A Modified Palmar Approach With Tendon Splitting for Distal Phalanx Enchondromas of the Thumb: A Report of Two Cases
Distal phalanx enchondromas of the thumb are rare and pose unique challenges for surgical management because of the thumb’s critical role in hand function. Traditional dorsal and lateral approaches risk damaging extensor tendons, the nail matrix, limiting interphalangeal mobility, or compromising pi...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-03-01
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| Series: | Journal of Hand Surgery Global Online |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589514125000027 |
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| author | Yukihiro Kokubu, MD Keisuke Hirose, MD Toshinori Kurashige, MD Yoshiaki Ando, MD Kiyoma Marusugi, MD Hiroshi Kawaguchi, MD, PhD |
| author_facet | Yukihiro Kokubu, MD Keisuke Hirose, MD Toshinori Kurashige, MD Yoshiaki Ando, MD Kiyoma Marusugi, MD Hiroshi Kawaguchi, MD, PhD |
| author_sort | Yukihiro Kokubu, MD |
| collection | DOAJ |
| description | Distal phalanx enchondromas of the thumb are rare and pose unique challenges for surgical management because of the thumb’s critical role in hand function. Traditional dorsal and lateral approaches risk damaging extensor tendons, the nail matrix, limiting interphalangeal mobility, or compromising pinch function. This report presents two cases of thumb distal phalanx enchondromas successfully treated using a modified palmar approach with Bruner’s incision followed by splitting the insertion of the flexor pollicis longus tendon. Both patients achieved complete curettage, bone regeneration, and full preservation of thumb function at the 1-year follow-up. The incision design avoided high-pressure zones of the pulp, reducing postoperative complications while maintaining functionality. Fluoroscopic guidance facilitated effective curettage through the flexor pollicis longus tendon split without extensive exposure. These findings underscore the tendon splitting palmar approach as a viable option in selected cases, highlighting the importance of individualized surgical strategies to optimize outcomes for distal thumb enchondromas. |
| format | Article |
| id | doaj-art-a8115339058f4a448cb0c8b312898fa1 |
| institution | DOAJ |
| issn | 2589-5141 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Hand Surgery Global Online |
| spelling | doaj-art-a8115339058f4a448cb0c8b312898fa12025-08-20T02:55:46ZengElsevierJournal of Hand Surgery Global Online2589-51412025-03-017224925210.1016/j.jhsg.2025.01.001A Modified Palmar Approach With Tendon Splitting for Distal Phalanx Enchondromas of the Thumb: A Report of Two CasesYukihiro Kokubu, MD0Keisuke Hirose, MD1Toshinori Kurashige, MD2Yoshiaki Ando, MD3Kiyoma Marusugi, MD4Hiroshi Kawaguchi, MD, PhD5Department of Orthopedic Surgery, Nadogaya Hospital, Chiba, JapanDepartment of Orthopedic Surgery, Nadogaya Hospital, Chiba, JapanDepartment of Orthopedic Surgery, Nadogaya Hospital, Chiba, JapanDepartment of Orthopedic Surgery, Nadogaya Hospital, Chiba, JapanDepartment of Orthopedic Surgery, Nadogaya Hospital, Chiba, JapanDepartment of Orthopedic Surgery, Nadogaya Hospital, Chiba, Japan; Correspondence author: Hiroshi Kawaguchi, MD, PhD, Department of Orthopedic Surgery, Nadogaya Hospital, Shin-Kashiwa 2-1-1, Kashiwa, Chiba 277-0084, Japan.Distal phalanx enchondromas of the thumb are rare and pose unique challenges for surgical management because of the thumb’s critical role in hand function. Traditional dorsal and lateral approaches risk damaging extensor tendons, the nail matrix, limiting interphalangeal mobility, or compromising pinch function. This report presents two cases of thumb distal phalanx enchondromas successfully treated using a modified palmar approach with Bruner’s incision followed by splitting the insertion of the flexor pollicis longus tendon. Both patients achieved complete curettage, bone regeneration, and full preservation of thumb function at the 1-year follow-up. The incision design avoided high-pressure zones of the pulp, reducing postoperative complications while maintaining functionality. Fluoroscopic guidance facilitated effective curettage through the flexor pollicis longus tendon split without extensive exposure. These findings underscore the tendon splitting palmar approach as a viable option in selected cases, highlighting the importance of individualized surgical strategies to optimize outcomes for distal thumb enchondromas.http://www.sciencedirect.com/science/article/pii/S2589514125000027Distal phalanxEnchondromaMinimally invasive surgeryPalmar approachThumb |
| spellingShingle | Yukihiro Kokubu, MD Keisuke Hirose, MD Toshinori Kurashige, MD Yoshiaki Ando, MD Kiyoma Marusugi, MD Hiroshi Kawaguchi, MD, PhD A Modified Palmar Approach With Tendon Splitting for Distal Phalanx Enchondromas of the Thumb: A Report of Two Cases Journal of Hand Surgery Global Online Distal phalanx Enchondroma Minimally invasive surgery Palmar approach Thumb |
| title | A Modified Palmar Approach With Tendon Splitting for Distal Phalanx Enchondromas of the Thumb: A Report of Two Cases |
| title_full | A Modified Palmar Approach With Tendon Splitting for Distal Phalanx Enchondromas of the Thumb: A Report of Two Cases |
| title_fullStr | A Modified Palmar Approach With Tendon Splitting for Distal Phalanx Enchondromas of the Thumb: A Report of Two Cases |
| title_full_unstemmed | A Modified Palmar Approach With Tendon Splitting for Distal Phalanx Enchondromas of the Thumb: A Report of Two Cases |
| title_short | A Modified Palmar Approach With Tendon Splitting for Distal Phalanx Enchondromas of the Thumb: A Report of Two Cases |
| title_sort | modified palmar approach with tendon splitting for distal phalanx enchondromas of the thumb a report of two cases |
| topic | Distal phalanx Enchondroma Minimally invasive surgery Palmar approach Thumb |
| url | http://www.sciencedirect.com/science/article/pii/S2589514125000027 |
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