Published: June 25, 2026
Patient is a 37-year-old male. He was referred to Norton orthopedic oncology following outpatient orthopedic hand X-rays demonstrated a nondisplaced fracture of the right third metacarpal neck, following low-energy work-related trauma. Open biopsy demonstrated leiomyosarcoma of the right volar palm with involvement of the third metacarpal neck.
Patient is right-hand dominant and operates machinery for a living. His condition required en bloc resection of the rapidly growing mass abutting his deep palmar arch in his dominant hand. Staging studies demonstrated isolated disease. Radiation options were considered and discussed, however it commonly creates significant long-term functional limitations in a young individual reliant on their hand function for skilled labor.
Patient underwent a technically successful third metacarpal ray resection with grossly negative intraoperative margins. Prior to surgery, the clinical team performed a simulation on a specimen provided by the Bioskills Lab on the Norton Brownsboro Hospital campus.
Pre-op MRI
The patient’s operative hand is neurovascularly intact and he has already begun functional mobility training and retraining of pincer grasp. Histologic assessment demonstrated negative margins post-operatively. The patient will remain under surveillance for the next 5 years.
Post-op X-ray
Joshua D. Harman, D.O.
Orthopedic Oncologist, Pediatric Orthopedic Oncologist, Sarcoma and Connective Tissue Medical Oncologist
Norton Cancer Institute
Charity S. Burke, M.D.
Hand Surgeon
Norton Arm & Hand Institute
Mary Katherine A. Spiker, PA-C
Physician Assistant
Norton Orthopedic Institute
Jamie Clark
Manager, Bioskills Lab
Norton Healthcare
Dr. Harman is the Steven Vanover Endowed Chair through generous funding from the Norton Healthcare Foundation. The Steven Vanover Endowed Chair is a significant initiative by the Steven Vanover Foundation through the Norton Healthcare Foundation, aimed at providing a sarcoma-focused oncologist in Louisville. This chair will be the first of its kind in Kentucky, enhancing cancer treatment and research efforts.