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Primary malignant bone tumours are rare. The annual incidence of these tumours is 10 per 1 million. Nearly 30% of the primary malignant bone tumours are malignant cartilage tumours. The frequency of benign cartilage tumours cannot be definitely estimated because these tumours are normally clinically inapparent and therefore often diagnosed as an incidental finding. The cartilage tumours appear as benign lesions (e.g. chondroma), as borderline tumours (proliferative chondroma vs grade I chondrosarcoma) or as highly malignant chondrosarcoma (e.g. dedifferentiated chondrosarcoma). Commensurate with the different clinical and oncological manifestations of the cartilage tumours, there are wide differences in the treatment and clinical course of the individual tumour. This article discusses the problems in the diagnosis and treatment of cartilage tumours from an orthopaedic point of view.

The treatment of enchondroma in long tubular bones has been the subject of controversial discussions for several years. Whereas secondary malignancy is very rare when the enchondroma is located in a hand, a position near to the trunk represents a high risk of transformation into a chondrosarcoma. For an enchondroma in long tubular bones, authors recommend a whole variety of approaches ranging from regular controls to radical en bloc resection. Between 1989 and 2001 we followed a concept of intralesional resection and cement filling. After an interval without recurrences, the cement was extracted and replaced by a spongiosaplasty. Of 16 patients 12.5% suffered from an intralesional fracture in the course of the treatment, and 25% complained of persistent pain and loss of function after surgery. These complications led us to change our concept. Though there were two cases of secondary transformation into chondrosarcoma G1, we now prefer to keep the patients under close clinical and radiological control without performing surgery.

The diagnosis and treatment of tumors of the skeleton of the hand are reviewed. Benign enchondromas were found to be the most common. Primary osteogenetic sarcoma was rare as was malignant degeneration in initially benign tumors and in the bony manifestations of systemic disease such as neurofibromatosis or hyperparathyroidism. Tumors were more common in phalanges and metacarpals than in the carpus and showed their highest incidence in the 4th decade. Diagnosis was aided by angiography and bone-scanning. Some difficulties were encountered in pathological examination. Treatment involved curettage and cancellous grafting in small tumors, en bloc resection followed by osteosynthetic stabilisation in larger instances and radical ablation followed by chemotherapy in malignancy.

The article reports on seven patients with a histologically established chondromatosis of the joints. The aetiology, diagnosis, pathologico-anatomic findings and treatment of this rare joint disease are discussed. The case history of a patient serves to illustrate how a benign chondromatosis can undergo malignant degeneration.