PMC10152951_01
Pre-operative clinical images. A solitary swelling is noticeable at the base of the right thumb. The range of movements of the first MTP joint is only terminally restricted.
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F1
The range of movements of the first metacarpophalangeal (MCP) joint was found to be terminally restricted and painful (Fig. 1).
Radiographs of the Hand. (a) The radiograph is done 4 months before presenting to us. Shows a solitary, expansile, and lytic lesion in the head of the first metacarpal. The lesion is seen to involve the epiphyseal and metaphyseal regions, extending up to the distal articular surface. A narrow zone of transition and a sclerotic rim was noted. Periosteal reaction, cortical breach, and soft-tissue extension are absent. (b) Radiograph done at the time of presenting to us. The lesion was noted to have increased in size and was more expansive compared to the previous radiograph.
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F2
Radiographs of the hand revealed a solitary, expansile, and lytic lesion in the head of the first metacarpal (Fig. 2).
MRI of the right hand showing the lesion to be hypointense in T1 and T2 sequences, and hyperintense on STIR sequence.
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F3
On magnetic resonance imaging (MRI) of the hand, the lesion showed a hypointense signal on T1 and T2 sequences and was hyperintense on STIR sequences (Fig. 3).
Intraoperative images. (a and b) Showing Kirschner distal end of the first metacarpal. No cortical breach was noted. (c) Excised lesions measure to be 1 x 1 cm in dimensions (d) Cavity left behind after excision of the lesion.
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F4
The child underwent an excisional biopsy of the lesion (Fig. 4).
(a) Post-operative radiograph showing bone graft in the region of the excised lesion. Two Kirschner wires were transfixed for stabilization and (b) a follow-up radiograph of the right hand after 12 months.
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F5
The distal end of the first metacarpal was reconstructed with a bone graft obtained from the iliac crest and fixed with two Kirschner wires (Fig. 5).