title: An alternative technique for the management of phalangeal enchondromas with pathologic fractures.
abstract: OBJECTIVE
  Enchondroma of the hand with a pathologic fracture is generally treated by tumor curettage and bone grafting after the fracture has healed. However, delayed surgery postpones definitive diagnosis and prolongs the period of disability. We have treated pathologic fractures in a single stage through a modified lateral surgical approach with curettage of the tumor and stabilization using injectable calcium sulfate cement. The aim of this study was to report the outcomes of treatment with this material and the modified approach.
  
  
  METHODS
  Between 2006 and 2010, we enrolled 8 patients with solitary hand enchondromas and pathologic fractures. The surgical procedure involved a lateral approach, an extended lateral cortical window, thorough tumor evacuation, and reconstruction of the bone defects using commercially available injectable calcium sulfate cement. We performed evaluations before surgery and in the postoperative follow-up series by radiographs and clinical assessments, including measurement of joint motion by goniometry and a visual analog pain scale.
  
  
  RESULTS
  The average time of follow-up was 19 months (range, 12-36 mo). The pathologic fractures of all patients healed clinically and radiographically within 8 weeks after surgery, and the mean active motion arcs of the metacarpophalangeal joints and proximal interphalangeal joints of the involved digit were 90° and 94°, respectively at 3-month follow-up. All patients returned to ordinary daily activities without obvious pain by 3 months postoperatively. We found no major complications, such as unacceptable alignment, nonunion, infection, or tumor recurrence, during follow-up.
  
  
  CONCLUSIONS
  This study demonstrated the outcomes of early management of phalangeal enchondromas with pathologic fractures using a lateral approach and injectable calcium sulfate cement for reconstruction. This combined approach avoided the need for supplemental internal fixation, allowed early mobilization, and resulted in minimal joint stiffness.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
authors.forename: Sung-Yen
authors.initials: SY
authors.lastname: Lin
authors.forename: Peng-Ju
authors.initials: PJ
authors.lastname: Huang
authors.forename: Hsuan-Ti
authors.initials: HT
authors.lastname: Huang
authors.forename: Chung-Hwan
authors.initials: CH
authors.lastname: Chen
authors.forename: Yuh-Min
authors.initials: YM
authors.lastname: Cheng
authors.forename: Yin-Chih
authors.initials: YC
authors.lastname: Fu
mesh_terms: D000293:Adolescent; D000328:Adult; D001843:Bone Cements / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D002133:Calcium Sulfate; D002812:Chondroma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005385:Fingers; D005598:Fractures, Spontaneous / Q000209:etiology; D006801:Humans; D008297:Male; D008662:Metacarpophalangeal Joint / Q000503:physiopathology; D019637:Orthopedic Procedures / Q000379:methods*; D010147:Pain Measurement; D016059:Range of Motion, Articular; D055815:Young Adult
chemical_list: D001843:Bone Cements; D002133:Calcium Sulfate