for this pathology.
Enchondromas are conventionally treated by curettage and the bone defect is then filled with morceellised autologous bone chips from the iliac crest or with an allograft. Recently, bone substitutes have also been used instead of autologous or allogenic bone graft.
Calcium phosphate cement is a promising injectable biomaterial able to increase the number of osteoblasts without inducing a marked de-differentiation, an effect that is useful when a high number of bone forming cells are required. This bone substitute has been used successfully for the treatment of distal radius fractures and or mal-unions, femoral neck fractures, tibial plate fractures, complex calcaneal fractures and enchondromas.
From 2001 we treated 12 patients who were diagnosed as having solitary enchondromas, nine in the hand (four metacarpal bones and five finger bones); 6 patients had an associated pathologic fracture that occurred as a result of simple trauma. A surgical treatment with a complete removal of the tumour and the injection of Norian SRS cement into the cavity and fluoroscopic control was performed as a standardised procedure in all cases. The patients allowed to perform complete range of motion 3 weeks after surgery. At follow-up they were evaluated by clinical examination, X-ray and the DASH questionnaire.
None of the patients had swelling or deformity or tendon injuries or wound infection. Four patients had a slight loss of flexion at the MF joint but none considered this a functional limitation; all the others regained a complete ROM. All the patients returned to their presurgical occupation. Five of them complained of a hypertrophic scar. The X-ray showed a complete fill of the bone gap. They were satisfied and the mean DASH score was 6.06.
Clinical results have been reported with simple curettage without bone grafting or bone substitutes, but these two elements minimise the volume of the bone defect, maintain bone strength and promote new bone formation. Autologous bone graft caused pain in the donor site. Reconstruction of the tumour cavity provides immediate mechanical stability and good functional outcome.
