Introduction. Giant-cell tumor of bone (GCTB) is a benign tumor with an unpredictable evolution, representing 4-5% of all primary bone tumors and 15% of benign bone tumors usually affecting 20-45 years old adults. The predilect location is the distal femur, proximal tibia, and distal radius. Case presentation. We report the case of a 31-year-old male, regardless of medical history, admitted in the emergency department (ED) for significant pain and functional impairment of the right knee, after suffering a traumatic event. Clinical examination and imaging tests established the diagnosis of lateral femoral condyle fracture. Therefore, osteosynthesis with 4 screws was performed. Postoperative evolution was uneventful until one year later when the patient presented to the ED for pain and inflammatory aspect of the right knee, but with no history of trauma during this time. The imagistic exams of the right knee (X-ray, magnetic resonance imaging and scintigraphy) detected a tumor of the lateral femoral condyle that also affected the osteosynthesis material. Thus, the removal of screws and histopathological exam were performed, the latter establishing the diagnosis of GCTB. Taking into consideration radiological and histological aspects of the tumor and relating them to the clinical findings, the GCTB was classified in stage III Enneking. The patient underwent surgery, segmental resection of the tumor in oncological limits and arthroplasty with modular tumoral prosthesis was performed. Postoperative results at 6 and 12 months according to Musculoskeletal Tumor Society Scoring System were very good. The key feature of this case consists of post-osteosynthesis appearance of the GCTB given the fact that only 3 cases of GCTB affecting the screw site were reported in literature.
Aim: To assess the clinical results after osteosynthesis with locked intramedullary nail in metastasis of the long bones. Material and methods. We designed a prospective study in which we included all the patients with metastasis of the long bones admitted and surgically treated in our department between 2013 and 2015. Data for 64 were available at the final check-up. Our cohort totalized a number of 69 fractures (2 long bones required surgical treatment in 5 patients). The mean follow-up for survivors was 37 months (limits: 18-49 months). The primary tumor was known in 51 patients (79,69%). For the remaining 13 cases (20,31%), the primary tumor was not known and the pathological fracture was the first sign of the malignant disease. In the last group, the tumor could be identified by imagistic methods in 6 cases, while in other 3 cases, a biopsy and histological examination (which were performed in all the remaining 7 cases) determined the source organ. Clinical and radiological check-ups were performed at every 3 months in the first year and at every 6 months after that. Results. Pain amelioration and mobilization of the involved limb were achieved in all the cases. In 3 patients, the osteosynthesis could not compensate the progressive bone loss and the permanent use of an external orthosis was mandatory. The survival rate was 82,81% at 6 months and 67,19% at 12 months. Conclusions. All patients could be mobilized. Two thirds of the patients will survive more than a year. The goals of osteosynthesis are the same, regardless the location of the fracture and implant used: pain amelioration, stability for immediate full weight bearing, durability for patient’s life expectancy.
Introduction. Giant-cell tumor of the bone is a benign tumor, but with high local aggressiveness, even with risk of remote metastasis. Material and methods. We present the case of a 57-year-old woman, without significant pathological history, who, after clinical, imagistic and anatomopathological investigations, was diagnosed with giant cell tumor of the right distal radius. The patient underwent surgery and due to the size of the tumor and destruction of the surrounding cortical bone, segmental resection of the tumor in oncological limits was performed. The bone defect was filled with the proximal one third of the ipsilateral fibula, fixed to the remaining radius diaphysis with a plate and screws. Also, the autograft was stabilized to the proximal row of the carpal bones with 2 k-wires for 6 weeks. Postoperatively, clinical and X-ray check-ups were performed at 6, 12, 24 weeks and 1 year after surgery. Results. According to Mayo functional assessment score, the results were good. At 1 year after surgery, the patient gained 85 points, representing a good functional outcome of the surgery. This way, the wrist joint mobility and the carpal cartilage were preserved, providing a barrier against distal migration of any remaining tumoral cells, as well. Conclusions. It can be stated that in aggressive giant cell tumors located at the distal radius, the best therapeutic option is a segmental resection of the lesion followed by the replacement of the bone defect with a proximal fibular autograft. This method provides the best postoperative functional results with a lower risk of local recurrence and does not require microvascular surgery or access to a bone bank.
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