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A Systematic Review of Outcomes of Treating Enchondroma of the Hand
Abdo Bachoura, MD; John D. Lubahn, MD
Orthopaedic Surgery, UPMC Hamot, Erie, PA

Introduction: Enchondroma is the most common primary tumor of the hand. Despite its relatively high prevalence however, much variability exists with regard to its surgical treatment. A systematic review of the existing literature on the management of hand enchondroma was conducted to compare treatment outcomes of (1) curettage alone; (2) curettage followed by augmentation with cancellous autograft; (3) curettage followed by augmentation with osteoconductive materials other than autograft; and (4) curettage followed by augmentation with bone cement.

Materials & Methods: Articles retrieved from CINAHL and MEDLINE were reviewed. The search query "enchondroma*[TI] AND (hand OR Wrist OR carpus OR phalanges OR fingers OR metacarpals OR thumb) NOT Review" with limitations to include English language articles and humans was applied. Reports with less than 5 patients were excluded. Secondary selection required the studies to report data with at least 1 month of clinical follow up and sufficient detail to enable subgroup analysis when applicable. Clinical outcomes were categorized into 2 arms: 1) no functional restrictions or 2) functional restrictions. Radiographic outcomes were assessed according to the Tordai classification. Complications including post-operative fracture and tumor recurrence were also compared in the 4 groups. Fisher's exact test was used for statistical analysis, and a p value less than 0.05 was considered statistically significant.

Results: A total of 98 papers were identified. After applying the inclusion and exclusion criteria, 20 studies were selected, involving a total of 398 patients and 425 lesions. The number of patients and lesions in each category were as follows: Group 1: 139 patients with 159 lesions; Group 2: 148 patients with 154 lesions; Group 3: 62 patients with 69 lesions; Group 4: 49 patients with 49 lesions. There were no significant differences in the functional outcomes, radiographic outcomes, incidence of post-operative fracture or recurrence in any group. Complications in the autograft group were significantly greater than in the group that did not undergo any augmentation, p=0.019.

Conclusion: Considerable variations exist in the reporting of clinical, patient rated and radiographic outcomes of hand enchondroma treatment. Curettage alone appears to be as effective as curettage followed by various types of augmentation when considering post operative function, the risk of post-operative fracture and recurrence. Curettage alone appears to be the simplest and most cost effective method to treat hand enchondromas and avoids patient morbidity associated with autograft.

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