The patient presents with a well-defined centrally located radiolucent lesion with cortical thinning and stippled calcification. The lesion was asymptomatic prior to fracture. This presentation is consistent with enchondroma, the most common tumor of the hand.

Radiographs of the lesion and patient history make the diagnosis of enchondroma in most cases. If the diagnosis is unclear, magnetic resonance imaging may be ordered. Indications for magnetic resonance imaging include increasing pain, large aggressive appearing lesions, cortical destruction, and surrounding soft tissue extension. The vast majority of enchondromas are found incidentally on radiographs and can be treated with observation. Routine follow-up radiography is generally not recommended unless the lesion becomes symptomatic, the tumor appears aggressive, or there is a risk for pathologic fracture.

If pathologic fracture is present at the initial consultation, it should be treated with immobilization for 6 weeks until the fracture heals. Surgery is recommended once the fracture heals because enchondroma are prone to future fracture. Surgery involves intralesional curettage and bone grafting, which fills the void and helps reduce the risk for future fracture. Bone biopsy is taken at the time of curettage to confirm the diagnosis.1,2

Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).

References

  1. Woon C. Enchondromas. http://www.orthobullets.com/pathology/8018/enchondromas. Accessed June 26, 2017.
  2. Lubahn JD, Bachoura A. Enchondroma of the hand: evaluation and management. J Am Acad Orthop Surg. 2016;24:625-633.
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