Enchondroma

Kevin D. Plancher and Michael Bothwell

History and Clinical Presentation

A 22-year-old woman with no prior hand injury presents after feeling a snap in her left ring finger while playing volleyball. The patient reports pain and swelling. She also reports pain with motion of the finger.

Physical Examination

The finger is tender to palpation. Range of motion is limited due to pain.

Diagnostic Studies

On radiographs a pathologic fracture in the hand or digits is frequently noted. Plain x-rays are diagnostic and reveal a centrally located lesion with marked bone expansion (Fig. 88—1). Cortical thinning and calcifications may also be present. Computed tomography (CT) has proven to be a useful tool in diagnosing enchondromas because it may detect endosteal scalloping and reveal the amount of bone destruction.

Histologically, this cartilage lesion is lobular and may penetrate the surrounding marrow spaces. The cells are often surrounded by a well-defined area of a proteoglycan matrix and a narrow rim of bone (Fig. 88-2).

Enchondroma Histology
Figure 88—1. Radiographic finding of enchondroma of the proxi- Figure 88—2. Histology of enchondroma showing cartilage lobular mal phalanx of the ring finger. surrounded by narrow rim of bone.

Differential Diagnosis

Inclusion cyst Fibrocystic defect of bone Giant cell tumors Aneurysmal bone cysts Fracture Enchondroma

Diagnosis

Enchondroma is the most predominant osseous tumor of the hand and is seen most frequently in the metacarpals and phalanges of the hand, but rarely affects the carpal bones, and accounts for approximately one fourth of all benign tumors. Enchon-dromas do not show a sex predilection, and can occur at any age, although most frequently they are seen in young adults. Most patients complain of pain in the fingers.

Surgical Management

The fracture was protected and allowed to heal in proper alignment. After the fracture had healed, the enchondroma was in its original state, as demonstrated by radiographs. The enchondroma was then excised by making a window in the cortex (Fig. 88—3). The contents, soft, blue, cartilaginous material, were carefully curetted. The cavity was then filled with cancellous bone (Fig. 88-4). The patient began early motion of the finger and returned for radiographs. No sign of the mass was seen.

Treatment consists of operative intervention when a fracture has occurred through the lesion. There is still a debate whether to treat the tumor and fracture simultane-

Enchondroma Finger

Figure 88—3. Clinical photograph showing enchondroma excised with cancellous bone graft prepared.

Figure 88—4. Bone graft after excision of tumor.

Enchondroma FingerEnchondroma Histology
Figure 88—5. Histology showing the development of chondrosarcoma in a patient with preexisting enchondroma.

ously or wait until the fracture heals and perform surgery at a later date. Curettage and bone grafting is the preferred option. If useful function of the finger is lost, amputation may be necessary.

Chondrosarcoma must be ruled out as a diagnosis when treating all patients with enchondroma (Fig. 88—5). A small enchondroma needs periodic evaluations; larger lesions that have an intact cortex should be treated aggressively. Malignant degeneration to a chondrosarcoma is reported to be between 30% and 50%, although it rarely will be localized to the hand. If a malignant lesion is suspected (an enlarging tumor or the onset of increasing pain), a bone scan should be performed.

Complications

Decreased range of motion has been seen in patients following reconstruction of the enchondroma site.

Suggested Readings

Ablove RH, Moy OJ, Peimer CA, Wheeler DR. Early versus delayed treatment of enchondroma. Am J Orthop 2000;29:771-772.

Aboulafia AJ, Temple HT, Scully SP. Surgical treatment of benign bone tumors. Instr Course Lect 2002;51:441-450.

Bickels J, Wittig JC, Kollender Y, et al. Enchondromas of the hand: treatment with curettage and cemented internal fixation. J Hand Surg [Am] 2002;27A:870-875.

Dell P, Stern P. Benign and malignant neoplasms of the upper extremity. In: Peimer CA, ed. Surgery of the Hand and Upper Extremity. New York: McGraw-Hill; 1996: 2231-2263.

Gitelis S, McDonald D. Common benign tumors and usual treatment. In: Simon M, Springfield D, eds. Surgery for Bone and Soft-Tissue Tumors. Philadelphia: LippincottRaven; 1998:191-205.

Montero LM, Ikuta Y, Ishida O, Fujimoto Y, Nakamusu M. Enchondroma in the hand retrospective study—recurrence cases. Hand Surg 2002;7:7-10.

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Responses

  • Anthony
    What is encondroma in the old fracture?
    6 years ago
  • Ralf
    How do you treat a benign enchondroma on the tail bone?
    5 years ago

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