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Outcome of surgical interventions for solitary enchondromas of the hand

Controversial issues

Outcome von chirurgischen Eingriffen bei solitären Enchondromen der Hand

Kontrovers diskutierte Aspekte

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Abstract

Background

Enchondromas are the most common primary bone tumors of the hand and are benign cartilaginous tumors. This study evaluated the clinical and radiologic results of patients who underwent surgical interventions for isolated hand enchondromas with a minimum follow-up of 1 year and focused on controversial issues.

Methods

A retrospective study included 66 patients with solitary hand enchondromas with follow-up >12 months who underwent surgical interventions between January 2014 and July 2020. Patients with multiple enchondromas, low-grade chondrosarcoma, or who missed follow-up were excluded. All patients underwent thorough curettage with or without filling. Follow-up visits were done at 6 weeks, 3 months, 6 months, and annually. Demographic characteristics, clinical presentation, surgical details, final histologic examination, rehabilitation program, complications, and recurrences were recorded. The range of movement of the affected hand was compared to the contralateral one. Radiological evaluation of defect filling using the modified Neer classification was done.

Results

Of the patients 25 were male and 41 were female (38 right hand affection, 28 left hand affection), the mean age was 30.4 ± 11.9 years. Indications for surgery were local pain, swelling, and pathological fractures. The mean follow-up period was 28.8 ± 12.9 months (range 12–67 months). The mean MSTS score was 28.73 ± 1.6 (range 24–30). The middle finger was most frequently affected (18 cases, 27.3%) and the proximal phalanx was the most common location (37 cases, 56.1%). The mean length of lesions was 18.9 ± 6.67 mm and the mean width was 12.3 ± 4.1 mm. According to the modified Neer classification, 50 cases were classified as grade 1 (healed), 16 cases as grade 2 (healed with defects), and no case presented as persistent or recurrent lesions.

Conclusion

Solitary hand enchondroma can be effectively treated with adequate curettage, with or without autologous bone grafting, with positive functional and radiological outcomes. When compared to grafting from the iliac crest, harvesting bone from the distal radius provides a shorter hospital stay and reduced complication rates.

Graphic abstract

Zusammenfassung

Hintergrund

Enchondrome sind die häufigsten primären Knochentumoren der Hand und sind gutartige Knorpeltumoren. Diese Studie untersuchte die klinischen und radiologischen Ergebnisse von Patienten, die wegen isolierter Enchondrome an der Hand chirurgisch behandelt wurden (mit einer Mindestnachbeobachtungszeit von einem Jahr), und fokussierte auf kontrovers diskutierte Aspekte.

Methoden

In die retrospektive Studie wurden 66 Patienten mit einem solitären Handenchondrom und einem Follow-up von >12 Monaten aufgenommen, die zwischen Januar 2014 und Juli 2020 operiert worden waren. Ausgeschlossen wurden Patienten mit multiplen Enchondromen, niedriggradigen Chondrosarkomen und Patienten, die eine Nachuntersuchung ausgelassen hatten. Alle Patienten wurden einer gründlichen Kürettage mit oder ohne Auffüllen unterzogen. Die Nachuntersuchungen erfolgten nach 6 Wochen, 3 Monaten, 6 Monaten und jährlich. Erfasst wurden demographische Merkmale, klinische Darstellung, chirurgische Details, definitive histologische Beurteilung, Rehabilitationsprogramm, Komplikationen und Rezidive. Der Bewegungsumfang der betroffenen Hand wurde mit dem der kontralateralen Hand verglichen. Die Defektauffüllung wurde anhand der modifizierten Neer-Klassifikation radiologisch beurteilt.

Ergebnisse

Von den Patienten waren 25 männlich und 41 weiblich (38 Tumoren in der rechten Hand, 28 in der linken), das Durchschnittsalter betrug 30,4 ± 11,9 Jahre. Indikationen für die Operation waren lokale Schmerzen, Schwellungen und pathologische Frakturen. Die mittlere Nachbeobachtungszeit lag bei 28,8 ± 12,9 Monaten (Range 12-67 Monate), der mittlere MSTS-Score bei 28,73 ± 1,6 (Range 24-30). Der Mittelfinger war am häufigsten betroffen (18 Fälle, 27,3 %), die proximale Phalanx war die am meisten betroffene Stelle (37 Fälle, 56,1 %). Die mittlere Länge der Läsionen betrug 18,9 ± 6,67mm, die mittlere Breite 12,3 ± 4,1 mm. Nach der modifizierten Neer-Klassifikation wurden 50 Fälle als Grad 1 (abgeheilt) und 16 als Grad 2 (abgeheilt mit Defekten) eingestuft. Kein Patient wies persistierende oder rezidivierende Läsionen auf.

Schlussfolgerung

Solitäre Handenchondrome lassen sich mit adäquater Kürettage, mit oder ohne autologes Knochentransplantat, wirksam behandeln, die funktionellen und radiologischen Ergebnisse sind positiv. Im Vergleich zur Entnahme von Knochen aus dem Beckenkamm bietet die Knochenentnahme aus dem distalen Radius einen kürzeren stationären Aufenthalt und geringere Komplikationsraten.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Menoufia University Faculty of Medicine, 32511, Shebin El-Kom, Menoufia, Egypt

    Badr Ismail Tawfeek MD & Hasan Bahaa Zakarya MD

  2. Department of Orthopaedics and Traumatology, Gazi University Medical Faculty, Ankara, Turkey

    Tokgöz Mehmet Ali MD

  3. Department of Orthopedics and Traumatology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey

    Ulucaköy Coşkun MD

  4. Department of Orthopedic Surgery, Tanta University Faculty of Medicine, Tanta, Egypt

    Eldaw Sheriff MD

Authors
  1. Badr Ismail Tawfeek MD
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  2. Tokgöz Mehmet Ali MD
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  3. Ulucaköy Coşkun MD
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  4. Eldaw Sheriff MD
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  5. Hasan Bahaa Zakarya MD
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Contributions

All authors have read and approved the final submitted manuscript. Ismail tawfeek badr: conceptualization, methodology, investigation, writing original draft and review and editing, visualization. Mehmet ali tokgöz: formal analysis, data curation, writing—original draft review and editing, visualization. Coşkun ulucaköy: methodology, formal analysis, data curation, writing—original draft, review and editing, visualization. Sheriff Eldaw: methodology, formal analysis, data curation, writing—original draft and review, editing, visualization. Bahaa zakarya hasan: investigation, conceptualization, methodology, review and editing, supervision.

Corresponding author

Correspondence to Badr Ismail Tawfeek MD.

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Conflict of interest

I.T. Badr, M.A. Tokgöz, C. Ulucaköy, S. Eldaw and B.Z. Hasan declare that they have no competing interests.

This retrospective study was performed after consultation with the institutional ethics committee of Menoufia University Faculty of Medicine and in accordance with national legal requirements. Written informed consent was obtained from all patients.

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Availability of data

The data are available on reasonable request to the corresponding author.

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Badr, I.T., Tokgöz, M.A., Ulucaköy, C. et al. Outcome of surgical interventions for solitary enchondromas of the hand. Orthopädie 52, 595–603 (2023). https://doi.org/10.1007/s00132-023-04361-x

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