Pathologic fractur_Finger_XRay_CT_Please help

Dear OCADers’s

If it was in the phalanx I would completely agree. But the metacarpal bone should be seen as a long tubular bone. Therefore you should be very carefull calling this a enchondroma. It is still possible also because of the age of the patient but there is  a bit thinned cortex and some expansion. I would do MRI (bone tumor protocol) if fracture is completely healed to assess it’s characteristics and FU if it is benign.

In added PowerPoint one case of the metacarpal bone 19 old, looks on xray pretty harmless but MRI shows different. Differentiating low grade and high grade CS can be difficault but if there is periostis, soft tissue mass, periosteal reaction, reactive soft tissue edema, peri-tumoral intraosseous edema, expansion of the medullary canal with thinner cortex, rapid enhancement and cortical breakthrough it could be a grade 2 chondrosarcoma (results still yet to be published 😊). Other research from Douis, same results (different pathology).

Greetings.

David Hanff

MSK radiologist

Erasmus MC Rotterdam (The Netherlands)

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just playing the odds, it’s most likely an enchondroma.

 

 

in the short tubular bones they often don’t mineralize, cause a lot of cortical thinning, and easily path fracture.

 

 

 

as long as there isn’t a big soft tissue component, at our place this would likely be presumptive enchondroma and they would go straight to surgical curettage and packing (and get pathology samples to confirm while doing it) 

 

 

pete

 

 

Peter C. Young, MD

Section Head, Division of Musculoskeletal Radiology

University Hospitals Cleveland Medical Center

Case Western Reserve University

11100 Euclid Avenue Cleveland, OH 44102

(216) 844-1542

 

From: ocad-msk@googlegroups.com <ocad-msk@googlegroups.com&gt; on behalf of Christos Loupatatzis <loupatatzis@gmail.com&gt;
Sent: Wednesday, May 4, 2022 4:22 AM
To: OCAD MSK
Subject: Pathologic fractur_Finger_XRay_CT_Please help

 

External E-mail: Careful opening links or attachments.

Dear OCADers,

 

Please share your opinion.

 

Best wishes

 

Chris

01.pdf
CS-Grade-2-metacarpal.pptx