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Giant cell tumors of tendon sheath are common soft tissue lesions affecting the digits, sometimes causing pressure atrophy of an adjoining bone and rarely perforating the cortex to expand into the medullary canal. One hundred thirty-three cases of giant cell tumors of tendon sheath were retrospectively reviewed; 15 (11%) showed cortical perforation and intraosseous expansion. Radiographic features, diagnoses, and surgical treatment are described. The use of soft tissue radiographic techniques and mammographic films was an extremely valuable diagnostic tool, although computed tomography and magnetic resonance imaging may be necessary in some cases.

Thirteen patients with 15 intraosseous carpal ganglia (6 scaphoid and 9 lunate cases) are reported. Eleven cases had cortical defects communicating the bone cysts either with the joint space or a coexisting soft tissue ganglion. Nine cysts were primary or idiopathic; soft tissue ganglia were found in 6 secondary cases and anatomic continuity of the intraosseous and extraosseous components through cortical defects was present. Treatment consisted of curettage of the cyst wall and cancellous bone grafting. Approaching lunate cysts through a small opening in the scapholunate interosseous ligament is described. Results were analyzed in 12 cases with at least 1 year of follow-up; the average follow-up period in these cases was 47 months (range, 12-119 months). Results were very good in all but 1 patient, who suffered a partial lunate collapse, which resulted in mild lunocapitate osteoarthritis. No graft reabsorption or recurrence was seen in the control radiographs obtained throughout the follow-up period.

Since 1973, 212 hands of 179 patients with disabling trapeziometacarpal osteoarthritis were treated with resection-arthroplasty stabilized by capsuloplasty and intermetacarpal ligament construction; 159 patients (180 hands) could be followed up (average, 7.8 years; range, 1 to 17.3 years). Pain relief was excellent in 89%, good in 10%, and fair in 1%. Patients were “delighted” (78%), “satisfied” (18%), “indifferent” (2%), or “disappointed” (2%) with their functional results. Palmar abduction improved 25%. The tip of the thumb reached the fifth metacarpophalangeal joint in 97% of the hands. Grip strength improved 29%; key pinch, 19%; pulp pinch, 24%. First metacarpal was stable in 94% of the cases. Scaphometacarpal space averaged 5.5 mm. There were three complete failures (2%); complications were mild and infrequent. Because of its good, predictable results, “stabilized resection-arthroplasty” is our preferred surgical treatment for osteoarthritic trapeziometacarpal joints.