Extensor Carpi Ulnaris Tenodesis Versus No Stabilization After Wide Resection of Distal Ulna Giant Cell Tumors

Papanastassiou, Ioannis D.; Savvidou, Olga D.; Chloros, George D.; Megaloikonomos, Panayiotis D.; Kontogeorgakos, Vasileios; Papagelopoulos, Panayiotis J.

doi:10.1177/1558944717743598

Cited by 8 publications

(8 citation statements)

References 43 publications

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“…38 Papanastassiou et al found similar functional outcome in patients treated with distal ulna excision with or without ulnar stump stabilization. 8 In our study, no additional procedure to stabilize the ulnar stump was performed in any of the patients. None of the patients developed prominence of ulnar stump or any other complaint attributable to the unstabilized ulnar stump.…”

Section: Discussionmentioning

confidence: 85%

“…4,5 The distal ulna is considered expendable by most authors. [6][7][8] En bloc resection is the preferred surgical choice in cases with complete erosion of cortical bone, the presence of extraosseous soft tissue mass, pathological fracture, or recurrent lesions. 4,6,7,9 Two potential complications need to be addressed with regard to resection of the distal ulna.…”

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confidence: 99%

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Ulnar Buttress Arthroplasty without Ulnar Stump Stabilization for Giant Cell Tumor of Distal Ulna

et al. 2023

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Purpose Reconstruction and stabilization of ulnar stump after distal ulna tumor resection is still a matter of debate. We present the outcomes of ulnar buttress arthroplasty without stabilization of the ulna stump in giant cell tumor of bone (GCTB) of the distal ulna. Methods Evaluation of functional outcome was performed using Musculoskeletal Tumor Society 93 (MSTS93) score, Modified Mayo Wrist score (MMWS), and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. We also assessed the hand grip strength, range of motion at the wrist, and ulnar carpal translation. Results The study included 8 patients with Campanacci grade 3 GCTB of the distal ulna with a mean follow-up of 35.5 ± 9.1 months. The mean resection length was 7.7 ± 1.3 cm. The mean hand grip strength on the operated side was noted to be 90 ± 0.04% of the contralateral side. Mean MSTS93 score was 27.9 ± 1.25, mean MMWS was 86.9 ± 4.58%, and the mean DASH score was 4.9 ± 1.67, depicting a good to excellent functional outcome with low degree of disability. No radiocarpal instability, ulnar carpal translation, prominence, or instability of the proximal ulnar stump was noted in any patient. Conclusion Reconstruction of the distal radioulnar joint using iliac crest bone graft for ulnar buttress without stabilization of the ulnar stump after resection of the distal ulna is an effective reconstruction option with good functional outcome and preservation of good hand grip strength. Level of Evidence Level IV, Therapeutic study

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Section: Discussionmentioning

confidence: 85%

mentioning

confidence: 99%

Ulnar Buttress Arthroplasty without Ulnar Stump Stabilization for Giant Cell Tumor of Distal Ulna

et al. 2023

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“…A review of the literature of the past 10 years since denosumab was first clinically used revealed that there were 19 reports describing 44 cases of Campanacci grade II and III distal ulnar GCTB (table 1). In 13 cases, bone curettage was performed in the initial surgery, [6][7][8][9][10][11] in which at least three were grade III cases. However, there was local recurrence in all grade III cases, 7 11 suggesting that en bloc resection is necessary in such conditions.…”

Section: Discussionmentioning

confidence: 99%

“…9 13 17 In three studies, prosthetic reconstruction with implant arthroplasty of the distal radioulnar joint was reported, [14][15][16] while reconstruction of the distal radioulnar joint using an iliac bone block and screws-a modification of the Sauvé-Kapandji procedure-was reported in two studies. [18][19][20] Ferguson et al 13 and Papanastassiou et al 9 reported that reconstruction was not essential based on case comparisons of their own studies. In fact, in more than half of the reviewed cases, no reconstruction was performed, and almost all obtained favourable results (average Musculoskeletal Tumor Society scoring system score: 88.7%, range 30%-100%).…”

Section: Discussionmentioning

confidence: 99%

Recurrent giant cell tumour of the distal ulna after en bloc resection with preoperative denosumab use

et al. 2021

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In recent years, denosumab has been used to treat giant cell tumour of bone (GCTB) not only in cases where surgery is complicated but also preoperatively to decrease the preoperative grade or to facilitate surgery for Campanacci grade II and III cases. However, there are no clear protocols regarding the preoperative use of denosumab before en bloc resection. There are a few reports of recurrent cases after en bloc resection; however, the association with the use of denosumab is unknown. We present the clinical, radiological and histopathological findings of a case of Campanacci grade III GCTB at the distal end of the ulna, which resulted in soft tissue recurrence after en bloc resection with the preoperative use of denosumab.

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“…Various options are available after resection of distal ulna GCT such as extensor carpi ulnaris (ECU) tenodesis of the residual ulnar stump, reconstruction of the ulnar head with second metatarsal head or allograft, ulnar head arthroplasty, or the Sauve-Kapandji procedure, which are helpful to preserve wrist function. [6][7][8][9][10] To the best of our knowledge, very few case reports have been found, in which the GCT was resected en bloc followed by iliac crest graft fixation to the distal end radius to maintain the ulnar support, and ECU tenodesis for achieving the ulnar stability. We present our series of seven cases of Campanacci grade III GCT distal ulna, managed with en bloc resection along with fixation of tricortical iliac crest graft to the distal end radius with screws for maintaining the ulnar wrist support followed by stabilization of the proximal ulnar stump using ECU tenodesis.…”

Section: Introductionmentioning

confidence: 99%

Clinical and functional outcomes of reconstruction following en bloc resection for the Campanacci grade III distal ulnar giant cell tumors

Kumar

Rustagi

Talwar

et al. 2022

Journal of Orthopaedics, Trauma and Rehabilitation

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Background: Wide resection of the tumor is essential for the treatment of Campanacci grade III giant cell tumor of the distal ulna but radioulnar convergence and dorsal displacement of the ulnar stump are known complications. Various reconstructive options to reduce these complications have been described in the literature. Methods: Seven patients with Campanacci grade III giant cell tumor distal end of the ulna were treated at our institute by extra-periosteal wide local excision of the tumor followed by reconstruction of the distal radioulnar joint by fixation of tricortical iliac crest graft to the distal end radius using two cancellous screws and extensor carpi ulnaris (ECU) tenodesis for stabilizing the residual ulnar stump. All patients were followed up for an average period of 3.5 years (32–48 months) at regular intervals. Functional outcome and complications if any, were recorded at every follow-up. Results: At final follow-up, the mean range of motion of wrist with 42.1° ± 5.9° of flexion, 72.9° ± 6.4° of extension, 82.1° ± 8.1° of supination and 85.0° ± 5.8° of pronation was achieved. The mean visual analog scale score at the final follow-up was 0.9 ± 0.9. The mean modified Mayo wrist score was 71.4 ± 6.4 with a mean modified Musculoskeletal Tumor Society score of 25.9 ± 0.8 and a mean Disability of Arm, Shoulder, and Hand score of 17.9 ± 1.6 at the final follow-up. The average time for the radiological union of iliac crest graft with the distal end radius was 13.3 weeks. None of the patient reported any complication or recurrence. Conclusion: The reconstruction of distal radioulnar joint by fixation of tricortical iliac crest graft with distal end radius and stabilization of ulnar stump by extensor capi ulnaris tenodesis after the wide resection of distal ulna giant cell tumor is recommended for good to excellent functional outcomes.

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Extensor Carpi Ulnaris Tenodesis Versus No Stabilization After Wide Resection of Distal Ulna Giant Cell Tumors

Abstract: The distal ulna may be widely resected with or without stabilization of the residual ulnar stump, yielding satisfactory local disease control and functional outcome.

Cited by 8 publications

References 43 publications

Ulnar Buttress Arthroplasty without Ulnar Stump Stabilization for Giant Cell Tumor of Distal Ulna

Ulnar Buttress Arthroplasty without Ulnar Stump Stabilization for Giant Cell Tumor of Distal Ulna

Recurrent giant cell tumour of the distal ulna after en bloc resection with preoperative denosumab use

Clinical and functional outcomes of reconstruction following en bloc resection for the Campanacci grade III distal ulnar giant cell tumors

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