Osseous tumours of the hand: a review of 99 cases in 20 years

Abstract

Background: Tumors involving the hand skeleton are rare. However, a basic knowledge of hand tumors is necessary for every clinician. This is due to the importance of distinguishing typical benign tumors from life or limb threatening malignant ones.

Methods: This study is a review of 99 cases of osseous hand tumors presented to the department of orthopedic surgery, Imam Khomeini Hospital in Tehran, Iran, from December 1990 to February 2011.

Results: Ninety-one cases were benign osseous tumors of the hand and eight tumors were malignant which four of them were considered as primary and four considered as metastatic type. The most common benign tumors were enchondroma and osteoid osteoma. Other benign tumors were epidermoid bone cyst, giant cell tumor of the bone, aneurysmal bone cyst, osteoblastoma, and osteochondroma. Primary malignant tumors were extremely rare and we have reported two chondrosarcomas, one osteosarcoma and one Ewing's sarcoma involving the hand skeleton.

Conclusion: This study indicates that the history, physical examination, laboratory and radiographic data as well as clinicians' knowledge of specific hand tumors are required for the best management strategy. New techniques could lead to earlier diagnosis, prevent complications and indentify the most effective type of treatment.

Keywords: Benign bone tumors; Hand tumors; Malignant bone tumors; Surgical management.

Figure 1.

Osteoid Osteoma of the hand: A 28-year-old man complained of pain in proximal phalanx of ring finger from four months ago. A. Clinical pictures. B. Radiographic appearance. C. T 99 bone scan shows increased uptake in the ring finger. D. CT scan shows sclerotic nidus and confirms diagnosis. E. Removal of nidus by surgery.

Figure 2.

Osteosarcoma in a 22-year-old man in the second metacarpal bone. A: “sunburst” periosteal reaction in radiography. B: Axial MRI image. C: Coronal MRI image.