Enchondroma with Pathologic Fracture

Gregory D N Pearson, MD, PhD
Carl S Winalski, MD

May 16, 1996

Presentation

A 36-year-old woman presented with pain in the ring finger of the left hand after minor trauma.

Imaging Findings

Radiograph of the hand, PA view.

Radiograph of the hand, lateral view.

Posteroanterior (PA) and lateral views of the hand show an expansile, lytic lesion in the midshaft of the proximal phalanx of the ring finger with an associated pathologic fracture (white arrows). Endosteal margins are scalloped, and there are a few punctate calcifications. In this patient, avascular necrosis of the lunate is also visible (black arrow).

Differential Diagnosis

Imaging findings are consistent with a benign cartilaginous tumor. Enchondroma is by far the most likely possibility. Malignant transformation rarely occurs in the short tubular bones of the hand.

Diagnosis

Enchondroma with pathologic fracture

Discussion

Enchondromas of the hand and wrist are the most frequent primary bone tumors and are usually asymptomatic unless pathologic fracture supervenes. Most of these tumors occur in the 10 to 40 age group with a mean age of 35. They appear as oval or round lucencies in the shaft near the epiphysis and often cause scalloping of the endosteal surface of the cortex. They tend to be near the proximal end of the bone in the phalanges and the distal end in the metacarpals. A typical ground glass appearance makes enchondromas less lucent than inclusion cysts or unicameral bone cysts. Calcifications varying from punctate stippling to large irregular areas strongly suggest the diagnosis. Treatment is curettage and bone graft, with excellent prognosis.

References

Ediken J, Dalinka M, Karasick D. Roentgen diagnosis of diseases of bone. 4th ed. Baltimore: Williams and Wilkins, 1990;79-85.

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