Giant cell tumor of distal ulna treated using en-bloc resection combined with extensor carpi ulnaris and flexor carpi ulnaris tendon stabilization: A case report

Solichin, Iman; Martika, Windi; Wikanjaya, Rio

doi:10.1016/j.ijscr.2021.01.065

Cited by 5 publications

(6 citation statements)

References 10 publications

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“…Excessive resection of the ulna, where the osteotomy was localised cranially from the distal oblique band of the interosseous membrane, can lead to ulnar stump instability with consequent dorsal migration, causing impingement with the radius, pain, and sometimes even a rupture of the extensor tendon. This unwanted biomechanical cascade represents the main reason why numerous authors suggest stabilisation of the ulnar stump using the tendon graft 4,7,8,15,18 . One half of the extensor carpi ulnaris tendon (ECU) is the most commonly used graft for such a procedure, while some authors combine both flexor and extensor carpi ulnaris tendon grafts in order to obtain more stability 4,7 .…”

Section: Discussionmentioning

confidence: 99%

“…This unwanted biomechanical cascade represents the main reason why numerous authors suggest stabilisation of the ulnar stump using the tendon graft 4,7,8,15,18 . One half of the extensor carpi ulnaris tendon (ECU) is the most commonly used graft for such a procedure, while some authors combine both flexor and extensor carpi ulnaris tendon grafts in order to obtain more stability 4,7 . Another problem related to wide resection of the distal ulna is wrist instability, with pain, weakness, and loss of grip strength.…”

Section: Discussionmentioning

confidence: 99%

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Operative technique for reconstruction of distal ulna after giant cell tumour resection

Barbarić Starčević

2023

ACC

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Giant cell tumour (GCT) is a rare, benign tumour, but it has a locally aggressive nature [1][2][3][4] . It accounts for 3 to 5% of all primary bone tumours, and affects adult people at the age of 20 to 40 years 2,4 . The distal ulna represents an extremely rare localization of this tumour, occurring in only 0.45-4,5 % of all GCT cases 1,3 . There are different treatment options for GCT of the distal ulna described in literature: curettage with or without bone grafting, cryotherapy of the cavity or application of phenol, radiation, insertion of bone cement in the cavity after curettage, en-bloc resection with or without reconstruction of the distal ulna with bone graft or reconstruction of the distal ulna with endoprosthesis 3 . Today, en-bloc resection of the distal ulna performed with or without additional stabilisation of the ulnar stump is the recommended treatment option 1,5-7 . Functional results after that kind of surgery are mostly satisfying 3,7,8 . However, in some cases with excessive resection of the distal ulna, the radiocarpal joint loses its ulnar support which can result in DRUJ instability, causing pain and weakness of grip strength 1,3 . This is the reason why in young people with high functional demands we prefer a reconstruction of the distal ulna and a stabilisation of the distal radioulnar joint after an en-bloc resection of the distal ulna. The distal ulna is reconstructed with an autologous free fibular graft and the distal radioulnar joint (DRUJ) is stabilised with an autologous palmaris longus tendon

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Operative technique for reconstruction of distal ulna after giant cell tumour resection

Barbarić Starčević

2023

ACC

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“…Jenis tumor lokal paling sering ditemukan di jari sedangkan subtipe GCT tipe difus dapat dibedakan sebagai intra-artikular dan ekstra-artikular. [5][6] Lesi dapat muncul di mana saja di sinovium, tetapi pada 80% hingga 90% kasus, GCT terjadi pada sendi tangan atau sinovium tendon, dan jarang terjadi pada sendi lutut dan kaki. Karena tingkat kekambuhan yang tinggi hingga 50%, klasifikasi tumor yang tepat sangat penting.…”

Section: Pendahuluanunclassified

Giant Cell Tumor pada Ulna Distal: Laporan Kasus

Noersasongko,

Rawung,

Lengkong

et al. 2023

eCl

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Giant cell tumor (GCT) in the distal end of ulna is extremely uncommon. We report a woman aged 53 tahun with a lump in the left wrist for three years that grew gradually and slowly. Physical examination of the left forearm revealed a tumor sized 8x9x10 cm, distinct border, hard in palpable without pain. X-ray of the left forearm showed a mass with distinct margin, regular edge, expansively invaded the epiphysis associated with thinning of cortex of distal ulna indicating a GCT in distal ulna. The aim of treatment in this case was to prevent recurrency and to keep the function of left forearm and hand. Patient was treated with tumor excision and fibular bone graft. Excision was performed after ulnar osteotomy until its clear margin. Fibular osteotomy 10 cm length was carried out followed by fibular bone graft to replace the excised ulna. Histopathological examination confirmed the diagnosis of a GCT. Patient was admitted for five days. Follow up after three months did not show any recurrency. Range of motion was within normal limit, and patient could do her daily activities. In conclusion, CGT in distal ulna treated with tumor excision until its clear margin followed by fibular bone graft showed satisfying result. Kata kunci: giant cell tumor; fibular bone graft; tumor excision; primary bone tumor Abstrak: Giant cell tumor (GCT) pada bagian distal ulna merupakan kasus langka. Kami melaporkan seorang perempuan berusia 53 tahun dengan benjolan di tangan kiri sejak tiga tahun yang membesar perlahan. Pada pemeriksaan fisik regio antebraki sinistra, didapatkan benjolan ukuran 8x9x10 cm, berbatas tegas, konsistensi keras, terfiksasi, tanpa disertai nyeri tekan. Rontgen manus sinistra memperlihatkan massa berbatas tegas, tepi reguler, mengenai epifisis ekspansif dengan penipisan korteks distal os ulna sinistra, kesan GCT distal os ulna sinistra. Tujuan terapi pada GCT untuk mencegah kekambuhan lokal dan menjaga fungsi anggota tubuh. Pasien diterapi dengan eksisi tumor dan fibular bone graft. Eksisi tumor dilakukan setelah osteotomi ulna hingga batas tulang yang sehat selanjutnya dilakukan osteotomi fibula sepanjang 10 cm dan dilakukan fibular bone graft menggantikan bagian ulna yang diangkat. Konfirmasi histopatologik sampel tumor menunjukkan interpretasi kesan giant cell tumor grade III. Pasien dirawat selama lima hari. Hasil follow-up selama tiga bulan tidak menunjukan tanda-tanda rekurensi. Range of motion pasien saat kontrol dalam batas normal, dan pasien dapat mengerjakan aktivitas sehari-hari. Simpulan kasus ini ialah GCT pada tulang ulna dengan pilihan terapi eksisi tumor hingga batas tulang yang sehat, dilanjutkan dengan fibular bone graft berhasil memuaskan. Kata kunci: giant cell tumor; fibular bone graft; eksisi tumor; tumor primer tulang

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A Comparison of Outcomes of ‘Extensor Carpi Ulnaris Tenodesis’ versus ‘No Tenodesis’ after Resection of the Distal Ulna in Patients with Giant Cell Tumor

Sahito

Ali

QAMAR

et al. 2022

J Hand Surg Asian-Pac Vol

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Background: One of the methods of stabilizing the stump of the ulna following resection of the distal ulna is tenodesis of the extensor carpi ulnaris (ECU). Some studies have recommended stabilization, whereas others have not found it useful. Most of these studies have a mix of different pathologies and often do not have a control group. The aim of this study is to compare the outcomes of ECU tenodesis versus no tenodesis after resection of the distal ulna in patients with grade III giant cell tumor (GCT) of the distal ulna. Methods: The retrospective study included 10 patients with Campanacci grade III GCT of the distal ulna treated by resection of the distal ulna between 2014 and 2019. Patients were stratified into two groups based on whether they underwent ECU tenodesis (n = 5) or no tenodesis (n = 5). The patients were assessed at 6 weeks, 6 months, and 12 months for complications and outcomes using the Mayo wrist score (MWS) and the revised musculoskeletal tumor society score (MSTS). Results: The MWS and the MSTS were significantly better in the ECU tenodesis group at 6 weeks. At 6 months, MWS was similar in both groups, but MSTS continued to be significantly better in ECU tenodesis group. At 12 months, both groups reported similar MWS and MSTS. There were no recurrences in either groups. One patient in the ECU tenodesis group developed ECU tendonitis that resolved with conservative treatment. Conclusions: The outcomes of ECU tenodesis were better in the short term (6 months), although both groups reported similar outcomes at 12 months. Level of Evidence: Level III (Therapeutic)

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Giant cell tumor of distal ulna treated using en-bloc resection combined with extensor carpi ulnaris and flexor carpi ulnaris tendon stabilization: A case report

Cited by 5 publications

References 10 publications

Operative technique for reconstruction of distal ulna after giant cell tumour resection

Operative technique for reconstruction of distal ulna after giant cell tumour resection

Giant Cell Tumor pada Ulna Distal: Laporan Kasus

A Comparison of Outcomes of ‘Extensor Carpi Ulnaris Tenodesis’ versus ‘No Tenodesis’ after Resection of the Distal Ulna in Patients with Giant Cell Tumor

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