A Modified Palmar Approach With Tendon Splitting for Distal Phalanx Enchondromas of the Thumb: A Report of Two Cases

Abstract

Distal phalanx enchondromas of the thumb are rare and pose unique challenges for surgical management because of the thumb’s critical role in hand function. Traditional dorsal and lateral approaches risk damaging extensor tendons, the nail matrix, limiting interphalangeal mobility, or compromising pinch function. This report presents two cases of thumb distal phalanx enchondromas successfully treated using a modified palmar approach with Bruner’s incision followed by splitting the insertion of the flexor pollicis longus tendon. Both patients achieved complete curettage, bone regeneration, and full preservation of thumb function at the 1-year follow-up. The incision design avoided high-pressure zones of the pulp, reducing postoperative complications while maintaining functionality. Fluoroscopic guidance facilitated effective curettage through the flexor pollicis longus tendon split without extensive exposure. These findings underscore the tendon splitting palmar approach as a viable option in selected cases, highlighting the importance of individualized surgical strategies to optimize outcomes for distal thumb enchondromas.