Giant cell tumor of distal radius treated with ulnar translocation and wrist arthrodesis

Abstract

The aim is to analyze the functional outcomes of patients of giant cell tumor (GCT) of distal radius treated with ulnar translocation and wrist arthrodesis. Methods: Study included 25 patients of aggressive GCT of distal radius, resected and reconstructed using ulnar translocation and wrist arthrodesis. The ulna-carpal radius fixation was performed with plate and screws. The patients were followed to bony union and minimum follow-up was 1 year. Result: Twenty-two patients were of Campanacci grade 3 and three patients were of Campanacci grade2. The mean follow-up was of 23 months (12-36). All patients had an excellent range of pronation and supination. The mean Musculoskeletal Tumor Society score was 24 (range 22-28). Grip strength of affected hand compared to the contra lateral hand was found good in 17 cases and average in 7 cases. The mean bone union time at ulna to radius junction was at 6.5 (5-8) months and ulna to carpal junction at 4.5 (4-6) months. The complications were surgical site infection (one case), recurrence (one case) and failure of union (one case), and ulna graft fracture with implant failure in (two cases). Conclusion: Reconstruction of distal end of radius using ulnar translocation and wrist arthrodesis provides excellent functional outcomes with preservation of rotational movement of forearm and hand function. Reconstruction of the distal radius by ulnar translocation without complete detachment from surrounding soft tissues functions like vascularized graft without use of microvascular techniques.

Giant cell tumors of bone localized in distal radius

“…Distal radius localized GCTs occur in young population between 20 and 40 years of age. This group is difficult to manage in terms of normal functional life expectancy of the patient [2,9]. Local recurrence and loss of range of motion are difficulties for the surgeons about which surgery should be performed.…”

“…It constitutes 5% of all primary bone tumors [1]. Distal radius is the 3rd most common tumor site after distal femur and proximal tibia [2]. The lesion is often characterized by thinning and expansion in the cortex and may include a soft tissue component.…”

“…While some cases are extremely benign, some may be aggressive and lung metastasis can be seen [4]. The proximity to the joint and to especially median nerve makes the resection of tumor and reconstruction of the tumor site hard in the tumors localized in distal radius [2,4]. Surgical treatment of GCTs of bone includes isolated curettage, curettage, and adjuvant therapy (e.g, high-speed burring, phenol, cryotherapy), en bloc resection and defect reconstruction or arthrodesis methods [4].…”

Tumor de células gigantes tratado con translocación cubital y artrodesis de muñeca tras fracaso de curetaje y cementación

“…4 Se suelen localizar en la zona distal de huesos largos, especialmente en la rodilla (fémur distal y tibia proximal), siendo la extremidad distal del radio la tercera localización en frecuencia con un 10% de los casos. 1,4,5 La recurrencia es variable situándose entre el 10%-65% de los casos, siendo más frecuente cuando el tumor invade las partes blandas. 4,6 El 10% malignizante teniendo entre el 1%-4% de metástasis pulmonares.…”

“…3,4 Los localizados a nivel de radio distal tienen más tendencia a la recurrencia local y a desarrollar metástasis. 2,4,5 La clínica más habitual es el dolor local asociado con aumento de volumen e hipersensibilidad en la región afecta. Muchas veces, la forma de presentación es una fractura secundaria al adelgazamiento cortical 1 ; esas fracturas son menos frecuentes en el radio distal que cuando la lesión está alrededor de la rodilla.…”