The Management and Surgical Intervention Timing of Enchondromas
Authors: Zhou Xijie , Weng Weidong , Li Zhijie , Gao Weiyang , Yan Hede 
Published: September 2016

Objective: To investigate the impact of pathological fractures on the treatment outcomes in patients with fractures due to enchondromas and evaluate the optimal surgical intervention timing for these patients. Patients and Methods: Medical records and x-ray studies of patients treated for enchondroma of hand between 2005 and 2015 were retrospectively reviewed. Enchondromas located in phalanges and metacarpal bones were included in the study. There were 92 patients with solitary enchondromas of the hand, including 52 males (56.5%) and 40 females (43.5%) in this series, aged from 2 to 69 years (mean, 29.4 years). Based on the clinical data, patients with pathologic fractures were assigned into the group with fractures (n = 27) and those without fractures, who were diagnosed by accident, or routine physical examinations were assigned into the group without fractures (n = 65). All the patients were treated with operation. According to the timing of surgical intervention, the patients in the group with fractures were divided into two subgroups: primary (≤ 4 weeks; mean, 16 days) and delayed surgery (> 4 weeks; mean, 87 days) groups. The operative methods were simple curettage or combined with bone grafting with autologous or bioactive materials. The Disabilities of the Arm, Shoulder and Hand (DASH) upper limb function scale was used to evaluate the function of the affected hand. The time of returning to work, complications, as well as the recurrence rate and in-hospital costs were recorded. Results: No significant differences in terms of consolidation time after surgery, recurrence rate, and DASH scores were noted between the groups with and without fractures (all P > .05); the in-hospital costs were higher in the group with fractures than those in the group without fractures ( P < .05); however, patients without fractures returned to work much earlier than those with fractures ( P < .01). Of the patients with fractures, there were no significant differences in terms of consolidation time after surgery, recurrence rate, DASH scores, as well as the occurrence rate of complications between the primary surgery group and the delayed surgery group (all P > .05); however, the time returning to work was statistically longer in the delayed surgery group, with an average 76 days than that of the primary surgery group, with an average 36 days ( P < .001). Of all the patients, different surgical options of curettage only or combined with different filling materials had no effects on the follow-up outcomes (all P > .05). Healing was noted to be progressive and complete in all cases, and no functional restriction was observed. Conclusion: The pathological fractures associated with enchondromas have no significant impact on the treatment outcomes compared with those with simple non-fractured endochondromas. Although a little bit more expense was needed for patients treated primarily with pathological fractures due to enchondroma, these patients could resume to their original work much earlier than those treated by a delayed surgery. Early surgical intervention is recommended with similar results and no increased risks for patients with pathological fractures caused by endochondromas.