Encondromas da mão: Uma experiência de 20 anos

Abstract

Objective Enchondromas are the commonest tumors of the bones of the hand. Treatment approaches vary. The present article presents the characteristics of the tumors, diagnostic methods, and treatments. Methods We discuss the approach used in our institution, where we have treated 48 patients with enchondromas of the hand between 1996 and 2016. Our technique of treatment, which has remained the same over 2 decades, comprises the use of curettage, high-speed burr, and autologous bone graft (harvested with a minimally invasive technique, using a Craig biopsy needle). Results Pain and fractures were the most common symptoms leading the patients to consultation, at frequencies of 33.3% and 31.3%, respectively. A total of 27.1% of the cases were asymptomatic, and their lesions were discovered incidentally. The mean age was 34.4 years (SD = 12.9 years). Tumors were more frequently presented in the ulnar side of the hand, in the fifth ray (41.5%) and in the proximal bones (in the proximal phalanges [43.8%], and in the metacarpal [33.3%]). The size of the tumors ranged from 0.2 cm 2 to 5.7 cm 2 , with a mean of 1.7 cm 2 (standard deviation [SD] = 1.0 cm 2 ) and were not associated with fracture ( p = 0.291). Fracture was also not associated with any of the symptoms, neither with the age of the patients ( p = 0.964). After the treatment, most patients achieved full range of motion (91.7%), with good integration of the bone graft. Three patients presented deficit in range of motion (6.3%) and the incidence of complications was also 6.3% (3 patients). At the end, after the needed surgical revisions, these three patients also recovered full function. They achieved full bone graft integration, regained full range of motion and returned to work. There was no tumor recurrence case during the follow-up period evaluated. For all cases, no donor site complications occurred. Conclusion Our method of treatment has consistently provided good outcomes, with only a few minor complications. Therapeutic level of evidence: IV.

Surgical Treatment of Solitary Enchondromas of the Hand

“…The findings of our study are largely consistent with those of previous studies [1][2][3][4][15][16][17]. In most patients, enchondromas were diagnosed in the third and fourth decades of life.…”

“…In a recent study, 48 patients with an enchondroma located in the hand were treated with an autologous bone graft, which was harvested from the iliac bone crest via a minimally invasive technique (using a Craig biopsy needle). The authors did not find any complications in the donor site [16]. In our study, minor complications, such as donor site pain or related thigh numbness and superficial infection, were observed in five patients (20,83%), which were related to the donor site (iliac crest bone graft harvested using the conventional technique).…”

Surgical Management of Enchondromas of the Hand: A 12-Year Experience

“…►Table 3 shows the comparison of our reported results with other studies in the literature reporting on more than 20 cases of surgical management of enchondroma. 10,12,[14][15][16][17][18][19][20][21][22][23][24][25][26] The distribution of lesions in our study correlates to the previous experience in the literature demonstrating both a preponderance for the ulnar digits and for the proximal phalanges. 27 However, while the results of Gaulke suggest this difference is significant and cannot be attributed to chance, there does not appear to be an accepted explanation or mechanism by which this occurs.…”

“…Table 3 shows the comparison of our reported results with other studies in the literature reporting on more than 20 cases of surgical management of enchondroma. 10 12 14 15 16 17 18 19 20 21 22 23 24 25 26…”

A long-standing large enchondroma of 5th metacarpal associated with deformity of the adjacent metacarpal bone: A rare case report

“…Bierry et al [3] study showed that enchondromas in children appear as relatively large lesions. Sollaci et al [5] are reporting their 20 years' experience in their institute and found that the size of the tumors ranged from 0.2 cm 2 to 5.7 cm2, with a mean size of 1.7 cm2 (SD ¼ 1.0 cm 2 ). [5] Other studies by Pandey [6] and Ambulgekar et al [4] reported large enchondromas presented with and without pathological fracture respectively.…”