Diagnosis and treatment of aneurysmal bone cysts of the metacarpals and phalanges of the hand

LI Zhong-zhe; GUO Yang; TIAN Guang-lei

doi:10.3969/j.issn.2095-252X.2014.03.003

Abstract：Objective To analyze the clinical features, imaging characteristics, differential diagnosis, clinical treatment methods and recurrence rate of aneurysmal bone cysts of the metacarpals and phalanges of the hand. Methods The clinical data of 12 patients with aneurysmal bone cysts of the metacarpals and phalanges of the hand who were adopted from 2002 to 2012 were retrospectively analyzed, including the clinical symptoms and signs, X-ray and Magnetic Resonance Imaging ( MRI ) features, intraoperative general characteristics, tumor performance, operative methods, bone graft and postoperative recurrence rate. Results Among the 12 cases, there were 8 cases in the metacarpal and 4 cases in the phalange. No deifnite characteristics existed referring to the age or gender. Local inlfation in 8 cases and pain in 6 cases were the main clinical features. The X-ray showed expansive lytic lesion, and soap-bubble-like and balloon-like bone destruction was noticed in the advanced stage. The MRI showed cyst cavities of various sizes and different signal intensities and intralesional lfuid-lfuid level. During the operation, the bone cortex became purple and thin and swelled. Curettage and bone grafting by a high-speed drill were performed on 4 patients, and resection and reconstruction on 8 patients. Postoperative recurrence was found in 1 case. The deifnitive diagnosis was made by the histopathological examination in all the patients. Combined giant cell tumors were noticed in 1 case. Conclusions Aneurysmal bone cysts of the metacarpals and phalanges of the hand is an infrequent disease, without speciifc clinical manifestations. It is very dififcult to make an early diagnosis, and it should be differentiated from other hand bone tumors. Based on the history characteristics and the X-ray and MRI examinations, the correct diagnosis ratio can be distinctly improved. The recurrence rate can be greatly reduced under the treatment of thorough curettage by a high-speed drill and resection and reconstruction.