Connective Tissue Oncology Society

2001 CTOS Annual Meeting Posters— Surgery

ENCHONDROMA OF THE HAND: MANAGEMENT WITH CURETTAGE AND CEMENTED INTRAMEDULLARY HARDWARE
Jacob Bickels¹, James C. Wittig², Yehuda Kollender¹, Kari L Mansour², Isaac Meller¹, Martin M Malawer²
¹Tel-Aviv Sourasky Medical Center National Unit of Orthopedic Oncology, ²Division of Orthopedic Oncology Washington Cancer Institute Washington Hospital Center

OBJECTIVE: Surgical removal by means of curettage is the mainstay of treatment of enchondromas of the hand. Methods of reconstruction after tumor removal usually entail no reconstruction or filling of the tumor cavity with a bone graft. These techniques necessitate a prolonged period of protected activity until bone healing of the tumor cavity occurs. The authors have utilized hardware and bone cement for the purpose of reconstruction of the tumor cavity. This technique provides immediate mechanical stability and allows early mobilization.

METHODS: Between 1986 and 1999 the authors treated 13 patients (8 females, 4 males) who ranged in age from 23 to 58 years (median, 32 years) and diagnosed with enchondroma of the hand. Eight patients presented with a pathological fracture. Anatomic locations included: metacarpal bones – 5, proximal phalanx – 4, and middle phalanx – 4. Tumors were approached through the retained thinned or destroyed cortex to minimize additional bone loss. Surgery included removal of all gross tumors with hand curettes; this was followed by high-speed burr drilling of the inner reactive bone shell. Reconstruction included intramedullary metal wire along the longitudinal axis of the cavity and polymehylmethacrylate (PMMA). Full activity as tolerated was allowed immediately after surgery. All patients were followed for more than 2 years; Follow-up included physical and radiological evaluation and functional evaluation.

RESULTS: Following surgery, all patients returned to their presurgical functional capability within two weeks. At the last followup, none of the patients had local tumor recurrence and although three patients had 15 to 20 decrease in flexion of the metacarpophalangeal joint, none reported a functional limitation. There were no postoperative infections or fractures.

CONCLUSION: Reconstruction of the tumor cavity, remaining after curettage of enchondroma of the hand, with intramedullary hardware and PMMA provides immediate mechanical stability and allows early mobilization. This technique is associated with good short- and long-term functional outcomes.