Abstract
Ten cases of histologically proven chondromyxoid fibroma (CMF) of the foot and ankle with a mean follow-up of 6.1 years were retrospectively reviewed using the Scottish Bone Tumour Registry. The patients' mean age was 19 years; there were six males and four females. The anatomical locations were five phalangeal, three metatarsal, one tarsal affecting body of os calcis and one distal tibial. The median delay in presentation was 4.5 months. The modes of presentation were pain only (n=4), painful lump (n=4) and painless lump (n=2). The typical radiological finding was an expansile, lobulated, cystic lesion. Cortical erosion was documented in 80% patients. In four cases, curettage alone was carried out, while five patients underwent curettage along with autogenous bone grafting. One patient with distal phalangeal CMF had a primary toe amputation. Two patients had recurrences 9 and 16 months after their initial curettage. Both of them were males with proximal phalangeal CMF, associated with cortical erosion. Foot and phalangeal CMF initially treated with curettage only should be closely followed up, as we observed a 20% recurrence rate within a 2-year period. Cases featuring cortical erosion require thorough curettage and may require autogenous bone grafting to prevent fracture.
Résumé
Nous avons revu rétrospectivement à l’aide du registre Ecossais des tumeurs osseuses, dix cas de fibromes chondromyxoides du pied et de la cheville. L’âge moyen était de 19 ans avec une répartition par sexe suivante : 6 garçons et 4 filles. La localisation anatomique de la tumeur était cinq fois une phalange, trois fois un métatarsien, une fois un os du tarse et une fois l’extrémité inférieure du tibia. Le délai moyen de consultation était de quatre mois et demi, les patients consultant quatre fois pour une douleur,quatre fois pour une boiterie douloureuse, deux fois pour une boiterie non douloureuse. Les lésions kystiques étaient radiologiquement typiques de type lobulées. L’atteinte corticale a été retrouvée dans 80% des cas. Pour quatre cas nous avons procédé à un curetage isolé, dans cinq cas à un curetage associé à une auto-greffe. Un cas (atteinte de la phalange distale) a bénéficié d’une amputation d’orteil. Deux cas ont récidivé à neuf et seize mois après le curetage, il s’agissait d’un sujet masculin avec une atteinte de la phalange distale et une érosion corticale. Les fibromes chondromyxoides du pied et de la phalange qui ont initialement été traités par curetage isolé ont récidivé dans les deux ans, dans 20% des cas. Lorsque les lésions entraînent une érosion corticale, il est nécessaire d’associer au curetage une greffe, afin de prévenir le risque de fracture.
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Sharma, H., Jane, M. & Reid, R. Chondromyxoid fibroma of the foot and ankle: 40 years’ Scottish bone tumour registry experience. International Orthopaedics (SICO 30, 205–209 (2006). https://doi.org/10.1007/s00264-005-0046-y
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DOI: https://doi.org/10.1007/s00264-005-0046-y