Information About Rare Finger Tumor Helps Surgeons Plan Treatment

There is a rare, benign tumor of the bone that can occur in the finger causing deformities and loss of motion. It's called osteochondroma. Benign means the tumor isn't cancerous and won't travel elsewhere in the body causing harm. But it's not benign in the sense that the loss of motion can affect hand function. And the deformity can lead to painful, limiting osteoarthritis.

This report on a series of 10 patients with a single osteochondroma of a finger helps point out the need for early surgery. The patients ranged in ages from three to 36 but the majority of them were older children and young teens (ages 10 - 15). Any finger can be affected by this condition. In this group, it was mostly the ring and long fingers.

Each person had just one finger affected and one joint of that finger. Since the joint was involved, the diagnosis for each patient was solitary intra-articular osteochondroma. It is possible to have the same problem without affecting the joint but that wasn't the case for any of these patients. In all cases either the middle bone (middle phalanx) of the finger was affected or the tip of the finger (distal phalanx).

Pain isn't a big feature of intra-articular osteochondroma. Loss of motion is more often the problem as the tumor blocks movement or causes the bone to shift. Changes in bone and joint alignment eventually result in finger deformity. As in the case of one patient who waited 20 years to seek treatment, the deformity can be severe enough to lead to arthritis where the joint surfaces no longer line up evenly.

Surgical treatment consists of removing the tumor, a procedure called excision. If there were any soft tissue problems, the surgeon corrected them at the same time. In several patients, a second procedure called osteotomy was necessary.

An osteotomy is used to correct angular deformities. For example, if the bone has shifted or tilted too far to one side, an osteotomy is done to realign the bones and joint. This is done by cutting a wedge- or pie-shaped piece of bone from one side of the bone and allowing the two edges of the bone to collapse back toward each other. The result is a straightening of the bone and a shift of forces on the joint from one side more to the middle with a more even distribution of joint contact.

Results were very good for most of the 10 patients. The one adult who waited so long was not able to get full motion back but his finger motion and hand function were much improved from before surgery. Removing the mass enabled the finger to move past where the tumor was blocking motion.

Solitary intraarticular osteochondroma is a fairly rare problem. At least one other study has been published with results similar to this one. The results of both studies confirm that early surgery is important to prevent deformity and early arthritis. When the tumor is allowed to grow unchecked, it can create problems with bone and joint alignment. Restoring normal appearance and function without delay should be the goals right from the start.

Reference: 

Goo Hyan Baek, MD, et al. Solitary Intra-Articular Osteochondroma of the Finger. In The Journal of Bone & Joint Surgery. May 2010. Vol. 92-A. No. 5. Pp. 1137-1143.

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