Objective: To expore the influence factors of the surgical effectiveness for solitary enchondroma of the hand with pathologic fracture.
Methods: A retrospective analysis was made on the clinical data of 65 patients with solitary enchondroma of the hand with pathologic fracture who were treated with operation and were accorded with selective standard between March 2010 and June 2013. There were 26 males and 39 females, aged 17 to 63 years (mean, 36 years). The left hands were involved in 32 cases and the right hands in 33 cases. The tumor located at the metacarpus in 18 cases, and at the phalanx in 47 cases (at the proximal phalanx in 30 cases, at the middle phalanx in 9 cases, and at the distal phalanx in 8 cases). The duration from fracture to operation was 2 days to 2 years (mean, 56 days). The operative methods were curettage and bone grafting. The ratios of the total active range of motion (ROM) of the metacarpophalangeal joint and interphalangeal joint between ipsilateral and contralateral fingers were used to evaluate the ipsilateral fingers' function. The time of returning to work was recorded. The multiple linear regressions were performed to analyze the risk factors of the effectiveness.
Results: A total of 65 cases were followed up 5-44 months (mean, 24 months). All incisions achieved primary healing. No infection, re-fracture, or recurrence occurred. The X-ray films showed fracture healing, the healing time was 5-10 weeks (mean, 6.5 weeks). All the bone grafts healed well. At last follow-up, the ROM ratio of the fingers was 0.46-1.00 (mean, 0.90). The time of returning to work was 92-180 days (mean, 130 days). Multiple linear regressions showed that internal fixation was risk factor for the ROM ratio of the fingers (P = 0.013). The duration from fracture to operation, internal fixation, and the tumor site were risk factors for the time of returning to work (P < 0.05).
Conclusion: To obtain good effectiveness for patients with solitary enchondroma of the hand with pathologic fracture, it is suggested that immediate operative treatment including tumor curettage, open reduction, and internal fixation with plate and screws of the fracture.