[Giant-cell tumor of the hand: midterm results in five patients]. / Tumeur à cellules géantes de la main: résultats du traitement: 5 cas au recul moyen de 7, 8 ans.

PURPOSE OF THE STUDY: Giant-cell bone tumors are benign but have great potential for recurrence. Frequently observed in epiphyseal areas of tubular bones, these tumors are rarely found in hand localizations. We examined the characteristic features of giant-cell tumors of the hand and analyzed the pertinence of surgical treatment. We noted complications, consequences of recurrence and later operations on the same tumor site in five cases. CASE REPORTS: Five patients treated between 1973 and 2000 for giant-cell tumors involving the hand bones were reviewed retrospectively. Mean age was 41.6 years and mean follow-up was 7.8 years. The surgical procedure was curettage for two, curettage with bone graft for two and amputation for one. The Enneking score was noted. RESULTS: Pain was the main symptom, with local swelling in several cases. At 7.8 years follow-up recurrence was noted for four of the five tumors. Two patients were treated for a second recurrence. Amputation of the forearm was required for one recurrence affecting soft tissue. Mean time between two consecutive recurrences was three months. In all six episodes of recurrent tumor were treated. These five patients had a total of ten operations. There were no cases of metastasis nor multicentric foci. DISCUSSION: Treatment of giant-cell tumors involving the hand bones is designed to eradicate the tumor and also protect hand function while keeping in mind the aggressive nature of these benign tumors. Surgical alternatives for radical treatment can include wide resection, resection of the ray and amputation.

Schwannomas of the hand and wrist: long-term results and review of the literature.

PURPOSE: To review the long-term results of 14 cases of histopathologically confirmed schwannoma of the hand and wrist treated with intracapsular tumour removal. METHODS: All operations were performed under loupe magnification and microsurgical dissection, and the tumour was removed after capsular (including endoneurium) incision. Patients were assessed for any residual symptoms. Sensory testing of light touch and pain was carried out. RESULTS: The mean age of the patients at the time of operation was 38.4 years (range, 11-78 years), and the mean follow-up period was 12.6 years (range, 3-36 years). Ten of the tumours were located in the median nerve distribution, whereas 4 in the ulnar nerve distribution. Four tumours were at the wrist level, 3 at the palm level, and 7 at the digital level (3 in the index finger). Only 5 patients were correctly diagnosed preoperatively. Neurological loss was not recovered in one patient in whom the tumour was resected with the digital nerve. No recurrence or muscle atrophy was noted at the latest follow-up. CONCLUSION: Meticulous dissection with magnification can achieve complete tumour removal without neurological loss or recurrence. Intracapsular tumour removal provides good results with a low complication rate.

An anatomical study of the first extensor compartment of the wrist.

Anatomical variations of the first extensor compartment of the wrist are important during surgical operations of the wrist with de Quervain's disease. We studied 41 wrists from cadavers (16 whole cadavers and nine forearms) and the wrists of twenty-eight patients with de Quervain's disease to determine the variations of tendons and septa in the first extensor compartment. In 85.4 percent of the wrists from cadavers, the number of the tendons differed from the standard. There was septation in 9.75 percent of the dissected wrists. These anatomic variations are discussed for de Quervain's disease. In twenty-eight patients with de Quervain's disease, septation was found in thirteen patients (46.43%). In 82.14 percent of the wrists from the patients, the number of tendons in the first extensor compartment was more than two.