Pathologic Fractures in Primary Bone Neoplasms of the Fingers
Kamilcan Oflazoglu, MD; Jonathan Lans, MD; Neal C Chen, MD; Santiago Lozano-Calderon, MD PhD
Massachusetts General Hospital, Boston, MA
Introduction: Primary bone tumors of the hand may present as incidental findings or as pathological fractures. The aim of this study was to identify predictors for pathological fractures in neoplasms affecting the bones of the fingers.
Methods: We retrospectively identified 131 histologically confirmed neoplasms affecting the bone, 97 phalanges and 34 metacarpals, over a 13-year period. The mean age at presentation was 42 years and 57% of the patients were female. Most tumors (84%) were benign bone neoplasms and the remainder were primary bone sarcomas. Tumors were located most frequently in the long finger (27%), ring finger (23%) and small finger (23%). Predictors evaluated included demographics, clinical information, tumor size, Enneking and Lodwick-Madewell classifications. All explanatory variables with a p-value of <0.10 in bivariate analysis were analyzed using a multivariable logistic regression model to identify factors independently associated with pathologic fractures.
Results: Forty-two percent of the tumors presented as a pathologic fracture. The small finger was independently associated with pathologic fractures compared to the other fingers (OR 4.8, p=0.0050). Fractures of the small finger were caused by no or minor trauma in >50%. tumors in the metacarpal bone were less likely to fracture compared to the proximal phalanx, (OR=0.21, p=0.0070).
Conclusions: Primary benign or malignant bone tumors located in the small finger are at risk for pathologic fracture. It may be reasonable to treat these tumors earlier to prevent sequelae of pathologic fracture.
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