Treatment of Bone Defects Resulted after Excision of Enchondroma of the Hand in 15 Patients, Comparing the Techniques of Autologous Bone Graft, Injectable Bone Substitute and Spontaneous Healing

Norin Forna,Stefanita Arcana,Razvan Tudor,Alexandru Covaciu,Iulian Radu,Bogdan Puha,Victor Niculescu,Petru Ciobanu,Vladimir Poroch,Andrian Panuta

doi:10.3390/app12031300

Abstract

Background: Enchondroma is the most common benign bone tumor of the hand. Surgical excision of the tumor using curettage is the treatment of choice. The management of the resulting defects is still a controversial topic in the literature. Methods: This retrospective study includes 15 patients diagnosed with solitary enchondroma in the hand bones: eight cases with type A, three cases with type B and four cases with type D according to Takigawa classification. The aim of this study was to compare the course and outcome in the three patient groups treated by curettage associated with natural consolidation of the bone defect, autologous bone graft or injectable synthetic bone substitute in association with plate and screw osteosynthesis. Results: Outcomes were assessed using the DASH score (mean score 2.5) and TAM score (excellent in all patients) with no significant functional differences between the three groups. Defects managed with k-IBS® injectable bone substitute were associated with shorter operating time, simpler surgical technique and less postoperative pain assessed by VAS score. Conclusion: The use of k-IBS® bone substitute is efficient and less technically demanding than autologous bone grafting. The Takigawa classification could be a good indicator for treatment choice.

Highlights

The well-defined lytic lesion was accidentally discovered, or a symptomatic patient raised the suspicion of enchondroma
Pain score in the patients who received autologous bone graft was 4.2, and it was 2.5 in the group of patients in which the defect was allowed to heal on its own, and the lowest score was recorded in the group which received injectable bone substitute
All 15 cases included in this study had solitary enchondromas, cases of multiple enchondromas were described in 3.4% of the cases

Summary

Introduction

Solitary enchondromas are benign bone tumors arising from the persisting cartilaginous cells from the growth plate. They are located in the hand bones in more than 50% of cases [1]. Methods: This retrospective study includes patients diagnosed with solitary enchondroma in the hand bones: eight cases with type A, three cases with type B and four cases with type D according to Takigawa classification. The aim of this study was to compare the course and outcome in the three patient groups treated by curettage associated with natural consolidation of the bone defect, autologous bone graft or injectable synthetic bone substitute in association with plate and screw osteosynthesis. The Takigawa classification could be a good indicator for treatment choice

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