Identifying enchondromas of the hand at risk for pathological fracture - a review of 79 cases

Transcription

1 Identifying enchondromas of the hand at risk for pathological fracture - a review of 79 cases Judit Réka Hetthéssy Judit Réka Hetthéssy (1), Noémi Szakács (1), Péter Vancsó (1), Andrea Újszászi (2),Tünde Szilas (3) (1) Semmelweis University, Department of Orthopedics, Budapest, Hungary; (2) Heim Pál Children's Hospital, Budapest, Hungary; (3) Semmelweis University, Faculty of Medicine, Budapest, Hungary

2 Introduction Enchondroma of the hand: most common primary bone tumor of the hand often found incidentally benign lesions, but they may weaken the cortex resulting in pathological fractures to banal trauma standard treatment of primary enchondromas uncomplicated by pathological fracture: curettage and bone grafting guidelines on timing of the surgery, and thresholds for conservative treatment involving observation and regular radiographic follow-up are unclear

3 Objectives to identify objective reproducible clinical criteria that are associated with pathological fractures involving enchondromas on the hand that may be used to guide clinical decision making

4 Materials and methods Retrospective study ( ) Department Of Orthopedics, Semmelweis University 79 cases of enchondroma involving the hand Analyzed criteria in pathological fracture and non-fracture group: gender age the hand involved (left vs right) the bone involved (distal, middle and proximal phalanx, or metacarpal) the digit involved (little, ring, middle, index, or thumb) the longitudinal percentage of the bone occupied by the lesion on anteroposterior (AP) radiographs Exclusion criteria: syndromic cases of enchondromatosis, pediatric patients under the age of 16 Statistical analysis: odds ratios were calculated for each clinical criterion; statistical significance was evaluated using chi-square test

5 Results Number in the sample (N) Percentage in the sample(%) Number of fractures in the group(n) Percentage of fractures in the group (%) Gender Male 53 67,09% 12 22,64% Female 26 32,91% 14 53,85% Total ,00% Age group ,53% 8 29,63% ,95% 14 34,15% ,53% 4 50,00% Total ,00% Hand Left 37 46,84% 15 40,54% Right 42 53,16% 11 26,19% Total ,00% Digit Thumb 2 2,53% Index 12 15,19% 3 25,00% Middle 15 18,99% 4 26,67% Ring 22 27,85% 5 22,73% Small 27 34,18% 14 51,85% ulna 1 1,27% Total ,00% Location Metacarpal 17 21,25% 8 47,06% Proximal phalanx 42 52,50% 12 28,57% Middle phalanx 13 16,25% 4 30,77% Distal phalanx 8 10,00% 2 25,00%

6 Results chi-square test Degrees of freedom p-value Fracture*Gender 0, ,58 Fracture*Hand 1, ,176 Fracture*Age group 1, ,566 Fracture*Metacarpal 1, ,161 Fracture*Proximal phalanx 0, ,382 Fracture*Middle phalanx 0, ,857 Fracture*Distal phalanx 0, ,615

7 Results radiologic measurement Method: the longitudinal length of the bone and the enchondroma were measured using the most distal and most proximal aspects of the bone and the lesion Result: p = 0,02 statistically significant difference between the fracture and non-fracture group in regard to the percentage of the bone involved by the lesion on AP radiographs

8 Discussion pathological fracture occurred in 1/3 of all cases (n=26, 34%) 2/3 of the patients were male (n=53, 67%), but only 22% (n=12) of the male patients had pathological fracture 53 % (n= 14) of the female patients with enchondromas on the hand (n=26, 32%) suffered a pathologic fracture 53% (n=41) of the patients were from the age group of 26 years to 50 years, 34 % (n=14) of them had a pathologic fracture enchondromas occurred evenly on the left and right hand in our series evenly (47 % and 53%) enchondromas on the left side were more prone to a fracture (40%, n= 15) the little and the ring finger were the most commonly affected fingers regarding enchondorma the little finger was fractured in 51% (n=14) of the cases most enchondromas were located on the proximal phalanx (52%, n=42), the metacarpal ones fractured most frequently (47%, n=8). statistically significant difference between the fracture and non-fracture group in regard to the digit involved, the percentage of bone occupied by the lesion on AP radiographs no statistically significant difference in regard to sex, age or bone involved

9 Discussion the small finger showed a much higher association with fracture then the other fingers same result as in the study of Riester susceptible to injury) (peripheral location potentially make it more the criteria, where we found statistically significant difference between the fracture and the non-fracture group the affected finger and the percentage of the bone occupied by the pathologic lesion on AP radiographs may be used as a clinical guide to identify enchondormas on the hand at risk for a pathological fracture limitation of the study: only surgically treated enchondromas were involved

10 References Gaulke R. The distribution of solitary enchondromata at the hand. J Hand Surg Br. 2002;27: Muller PE, Durr HR, Wegner B, Pellegahr C, Maier M, Jansson V. Solitary enchondromas: is radiographic follow-up sufficient in patients with asymptomatic lesions? Acta Orthop Belg. 2003;69: Sassoon AA, Fitz-Gibbons PD, Harmsen WS, Moran SL. Enchondromas of the hand: factors affecting recurrence, healing, motion, and malignant transformation. J Hand Surg Am. 2012;37: Riester S, Ramaesch R, Wenger D, van Wijnen A, Kakar S. Predicting Fracture Risk for Enchondroma of the Hand. Hand (New York, NY). 2016;11(2): doi: /