A 2-year-old girl was brought to the emergency department with a deformity of the 2nd finger of the right hand.
The family reported that 1 year before she suffered a fall from a height of 20 cm and a history of crushing 6 months before.
His personal history included a karyotype study with normal results in the context of electroencephalographic abnormalities and resolved parietooccipital plagiocephalia.
On examination performed in the emergency room, we observed widening of the base of the middlephalangeal joint of the 2nd finger of the right hand and alteration in the flexion of the proximal interphalangeal joint, reaching 50 degrees.
Neurovascular examination did not reveal any pathological findings of interest.
We also performed radiological examinations of the 2nd finger in anteroposterior and lateral projections, which determine the existence of an increase in the base of the medial phalanx of that finger at volar level.
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The patient was diagnosed with subjacent pathology and referred to pediatric trauma consultations with radiographic control.
The examination shows a macroscopic increase in the base of the middle phalanx of the second finger of the right hand and limitation of proximal interphalangeal flexion, with a maximum of 50 degrees.
She came with a control X-ray.
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Radiography shows an increase in the palm portion at the base of the mid-phalanx with a blurring of the cartilage at this level; anteroposterior growth shows evidence of bone superposition.
The existence of an old mid-phalanx fracture with prominent callus fracture and epiphysiodesis is postulated as a possible diagnosis.
The patient was referred to the Plastic Surgery and Repair Hand Unit for evaluation of fracture sequelae.
In the first consultation in the Plastic and Reparative Surgery Service there were no changes in the exploration with respect to those described by Child Traumatology.
The patient does not provide the radiographs that had been hand-delivered in the Emergency and Child Traumatology, so she is re-cited for control radiography and insists on the need to provide previous radiographs.
Giant phalanx osteochondroma in a paediatric patient Surgery
The patient did not come to the appointment within 2 years.
After this time, he again asks for an appointment in Plastic and Repair Surgery for increased deformity of the finger.
Examination revealed a marked increase in the base of the middle phalanx of the second finger of the right hand (macrodactyly).
Flexion alteration is greater, reaching 20 degrees of maximum flexion.
We requested a control X-ray.
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A lobulated mass with different densities appears to exist in the lateral third of the middlephalanx of the second finger.
The mass reaches the upper third of soft parts of the proximal phalanx.
It also highlights the presence of a dog in its upper portion.
In anteroposterior position we appreciate that the mass exceeds the width extension of the second speak.
If there is a suspicion of osteochondroma/chondroma, MRI was requested to report a deep osteochondromatosis of the 12-mm thick plate with a 20x20 mm base, which extended proximally to the flexor system.
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We staged the tumor using the Enneking classification and determined that it is a stage III, aggressive benign lesion: low aggression lesion (G) with affectation of the insertion (extracommental) of the superficial extensor (M0).
Given the patient's functional impairment and the size of the tumor mass, we decided to treat the lesion.
During surgery, we made access to the lesion using the Brunner technique inzygosity-zag, thus avoiding the transversal section of the palm folds that could generate future defects.
We located the superficial flexor tendon and placed the metaphalangeal joint of the second finger, as well as the wrist, in maximum flexion to reach the most proximal portion of the tendon.
We chose to perform this section proximally to prevent the occurrence of the phenomenon known as Verdádriga de Verdán, understood as a change in cable flexion after the proximal articulation of a tendon section.
Median scople, we separated the portion of the tumor that emerged from the healthy phalanx and a portion of the adjacent cortical bone.
We then performed curettage using a spoonful of the spinal cord and bone tissue on the dorsal surface.
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For reconstruction: from the generated cavity we used osteoconductive material (Actifuse Abx Silicated Calcium Phosphate®, BioSomics, USA).
Immobilization was performed using a dorsal splint from the proximal third of the forearm to the end of the fingers, with wrist in 40 palmophalangeal joint flexion and extension of the chin between the lips.
Immobilization was maintained for 3 weeks, after which rehabilitation was not necessary given the patient's age and good postoperative mobility.
We performed an annual follow-up radiograph with no evidence of recurrence and complete mobility after 3 years and 8 months of postoperative follow-up.
