Acta Chir Orthop Traumatol Cech. 2024; 91(6):331-338 | DOI: 10.55095/achot2024/067
Hand Enchondromas Treated with Curettage: a Single Institution Experience and Literature Review
- University of Pisa, Department of Orthopedic and Trauma Surgery, Pisa, Italy
Purpose of the Study: Hand enchondromas are benign cartilage bone tumors. Curettage represents the actual gold standard for hand enchondromas. Little has been written about the effectiveness of curettage on hand functionality.
Material and Methods: In this retrospective study, we evaluated the effectiveness of curettage and bone grafting on the hand. For each case, we compared the pre-operative and post-operative QuickDASH of the treated limb. The final functional outcome was also evaluated by calculating the affected finger's Total Active Movement (TAM). Complications and local recurrences were recorded.
Results: Forty-five cases were included in our study. Fifteen of them had a pathological fracture. The mean pre-operative QuickDASH score was 48.4. No intraoperative complications occurred. After a mean follow-up of 38.1 months, the mean QuickDASH score had decreased to 4.4, and the TAM was optimal or sub-optimal. QuickDASH and TAM were significantly better for those with pathologic fractures before surgery. Only 3 cases (7%) had postoperative complications, and 1 (2%) had a local recurrence.
Discussion: Our results prove the effectiveness of curettage and early rehabilitation in increasing and restoring the performances of the treated hands. Our patients experienced a significant improvement in their functionality after surgery, generally passing from a poor to an excellent status. In our cohort, those who had a pathologic fracture before surgery had slightly but significantly worse functional outcomes compared to those who did not suffer pre-operative lesions.
Conclusions: Curettage and early postoperative rehabilitation can lead to good clinical and functional outcomes for hand enchondromas. Patients with pathologic fractures, although slightly exposed to a higher risk of sub-optimal outcomes, can also aim for good post-operative functionality.
Keywords: hand, chondroma, QuickDASH, fracture, rehabilitation.
Received: January 23, 2024; Revised: January 23, 2024; Accepted: November 7, 2024; Published: February 3, 2025 Show citation
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References
- Bachoura A, Rice IS, Lubahn AR, Lubahn JD. The surgical management of hand enchondroma without postcurettage void augmentation: authors' experience and a systematic review. Hand (N Y). 2015;10:461-471. doi: 10.1007/s11552-015-9738-y.
Go to original source...
Go to PubMed...
- Bickels J, Wittig JC, Kollender Y, Kellar-Graney K, Mansour KL, Meller I, Malawer MM. Enchondromas of the hand: treatment with curettage and cemented internal fixation. J Hand Surg Am. 2002;27:870-875. doi: 10.1053/jhsu.2002.34369.
Go to original source...
Go to PubMed...
- Cha SM, Shin HD, Kim KC, Park IY. Extensive curettage using a high-speed burr versus dehydrated alcohol instillation for the treatment of enchondroma of the hand. J Hand Surg Eur Vol. 2015;40:384-391. doi: 10.1177/1753193413517204.
Go to original source...
Go to PubMed...
- Choy WS, Kim KJ, Lee SK, Yang DS, Park HJ. Treatment for hand enchondroma with curettage and calcium sulfate pellet (OsteoSet®) grafting. Eur J Orthop Surg. 2012;22:295-299. doi:10.1007/s00590-011-0842-6.
Go to original source...
- Gaasbeek RD, Rijnberg WJ, van Loon CJ, Meyers H, Feith R. No local recurrence of enchondroma after curettage and plaster filling. Arch Orthop Trauma Surg. 2005;125:42-45. doi: 10.1007/s00402-004-0747-5.
Go to original source...
Go to PubMed...
- Gaulke R, Suppelna G. Solitary enchondroma at the hand. Long-term follow-up study after operative treatment. J Hand Surg Br. 2004;29:64-66. doi: 10.1016/j.jhsb.2003.08.003.
Go to original source...
Go to PubMed...
- Georgiannos D, Lampridis V, Bisbinas I. Phenolization and coralline hydroxyapatite grafting following meticulous curettage for the treatment of enchondroma of the hand. A case series of 82 patients with 5-year follow-up. Hand (N Y). 2015;10:111-115. doi: 10.1007/s11552-014-9674-2.
Go to original source...
Go to PubMed...
- Goto T, Yokokura S, Kawano H, Yamamoto A, Matsuda K, Nakamura K. Simple curettage without bone grafting for enchondromata of the hand: with special reference to replacement of the cortical window. J Hand Surg Br. 2002;27:446-451. doi: 10.1054/jhsb.2002.0843.
Go to original source...
Go to PubMed...
- Herget GW, Uhl M, Opitz OG, Adler CP, Südkamp NP, Knöller S. The many faces of chondrosarcoma of bone, own cases and review of the literature with an emphasis on radiology, pathology and treatment. Acta Chir Orthop Traumatol Cech. 2011;78:501-509.
Go to original source...
- Hung YW, Ko WS, Liu WH, Chow CS, Kwok YY, Wong CW, Tse WL, Ho PC. Local review of treatment of hand enchondroma (artificial bone substitute versus autologous bone graft) in a tertiary referral centre: 13 years' experience. Hong Kong Med J. 2015;21:217-223. doi: 10.12809/hkmj144325.
Go to original source...
Go to PubMed...
- Joosten U, Joist A, Frebel T, Walter M, Langer M. The use of an in situ curing hydroxyapatite cement as an alternative to bone graft following removal of enchondroma of the hand. J Hand Surg Br. 2000;25:288-291. doi: 10.1054/jhsb.2000.0383.
Go to original source...
Go to PubMed...
- Kim JK, Kim NK. Curettage and calcium phosphate bone cement injection for the treatment of enchondroma of the finger. Hand Surg. 2012;17:65-70. doi: 10.1142/S0218810412500104.
Go to original source...
Go to PubMed...
- Lin SY, Huang PJ, Huang HT, Chen CH, Cheng YM, Fu YC. An alternative technique for the management of phalangeal enchondromas with pathologic fractures. J Hand Surg Am. 2013;38:104-109. doi: 10.1016/j.jhsa.2012.08.045.
Go to original source...
Go to PubMed...
- Montero LM, Ikuta Y, Ishida O, Fujimoto Y, Nakamasu M. Enchondroma in the hand retrospective study--recurrence cases. Hand Surg. 2002;7:7-10. doi: 10.1142/s0218810402000893.
Go to original source...
Go to PubMed...
- Morii T, Mochizuki K, Tajima T, Satomi K. Treatment outcome of enchondroma by simple curettage without augmentation. J Orthop Sci. 2010;15:112-117. doi: 10.1007/s00776-009-1419-7.
Go to original source...
Go to PubMed...
- Mulligan ME. How to Diagnose Enchondroma, Bone Infarct, and Chondrosarcoma. Curr Probl Diagn Radiol. 2019;48:262-273. doi: 10.1067/j.cpradiol.2018.04.002.
Go to original source...
Go to PubMed...
- Nazarova NZ, Umarova GS, Vaiman M, Asilova SU, Abba M, Foonberg M, Shterenshis M. The surgical management of the cavity and bone defects in enchondroma cases: a prospective randomized trial. Surg Oncol. 2021;37:101565. doi: 10.1016/j.suronc.2021.101565.
Go to original source...
Go to PubMed...
- O'Connor MI, Bancroft LW. Benign and malignant cartilage tumors of the hand. Hand Clin. 2004;20:317-323, vi. doi: 10.1016/j.hcl.2004.03.019.
Go to original source...
Go to PubMed...
- Orman O, Adiguzel İF, Sencan A, Baydar M, Orman M, Ozturk A. Comparison of distal radius autograft technique with iliac crest autograft technique in solitary finger enchondromas. Sisli Etfal Hastan Tip Bul. 2022;56:400-407. doi: 10.14744/SEMB.2022.00483.
Go to original source...
Go to PubMed...
- Park HY, Joo MW, Choi YH, Chung YG, Park CJ. Simple curettage and allogeneic cancellous bone chip impaction grafting in solitary enchondroma of the short tubular bones of the hand. Sci Rep. 2023;13:2081. doi: 10.1038/s41598-023-29130-w.
Go to original source...
Go to PubMed...
- Rabarin F, Laulan J, Saint Cast Y, Césari B, Fouque PA, Raimbeau G. Focal periosteal chondroma of the hand: a review of 24 cases. Orthop Traumatol Surg Res. 2014;100:617-620. doi: 10.1016/j.otsr.2014.05.014.
Go to original source...
Go to PubMed...
- Rajeh MA, Diaz JJ, Facca S, Matheron AS, Gouzou S, Liverneaux P. Treatment of hand enchondroma with injectable calcium phosphate cement: a series of eight cases. Eur J Orthop Surg Traumatol. 2017;27:251-254. doi: 10.1007/s00590-016-1888-2.
Go to original source...
Go to PubMed...
- Sassoon AA, Fitz-Gibbon PD, Harmsen WS, Moran SL. Enchondromas of the hand: factors affecting recurrence, healing, motion, and malignant transformation. J Hand Surg Am. 2012;37:1229-1234. doi: 10.1016/j.jhsa.2012.03.019.
Go to original source...
Go to PubMed...
- Schaller P, Baer W. Operative treatment of enchondromas of the hand: is cancellous bone grafting necessary? Scand J Plast Reconstr Surg Hand Surg. 2009;43:279-285. doi: 10.3109/02844310902891570.
Go to original source...
Go to PubMed...
- Simon MJ, Pogoda P, Hövelborn F, Krause M, Zustin J, Amling M, Barvencik F. Incidence, histopathologic analysis and distribution of tumours of the hand. BMC Musculoskelet Disord. 2014;15:182. doi: 10.1186/1471-2474-15-182.
Go to original source...
Go to PubMed...
- Sollaci C, Araújo GCS. Enchondromas of the Hand: A 20-year experience. Rev Bras Ortop (Sao Paulo). 2019;54:714-720. doi: 10.1055/s-0039-1697970.
Go to original source...
Go to PubMed...
- Strike SA, Puhaindran ME. Tumors of the hand and the wrist. JBJS Rev. 2020;8:e0141. doi: 10.2106/JBJS.RVW.19.00141. PMID: 32487977.
Go to original source...
Go to PubMed...
- Wang W, Yeung KWK. Bone grafts and biomaterials substitutes for bone defect repair: a review. Bioact Mater. 2017;2:224-247. doi: 10.1016/j.bioactmat.2017.05.007.
Go to original source...
Go to PubMed...
- Wessel LE, Christ AB, Athanasian EA. Impact of patient and tumor characteristics on range of motion and recurrence following treatment of enchondromas of the hand. J Hand Surg Am. 2023;48:512.e1-512.e7. doi: 10.1016/j.jhsa.2021.11.027.
Go to original source...
Go to PubMed...
- Yasuda M, Masada K, Takeuchi E. Treatment of enchondroma of the hand with injectable calcium phosphate bone cement. J Hand Surg Am. 2006;31:98-102. doi: 10.1016/j.jhsa.2005.08.017.
Go to original source...
Go to PubMed...
- Yercan H, Ozalp T, Coşkunol E, Ozdemir O. Long-term results of autograft and allograft applications in hand enchondromas. Acta Orthop Traumatol Turc. 2004;38:337-342.
- Zheng H, Liu J, Dai X, Schilling AF. Modified technique for one-stage treatment of proximal phalangeal enchondromas with pathologic fractures. J Hand Surg Am. 2014;39:1757-1760. doi: 10.1016/j.jhsa.2014.06.131.
Go to original source...
Go to PubMed...
- Zhou X, Zhao B, Keshav P, Chen X, Gao W, Yan H. The management and surgical intervention timing of enchondromas: A 10-year experience. Medicine (Baltimore). 2017;96:e6678. doi: 10.1097/MD.0000000000006678.
Go to original source...
Go to PubMed...
- Żyluk A. Outcomes of Surgery for Enchondromas within the Hand. Ortop Traumatol Rehabil. 2021;23:325-334. doi: 10.5604/01.3001.0015.4344.
Go to original source...
Go to PubMed...