Failure of Osteosynthesis in a Pathological Fracture Caused by Enchondroma of the Fourth Metacarpal: Surgical Revision with Structural Bone Graft Case Report

Background: Enchondromas are benign cartilaginous tumors that frequently affect the small bones of the hand and may present with pathological fractures. The optimal management of these lesions remains debated, particularly when structural bone defects persist after curettage. Case presentation: We present the case of a 38-year-old female with a pathological fracture of the fourth metacarpal secondary to an enchondroma. Initial treatment consisted of curettage and internal fixation with plate osteosynthesis. Although early postoperative evolution was satisfactory, the patient developed implant failure associated with persistent structural bone weakness. Revision surgery was performed with removal of the failed implant, structural tricortical bone grafting, and stable fixation. Results: The patient evolved with progressive bone consolidation and functional recovery of the hand. This case highlights the importance of restoring structural stability in metacarpal enchondromas associated with pathological fractures, especially when significant bone defects remain after curettage. Conclusion: Structural bone grafting may play an important role in restoring mechanical stability and preventing implant failure in metacarpal enchondromas associated with pathological fractures.