Giant Cell Tumor of the Capitate Treated with Excision and Midcarpal Fusion

Abstract

Giant cell tumor (GCT) of bone is rare in the carpus, and only 11 cases have been reported in the capitate bone. The problem with this location is the high recurrence rate due to easy extension to the adjacent joint spaces and bones. We describe a case of GCT on the capitate bone and the treatment in comparison with the previously reported cases. The case report concerns a 48-year-old woman with a GCT of the capitate diagnosed on curettage. The treatment consisted of large resection with the lunatum and third metacarpal arthrodesis, with a successful union at 2 years follow-up, no recurrence, and an improved function of the wrist. When treated by curettage (alone or with adjuvant procedures), the GCT of the capitate recurred in four out of five cases. All tumors treated with large resection did not recur. Recommended treatment of GCT of the capitate is resection with carpometacarpal arthrodesis.

Tricortical Bone Grafting with Limited Midcarpal and Carpometacarpal Fusion for the Treatment of Giant Cell Tumor of the Capitate

“…The location of GCT at the midcarpal region is extremely rare and subsequent surgical treatment is often a difficult and challenging issue. [1][2][3][4][5][6] Resection of the lesion may be associated with local recurrence and lung metastasis that usually occur within the first 3 years. 3 Therefore, meticulous and extended curettage along with adjuvant treatment including hydrogen peroxide, alcohol and bone grafting is necessary to minimize the potential of recurrence.…”

“…3 In this scenario, autologous iliac corticocancellous bone graft offers enhanced structural stability, biologic stimulation of healing, and high fusion rate. 5 Conversely, there are reports where capitate removal combined with allogenic or autologous bone grafting without fusion was not followed by any further operative procedure. 6 Several authors reported an excellent functional outcome and low recurrence rate without reconstruction of distal row or distal row carpectomy.…”

“…According to the current long followup case report and the literature findings, satisfactory outcome with minimal radiocarpal degeneration should be expected after limited midcarpal and carpometacarpal fusion and despite the alteration of wrist kinematics. 5…”

“…2 Capitate bone involvement is exceedingly rare and very few cases have been reported in the literature. 1,[3][4][5] We present an unusual case of a GCT in the capitate in a 12-year-old girl and we describe the surgical treatment that was performed.…”

Re: Giant cell tumor in the proximal phalanges of the hand: a report of two cases treated with a nonbiological construct, letter to the editor

“…4 recurrence cases were managed with another local resection and did not notice any third recurrence in a follow-up period of 1 to 5 years. [8] Amputation and ray resection is an option to reduce recurrence; at the same time, it is the most aggressive locally. We cannot be certain that our chosen procedure is the standard of care.…”