Radiofrequency Ablation for Osteoid Osteoma of the Hand

Purpose or Learning Objective: To present our technique for the treatment of osteoid osteoma of the hand using radiofrequency thermal ablation (RTA).

Methods or Background: Six patients with osteoid osteoma of the hand were treated at our institution. One case was a second RTA after a first failed attempt that resulted in fracture of the phalanx. The tumors were located in the proximal (two), middle (two), and distal (one) phalanx, and in the hamate bone (one). We used a T-wrench and inserted a Kirschner wire (1.4–1.6 mm thick) into the nidus by pressing and turning. Once the Kirschner wire was inserted, we introduced the cannula of a beveled vertebroplasty needle coaxially, using the needle as a guide. Next, we removed the wire by pulling it, grasped by the wrench. Finally, we introduced the 7-mm active tip electrode and performed dry ablation for 5 minutes at 70°C.

Results or Findings: Technical success was achieved in all six cases, but one patient developed a fracture shortly after treatment, with a stiff interphalangeal joint that required arthrolysis and plaster cast of the finger. The visual analog score improved from a mean value of 8 (range: 8–10) to a mean value of 1 (range: 0–4).

Follow-up imaging was performed in four patients (one magnetic resonance imaging [MRI], one computed tomography [CT], two radiographs). CT and radiography showed increased sclerosis and/or disappearance of the nidus. MRI showed resolution of bone marrow edema.

Conclusion: RTA of osteoid osteoma of the hand is feasible and provides good results in terms of pain control and functional recovery. However, special care must be taken to avoid fractures due to the small size of bones in this anatomical region. Most clinicians rely on clinical findings to consider healing of the process, but imaging methods can demonstrate sclerosis and/or disappearance of the nidus and resolution of bone marrow edema.

Publication History

Article published online:
02 June 2022