The Surgical Management of Hand Enchondroma without Postcurettage Void Augmentation: Authors' Experience and a Systematic Review

Abstract

Background Postcurettage void augmentation in the management of hand enchondroma is a debated practice. The objectives of this study are to present the outcomes of hand enchondroma treatment by curettage without void augmentation at the authors' institution and to systematically review the literature pertinent to this aspect of management. Methods Initially, a retrospective case series of patients treated for hand enchondroma at the authors' institution was conducted to assess postoperative complications and radiographic consolidation. All patients were treated by curettage without void augmentation. Next, a systematic review was conducted. Postcurettage void management was categorized into four groups: (1) curettage alone, (2) curettage followed by augmentation with cancellous autograft, (3) curettage followed by augmentation with bioactive and osteoconductive materials other than autograft, and (4) curettage followed by augmentation with bone cements. Complication and recurrence rates were compared. Results The authors' series was composed of 24 patients with 26 lesions. The mean age was 38.9 years (range 14–61), and the mean follow-up was 26 months (range 3–120). There was one recurrence but no postoperative fractures or nonunions. As for the systematic review, a total of 22 studies involving 591 patients and 609 lesions were assessed. Complications occurred at an incidence of 0.7 % following curettage alone, 3.5 % following autograft, 0 % following augmentation with bioactive/osteoconductive materials, and 2.0 % following cement augmentation. No statistical differences were noted for complication or recurrence rates. Conclusions Simple curettage is an effective and inexpensive technique that does not lead to increased complication rates in the treatment of most hand enchondromas.