Imaging Features of Primary Tumors of the Hand

Comparison of the effect of early versus late surgical strategies on outcomes in patients with hand enchondromas complicated with pathological fractures

This study aimed to evaluate the advantages and disadvantages of early versus delayed single-stage surgery in patients with hand enchondromas who developed pathological fractures, focusing on local tumor control and hand function, to determine the optimal timing for surgery. Delayed surgical curettage may offer advantages regarding both local tumor control and hand function outcomes.Thirty-five patients who developed pathological fractures due to solitary hand enchondromas and underwent surgical treatment between 2015 and 2021 were analysed. Patients were divided into two groups based on the timing of surgery. Patients who underwent surgical treatment immediately after a pathological fracture were assigned to the early-surgery group, and those who underwent surgical treatment after waiting for fracture union were assigned to the late-surgery group. Demographic data, lesion characteristics, and fixation methods were analysed. Parameters affecting outcome measurements were analysed, including visual pain scale, fracture healing time, recurrence, ROM, time to return to daily activities, and secondary surgical procedures.The study included 35 patients, of whom 24 were female, with a median age of 33 years. Fifteen patients were included in the early-surgery group and 20 in the late-surgery group, with a follow-up period of 36.3 and 38.9 months, respectively. The duration of surgery, time to fracture union, and total physical therapy duration during treatment were lower in the late-surgery group (p<0.05). At the final follow-up, the mean loss of ROM was 17.6˚ in the early-surgery group and 3.3˚ in the late-surgery group (p=0.00). The rate of secondary surgery was higher in the early-surgery group (p=0.040).In patients with hand enchondromas presenting with pathological fractures, early surgery resulted in higher complication rates, poorer functional outcomes, and an increased need for secondary surgeries.

Cemented K-wire external fixation in juxta-articular enchondroma-related phalangeal pathological fracture

PURPOSE

This study aimed to introduce a technique of external fixation using a combination of bone cement and K-wires, to treat pathological fractures related to solitary digital enchondroma close to the finger joints.

METHODS

From October 2015 to January 2021, 21 patients (8 males and 13 females) with acute pathological fracture due to solitary digital enchondroma close to the finger joints were treated with cemented K-wire external fixators. Mean age was 32 (19-51) years. The digits involved were the index (n = 4), long (n = 4), ring (n = 6), and little (n = 7) fingers. Time to bone healing and complications were assessed. At final follow-up, active range of motion, grip strength and key pinch strength of the tumor-involved and contralateral healthy digits were measured and compared. Functional outcomes were evaluated on Takigawa criteria. Pain was measured on a 10-cm visual analog scale. We assessed the affected upper extremity on the Musculoskeletal Tumor Society score questionnaire.

RESULTS

Mean bone healing time was 5.5 (4-8) weeks. Pin site infection was observed in 1 patient and cured with dressing changes. Mean follow-up was 34 months, with no recurrences or refractures. Mean active range of motion of the proximal interphalangeal joint, grip and key pinch strength of the involved digits reached 92%, 97%, and 99% of the contralateral digits, respectively. On Takigawa criteria, 20 functional results were excellent and 1 good. Mean pain score was 1 (0-3) cm. Mean Musculoskeletal Tumor Society score was 95 (80-100).

CONCLUSION

The combination of bone cement and K-wires is a reliable technique for pathological fracture related to solitary enchondroma close to the joints of the digits, leading to good functional outcomes.

LEVEL OF EVIDENCE

Therapeutic study, Level IVa.

Malignant transformation of a phalangeal enchondroma into a recurrent grade II chondrosarcoma requiring successive transcarpal amputations: a case report

We report a case of malignant transformation of a phalangeal enchondroma into a grade II chondrosarcoma requiring two successive transcarpal amputations owing to recurrence. Soft tissue defects were repaired using single-stage reconstruction with a posterior interosseous artery flap. The 2-year follow-up assessment was satisfactory and no recurrence was observed.