Ortho Dx: A nondisplaced fracture through a radiolucent lesion - Clinical Advisor

Ortho Dx: A nondisplaced fracture through a radiolucent lesion

Slideshow

  • Anteroposterior radiograph of a patient’s injured finger shows a nondisplaced fracture at the base of the distal phalanx through a radiolucent lesion.

    Slide

    Anteroposterior radiograph of a patient’s injured finger shows a nondisplaced fracture at the base of the distal phalanx through a radiolucent lesion.

  • Lateral radiograph of the patient’s finger.

    Slide

    Lateral radiograph of the patient’s finger.

A 24-year-old man presents with left index finger pain that has been present for 1 week. The pain began abruptly when he was moving books. He denies prior injury to the finger. The tip of the finger continues to be painful to touch and with any motion. On examination, the patient has tenderness to the distal phalanx without deformity. Anteroposterior and lateral radiographs of the finger show a nondisplaced fracture at the base of the distal phalanx through a radiolucent lesion.

This case has been brought to you in partnership with the Journal of Orthopedics for Physician Assistants.

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...

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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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