Comparison of Distal Radius Autograft Technique with Iliac Crest Autograft Technique in Solitary Finger Enchondromas

Abstract

Objectives: The purpose of the study was to compare clinical and radiological outcomes of autografts obtained from the iliac crest (IC) and distal radius (DR) and to evaluate their superiority for surgical treatment of solitary finger enchondromas.

Methods: Twenty-five patients for whom curettage and autografting were carried out for finger enchondroma were retrospectively analyzed. DR autograft was used in eight patients and IC autograft was used in 17 patients. Data on pre-operative total active motion (TAM), disabilities of the arm, shoulder, and hand (DASH) score, and pain visual analog scale (VAS) scores of the involved finger, duration of surgery, amount of bleeding during the operation, length of hospital stay, presence of complications related to anesthesia, and post-operative donor site morbidity were obtained. Pre-operative and post-operative 12^th month radiographies were evaluated for pre-operative tumor volume, post-operative remnant volume, and Tordai radiologic evaluation grade.

Results: No statistically significant difference could be identified between post-operative TAM (p=0.154), DASH (p=0.458), pain VAS scores (p=0.571), remnant volume (p=0.496), Tordai radiologic evaluation grade (p=0.522), duration of surgery (p=0.288), and amount of bleeding (p=0.114) between DR and IC groups. However, mean hospital stay duration was shorter for the DR group (p=0.0001). Recurrence was observed in one patient in the DR group and three patients in the IC group (p=0.996).

Conclusion: The clinical and radiological outcomes of grafting from the DR and IC were similar in the treatment of hand enchondromas. However, grafting from the DR may result in shorter hospital stay compared to IC grafting.

Keywords: Bone grafting; Local anesthesia; Pathological fracture; bone neoplasm.

Figure 1

Hasselgren classification. I: Type of tumor: (a) Monocentric, (b) polycentric, and (c) giant. II: Form of tumor: (a) Non-expanding and (b) expanding. III: Localization of tumor: (a) Central, (b) eccentric, and (c) associated.

Figure 2

Surgical photographs of a patient operated with distal radius graft under WALANT surgery. (a) A transverse incision was made from the dorsal over the radial styloid, the radius was reached by going deeper between the first and second extensor compartments, and the bone window was opened. (b) Amount of bone graft obtained and amount of bleeding. (c) Skin closure.

Figure 3

Patient operated with distal radius autograft technique. (a) Pre-operative anteroposterior view. (b) Pre-operative lateral view. (c) Post-operative 12^th month anteroposterior view. (d) Post-operative 12^th month lateral view.

Figure 4

Patient operated with iliac crest autograft technique. (a) Pre-operative anteroposterior view. (b) Pre-operative lateral view. (c) Post-operative 12^th month anteroposterior view. (d) Post-operative 12^th month lateral view.