An Alternative Technique for the Management of Phalangeal Enchondromas With Pathologic Fractures

作者：Lin Sung Yen; Huang Peng Ju; Huang Hsuan Ti; Chen Chung Hwan; Cheng Yuh Min; Fu Yin Chih^*

来源：Journal of Hand Surgery-American Volume, 2013, 38A(1): 104-109.

DOI：10.1016/j.jhsa.2012.08.045

• Enchondroma
• pathologic fracture
• calcium sulfate

Purpose Enchondroma of the hand with a pathologic fracture is generally treated by tumor curettage and bone grafting after the fracture has healed. However, delayed surgery postpones definitive diagnosis and prolongs the period of disability. We have treated pathologic fractures in a single stage through a modified lateral surgical approach with curettage of the tumor and stabilization using injectable calcium sulfate cement. The aim of this study was to report the outcomes of treatment with this material and the modified approach. %26lt;br%26gt;Methods Between 2006 and 2010, we enrolled 8 patients with solitary hand enchondromas and pathologic fractures. The surgical procedure involved a lateral approach, an extended lateral cortical window, thorough tumor evacuation, and reconstruction of the bone defects using commercially available injectable calcium sulfate cement. We performed evaluations before surgery and in the postoperative follow-up series by radiographs and clinical assessments, including measurement of joint motion by goniometry and a visual analog pain scale. %26lt;br%26gt;Results The average time of follow-up was 19 months (range, 12-36 mo). The pathologic fractures of all patients healed clinically and radiographically within 8 weeks after surgery, and the mean active motion arcs of the metacarpophalangeal joints and proximal interphalangeal joints of the involved digit were 90 degrees and 94 degrees, respectively at 3-month follow-up. All patients returned to ordinary daily activities without obvious pain by 3 months postoperatively. We found no major complications, such as unacceptable alignment, nonunion, infection, or tumor recurrence, during follow-up. %26lt;br%26gt;Conclusions This study demonstrated the outcomes of early management of phalangeal enchondromas with pathologic fractures using a lateral approach and injectable calcium sulfate cement for reconstruction. This combined approach avoided the need for supplemental internal fixation, allowed early mobilization, and resulted in minimal joint stiffness. (J Hand Surg 2013;38A:104-109.

• 出版日期2013-1