From the Guidelines
Enchondroma is a benign, cartilaginous neoplasm that arises from the medullary cavity of bones, typically growing to sizes up to 3 cm and often causing no pain 1.
Definition and Characteristics
Enchondromas are benign bone tumors that develop from cartilage within the bone, most commonly affecting the small bones of the hands and feet, though they can also occur in long bones like the femur or humerus. They are characterized by their cartilaginous nature and tendency to cause bone expansion.
Treatment Approaches
Treatment typically involves:
- Observation with regular imaging if the enchondroma is small, asymptomatic, and shows no aggressive features.
- Surgical treatment through curettage (scraping out the tumor) and bone grafting for painful enchondromas or those at risk of fracture, as recommended by recent clinical practice guidelines 1.
Post-Treatment Care and Prognosis
After surgery, patients may need to limit weight-bearing activities for several weeks while the bone heals. The prognosis is excellent, with a low recurrence rate after treatment. However, regular follow-up is crucial as there is a small risk of malignant transformation, particularly in multiple enchondromas (Ollier disease) or when associated with soft tissue hemangiomas (Maffucci syndrome) 1.
Importance of Follow-Up
Pain, rapid growth, or changes in appearance on imaging should prompt immediate medical evaluation as these could indicate malignant transformation. The risk of malignant transformation to chondrosarcoma is notable, occurring in about 30% of patients with enchondromatosis, emphasizing the need for vigilant monitoring 1.
From the Research
Definition of Enchondroma
- Enchondroma is a benign tumor in the medullary cavity of bone, composed of mature hyaline cartilage 2.
- It is the most commonly found benign tumor of the small bones of the foot, mainly involving the phalanges and metatarsals 3.
- Enchondroma has a predilection for the ulnar-sided tubular bones of the hand and occurs most commonly in the proximal phalanx, and less commonly in the middle phalanx and metacarpals, and rarely in the distal phalanx 2.
Symptoms and Treatment
- Enchondromas are usually asymptomatic, and are found as an incidental finding on routine X-rays 3.
- Surgical intervention is indicated in symptomatic lesions as well as larger lesions (greater than 3-4cm) even if these lesions are asymptomatic 3, 2.
- The treatment options for enchondromas include conservative regular follow-up or surgery 2.
- Enchondroma can be adequately treated with intralesional curettage and bone grafting 3.
- A minimally invasive approach, such as endoscopic curettage and bone grafting, can preserve the cortical integrity and periosteum of the involved phalanx 3, 2.
Outcomes and Complications
- The use of the impaction technique combined with cancellous allochip bone grafting yields favorable results in the treatment of solitary hand enchondroma 4.
- The extent to which the bone defect was filled did not significantly impact the overall outcomes 4.
- Curettage and early rehabilitation can lead to good clinical and functional outcomes for hand enchondromas 5.
- Patients with pathologic fractures, although slightly exposed to a higher risk of sub-optimal outcomes, can also aim for good post-operative functionality 5, 6.
- Early single-stage surgical treatment with curettage and autogenous bone grafts without fixation yielded satisfactory results for non- or minimally displaced pathologic fractures in enchondroma 6.