This article reviews the follow up of 13 patients with Grade I chondrosarcoma of the small bones of the hand treated with either curettage and reconstruction with a cancellous bone graft (Group I – 8 patients) or a wide resection (Group II – 5 patients). At a mean follow up of 100 months (range, 26 to 293 months), there were no relapses in Group II and 1 local relapse noted at 18 months in Group I. Using the Musculoskeletal Tumor Society Score for evaluation, the clinical results showed an average of 98% and 95% of the normal function in Groups I and II, respectively. There was no evidence of systemic spread of the disease at final follow-up. Eleven patients in this group had a central chondrosarcoma as defined by a well-defined osteolytic lesion with a short transitional zone composed mostly of calcified elements. There were two peripheral chondrosarcomas with a large soft tissue mass containing distinct calcifications attached to the bone which had cortical thickening at the site of origin. Histologic criteria included hypercellularity, double-nucleated chondrocytes, myxoid change of the matrix, and nuclear atypia. Three patients presented with a pathologic fracture, 1 with a local relapse after 2 previous operations and 1 after a biopsy was done at another hospital. Eight patients presented with a history of pain and swelling. The bones involved included the scaphoid in 1 patient, metacarpal in 4 patients and the phalanges in 8 patients. All patients had solitary lesions except for 1 patient with a lesion in the proximal and middle phalanx. The mean age of the patients at the time of surgery was 37 years (range 17 to 58 years).
Although chondrosarcoma is the second most common primary malignant tumor of bone, it is extremely rare in the hand (3%). Previous controversy among reported studies include a high recurrence rate with distant metastases in Grade I tumors treated with curettage. With other studies showing no evidence for distant metastases, Mankin introduced the term primary non-metastasizing chondrosarcoma of the digits. In this study, a local relapse rate of 12.5% after curettage without distant metastatic disease supports intralesional excision as a primary treatment for Grade I chondosarcomas of the hand. However, routine follow-up is necessary in order to identify early recurrence.
Clin Orthop 211-215, 2004.