Enchondroma Specialist Surgeon Singapore 

Surgical Surveillance and Curettage with Stabilization 

We manage enchondroma through a balance of vigilant monitoring and active intervention when pathological fracture risk is identified. Under the clinical direction of Dr. Saminathan Suresh Nathan, we navigate the subtle diagnostic boundaries between benign cartilaginous lesions and low-grade malignancy. Our approach utilizes meticulous curettage followed by bone grafting to reinforce the skeletal structure and eliminate the risk of malignant transformation. Enchondromas are very common lesions and involve mostly the long bones. They are by definition cartilage containing lesions and can usually be observed. They happen in older patients but are likely to be developmental though probably not congenital in origin. Indices of poor prognosis make a diagnostic and therapeutic measure necessary in the form of curettage and cryotherapy if a chondrosarcoma grade I is suspected. Grade II and III chondrosarcomas are usually much more aggressive and do not pose diagnostic dilemmas.

The main criterion for malignancy or aggressive behaviour include

1. Size greater than 3cm

2. Bone expansion

3. Scalloping of walls

4. Myxoid appearance versus the benign icing sugar

5. Activity on bone scan

6. (Often) Pain

Surgical Considerations

• Structural Augmentation: Use of bone grafting or synthetic substitutes to fill the void after curettage and prevent fracture.

• Biological Surveillance: Differentiating benign enchondromas from low-grade chondrosarcomas through histological and radiological correlation.

• Prophylactic Stabilization: Internal fixation in cases where the lesion significantly compromises the mechanical integrity of the bone.

Figure. This 55 year-old lady had pain in the knee due to patello-femoral (knee cap) arthritis. The MRI and bone scan showed no activity and the lesion could be observed.However, because she also had a meniscal tear (the actual cause of her pain) she underwent an arthroscopic meniscectomy and biopsy at the same sitting confirming the diagnosis of an enchondroma.