Enchondromas of the hand: treatment with curettage and cemented internal fixation

Abstract

Removal by means of curettage is the mainstay of surgical treatment of enchondromas of the hand. Reconstruction traditionally entails filling the tumor cavity with a bone graft, or it may be decided not to perform a reconstruction. In either case a period of protected activity is needed until the tumor cavity has healed. The current study describes the use of cemented internal fixation for the purpose of reconstruction of these cavities. This technique provides immediate mechanical stability and allows early mobilization. Between 1986 and 1999, we treated 13 patients who were diagnosed as having enchondroma of the hand. Surgery included tumor removal with hand curettes and high-speed burr drilling. The remaining tumor cavity was reconstructed by using bone cement and intramedullary hardware. All patients were followed-up for more than 2 years. There were no postoperative infections or fractures, and all patients returned to their presurgical functional capability within 4 weeks. At the most recent follow-up evaluation, none of the patients had local tumor recurrence. Although 7 patients had a decrease in flexion of the metacarpophalangeal or interphalangeal joints, none reported a functional limitation. Reconstruction of the tumor cavity with cemented hardware provides immediate mechanical stability, allows early mobilization, and is associated with good functional outcome.