Distal radius reconstruction with vascularized proximal fibular autograft after en-bloc resection of recurrent giant cell tumor

Abstract

BackgroundGiant cell tumors (GCTs) located in the distal radius are likely to recur, and the treatment of such recurrent tumors is very difficult. Here, we report our clinical experience in distal radius reconstruction with vascularized proximal fibular autografts after en-bloc excision of the entire distal radius in 17 patients with recurrent GCT (RGCT) of the distal radius.MethodsAll 17 patients with RGCT in distal radius underwent plain radiography and/or magnetic resonance imaging (MRI) of the distal radius as the initial evaluation after hospitalization. Then the distal radius were replaced by vascularized proximal fibular autografts after en-bloc RGCT resection. We assessed all patients by using clinical examinations, plain radiography of the wrist and chest, and Mayo wrist scores in the follow-ups.ResultsAfter an average follow-up of 4.3 years (range: 1.5–10.0 years), no lung metastasis or local recurrence was detected in any of the 17 patients. In total, 14 patients had excellent or good functional wrist scores, 16 were pain free or had occasional pain, and 15 patients returned to work. The mean range of motion of the wrist was 101° (flexion-extension), and the mean grip strength was 77.2 % of the contralateral normal hand.ConclusionEn-bloc excision of the entire distal radius and distal radius reconstruction with a vascularized proximal fibular autograft can effectively achieve local tumor control and preserve wrist function in patients with RGCT of the distal radius.

En bloc giant cell tumor resection following direct hemiarthroplasty shoulder reconstruction–functional outcome: A case report

“…Proximal fibular autograft has disadvantages, including lack of blood supply and osteogenic cells, potential immunologic reactions, and possibility of collapse secondary to bone allograft absorption. Therefore, bone allografts are not the best choice for reconstruction and do not result in very satisfactory outcomes [13]. The use of megaprosthetic implant gained the worldwide recognition for tumor reconstruction, however, due to the large portion of implant and major resection of the tumor, the surgery needs free flap for soft tissue coverage [19].…”

“…Giant cell tumor (GCT) is a type of benign tumor which is locally aggressive and has the capability to metastasize [[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14]]. It represents approximately 5% of all primary bone tumors [2,[2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14]].…”

“…Giant cell tumor (GCT) is a type of benign tumor which is locally aggressive and has the capability to metastasize [[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14]]. It represents approximately 5% of all primary bone tumors [2,[2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14]]. 85% lesion occur in long bones with most frequent sites in distal femur (26%), proximal tibia (19%) and distal radius (11%) [[1], [2], [3], [4], [5], [6], [7], [8],10,[2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14]].…”

Joint salvage and biological repair of massive-cavity bone defects after extensive curettage of giant cell tumor around the knee with vascularized fibular autograft and cancellous allograft

“…Tumor cells remaining or being implanted in the surgical site during surgery usually causes local recurrence of GCT [22]. Previous studies have shown that en-bloc resection of GCT is very effective in reducing recurrence [23]. However, when the GCT is located around the knee, en-bloc resection is not recommended if we want to save the knee joint.…”

“…Non-vascular autografts have many advantages since they contain normal bone structure and are free from disease transmissions. However, these grafts may also have some complications (such as nonunion, donor complications), which may eventually lead to unsatisfactory outcomes [23]. Since some cases of our patients presented with the non-vascular bular autografts collapse in wrist and knee reconstruction, we did not repair massive bone defects only by using non-vascular bular grafts.…”