Proximal Phalanx Enchondroma in a Pediatric Patient: Curettage, Liquid Nitrogen Cryotherapy, Iliac Crest Autograft, and Microfragment Plate Fixation.
This report describes a 14-year-old with an extensive proximal phalanx enchondroma who had pain-free full motion, preserved stability, graft integration, and no cryotherapy-related complications six months after combined curettage, liquid nitrogen cryotherapy, iliac crest autografting, ligament repair, and plate fixation.
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This report describes a 14-year-old with an extensive proximal phalanx enchondroma who had pain-free full motion, preserved stability, graft integration, and no cryotherapy-related complications six months after combined curettage, liquid nitrogen cryotherapy, iliac crest autografting, ligament repair, and plate fixation.
Research significance
The single case provides preliminary evidence that this combined surgical approach is technically feasible with favorable short-term functional and radiographic findings; it may improve local control and structural stability in selected pediatric enchondromas with cortical compromise, but that benefit remains an inference requiring longer follow-up and comparative studies.
Source abstract
Enchondromas are benign, slow-growing cartilaginous tumors, with the phalanges of the hand being the most common site. Although standard surgical treatment consists of curettage and bone grafting, the combined use of liquid nitrogen cryotherapy and internal fixation in pediatric patients with extensive cortical involvement remains poorly documented in the literature. A 14-year-old male patient presented with progressive deformity of the middle finger of the right hand over a period of more than one year. Radiographs demonstrated an expansive lytic lesion in the proximal phalanx measuring 21.85×13.00 mm, with marked expansion and thinning of the ulnar cortex. Surgical treatment consisted of a dorsal approach, thorough manual and high-speed burr curettage, liquid nitrogen cryotherapy in two freeze-thaw cycles, filling of the defect with iliac crest cancellous autograft, microfragment plate fixation, and repair of the ulnar collateral ligament. Histopathological examination confirmed the diagnosis of enchondroma. At six months of follow-up, the patient was pain-free and had achieved complete range of motion (total active motion of 255°), preserved ligamentous stability, and radiographic evidence of graft integration, without cryotherapy-related complications. In this case of proximal phalanx enchondroma with significant cortical involvement in a pediatric patient, the combination of extensive curettage, liquid nitrogen cryotherapy, iliac crest autograft, and microfragment plate fixation proved to be a safe and effective surgical strategy. Extended follow-up is required to evaluate the risk of local recurrence.