Working Diagnosis:
The patient was diagnosed with enchondroma leading to pathologic fracture of the proximal diaphysis of the right fifth proximal phalanx.

Treatment:
She was treated with curettage and bone grafting of the fifth proximal phalanx.

Outcome:
Revision bone graft material was placed into void left by enchondroma and the patient fully recovered with 100% resolution of symptoms and no complications.

Author's Comments:
Enchondromas are the most common type of hand tumor. They typically present between the ages of 10 and 20 years old and occur in the long bones of the hand, humerus, and femur. Most are asymptomatic unless a fracture is present, and they are often incidental findings. Treatment is curettage and bone graft as there is a rare chance of malignant transformation to chondrosarcoma.

Editor's Comments:
Endochondromas are painless, benign, chondrogenic tumors composed of hyaline cartilage and usually discovered incidentally on radiographs. They classically occur in the medullary cavity of bones in the hand and feet. Other typical locations include distal femur, proximal humerus, and tibia. Pelvis, scapula, and ribs are rare locations and should bring up consideration of chondrosarcoma. Diagnosis is made radiographically with the presence of a well-defined, lucent, central medullary lesion. MRI is not necessary for diagnosis but can be useful to differentiate between endochondroma and chondrosarcoma. Treatment is observation as most lesions are asymptomatic. Serial radiographs at 6 months and 12 months can confirm radiographic stability as there is a 1% risk of malignant transformation. Intralesional curettage and bone grafting is indicated for lesion that show any change on serial x-rays, symptomatic lesions, and pathologic fractures or large lesions at risk of fracture.

References:
Lubahn, J. D., & Bachoura, A. (2016). Enchondroma of the hand: evaluation and management. Journal of the American Academy of Orthopaedic Surgeons, 24(9), 625-633.

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