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Total destruction of the fourth metacarpal bone by aneurysmal bone cyst is presented. Despite the benign nature of the lesion on plain radiograms, magnetic resonance imaging (MRI) has revealed total destruction of metacarpal bone with shelling off the articular cartilages on both ends of the metacarpal. Both adjacent dorsal interosseous muscles were also involved with tumour. After removal of the metacarpal bone and third and fourth interossei, fibular bicortical strut graft was used for reconstruction. Arthrodesis was done both at the carpometacarpal and metacarpophalangeal (MCP) joints. The follow-up radiograms at one year revealed excellent incorporation of the graft with no evidence of local recurrence. A careful pre-operative work-up including MRI seems necessary even in lesions that look typically benign with intraosseous location on plain radiograms. This approach may prevent unpredicted morphologic picture during surgery, high recurrence rate and the number of operations.

Aneurysmal bone cysts are benign lesions that rarely occur in the bones of the hand. Curettage and bone grafting are the most common treatment modalities performed considering the possible functional loss after total excision. Four cases of aneurysmal bone cyst of the hand were identified. Three out of four cases were treated initially with curettage and bone grafting alone without any other local therapy. One had total excision of the lesion. There were two recurrences in the curettage group. Both were treated with excision and followed up for a minimum of 12 months. Curettage alone was associated with high recurrence rates. Total excision of the lesion was the most successful procedure employed. In view of the high recurrence rates following curettage alone and non-neoplastic nature of the lesion, adjuvant treatment modalities such as cryosurgery, electric cauterisation should be considered for initial treatment of ABC. Resection should be preserved for recurrent cases.

Aneurysmal bone cysts associated with tubular bones of the hand are rare and even rarer in the paediatric age-group. They are rapidly growing, destructive benign bone tumors. Multiple treatment modalities for aneurysmal bone cyst have been reported in the literature, but controversy exists regarding optimal treatment. We report a case of aneurysmal bone cyst of proximal phalanx of middle finger in a 2 year old child treated at our tertiary care hospital. The diagnosis was confirmed with pre-operative MRI, FNAC and post-operative histopathology. Curettage of the lesion and autologous bone grafting was performed. The hand was immobilized in a short below elbow slab for 4 weeks followed by physiotherapy. Excellent radiological and functional outcomes were obtained with no recurrence at a 5 year of follow up.

Aneurysmal bone cyst (ABC) is a benign expansile bone tumor without metastasis capability. Only 3–4% of ABCs occur in the hand and they mainly take place in metaphysis’ of long bones like metacarpals or phalanges. Carpal ABCs have been reported as individual case reports in the literature due to rarity. A patient presented with pain in her right wrist. Magnetic resonance imaging revealed a well circumscribed one cm sized mass in the pisiform bone that resembled an aneurysmal bone cyst. Total pisiformectomy was performed. Treatment options are total excision or curettaging in ABCs. But rarity of these lesions may delay the diagnosis process for the inexperienced surgeon.