Surgical Care
Enchondroma
Enchondromas of the long bones are usually asymptomatic and do not require treatment. Curettage and histopathologic evaluation are indicated if the diagnosis is uncertain, if the lesions are predominantly lytic (as seen on radiographs), if they are symptomatic and borderline in size, or if they are in any way suspicious. For patients with pathologic fractures related to enchondromas, early surgical intervention has been recommended. [16]
Enchondromas of short tubular bones are treated with curettage and bone grafting because they tend to deform the bony contour and interfere with function. A systematic review by Bachoura et al suggested that simple curettage of hand enchondromas, without void augmentation, is safe and effective and does not increase the complication rate. [17]
Enchondromas are rare in the axial skeleton. If, however, they are found in the ribs, sternum, pelvis, or scapula, they should be treated with wide local resection and histopathologic evaluation to rule out the possibility of chondrosarcoma, which is common at these sites.
After curettage and bone grafting, enchondromas heal well with consolidation of the grafted site. If a lytic element recurs, malignancy should be ruled out. Recurrence can affect short tubular bones; it can be successfully treated with a second curettage procedure and histopathologic examination. The recurrence rate is low for surgically treated enchondromas of the hand, and the main risk factor for recurrence is a diagnosis of multiple enchondromas; malignant transformation is rare. [18]
Periosteal (juxtacortical) chondroma
Wide local excision is indicated for periosteal chondromas because surface chondrosarcomas can clinically and radiologically mimic these tumors. Wide local excision is a curative procedure.
Soft-tissue (synovial) chondroma
Depending on the symptoms (especially if they are only mechanical), removal of loose bodies may be all that is required. Synovial chondroma is a local self-limiting condition and may reach a quiescent stage. However, if the lesion produces frequent symptoms, synovectomy may be needed to control the disease. Frequent recurrences with short intervening periods should raise the suspicion of synovial chondrosarcoma.
Long-Term Monitoring
Chondromas that are clinically and radiographically benign should be followed up every 3-6 months and then every year only in cases where malignant degeneration is expected (as in Ollier disease or Maffucci syndrome). Otherwise, patients should be educated about the warning signs of malignant transformation (eg, deep, dull ache or night pain) and about the need for an early assessment should these signs appear.
During regular follow-up of benign chondromas, radiographs should be obtained and compared with previous images to detect any differences in the radiologic appearance of the lesion.
Patients who undergo surgical curettage and bone grafting should receive regular follow-up with radiography. Radiographs should show consolidation of the lesion and healing. Recurrence of a lytic appearance in the bone-grafted area should be treated because it suggests malignancy.
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Enchondroma of proximal femur.
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Plain radiograph reveals chondroma in left proximal femur (A) and low-grade chondrosarcoma in right superior pubic ramus and symphysis (B).
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MRI showing chondroma (A) and low-grade chondrosarcoma (B).
