Joint‐sparing versus nonjoint‐sparing reconstruction of the radius following oncologic resection: A systematic review

Abstract

Background and Objectives: Reconstructions of the distal radius are uncommon procedures. This systematic review compares joints-sparing (JS) versus nonjointsparing (NJS) reconstructions following oncologic resection of the distal radius.Methods: A search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Collected outcomes included patient-reported outcome measures (PROMs), range of motion and grip strength, and complication and reoperation rates.Results: A total of 52 nonrandomized cohort studies (n = 715) were included.PROMs were comparable between the cohorts, while the range of flexion-extension was greater in JS reconstructions (78.1°vs. 25.6°) and the range of pronationsupination was greater in NJS reconstructions (133.6°vs. 109.8°). Relative grip strength was greater following JS reconstruction (65.0% vs. 56.4%). About one in sixteen of the JS reconstructions were eventually revised to an NJS construct.Conclusions: This systematic review demonstrates that JS reconstructive techniques can offer satisfying results in patients treated for oncologic distal radius defects.However, about 6% of JS reconstructions are eventually revised to a NJS construct.Further investigation is warranted to identify factors that affect or predict these findings, to aid in future in treatment selection and reduce the common need for reoperations following these procedures.

Treatment of giant cell tumors of the distal radius: A long‐term patient‐reported outcomes study

“…There have been conflicting results when examining patient function following surgical treatment of GCTs of the distal radius, with series showing no difference in functional outcome scores between joint preserving procedures compared to joint resection. 9,16 However in a recent series by Abuhejleh et al, 19 the authors noted improved functional outcomes with joint salvage. In the current study, we found no difference in patient outcome when comparing all patients undergoing joint salvage or joint preservation, however, we noted a difference when examining qDASH when comparing patients undergoing an arthrodesis and those that did not.…”

“…There have been conflicting results when examining patient function following surgical treatment of GCTs of the distal radius, with series showing no difference in functional outcome scores between joint preserving procedures compared to joint resection 9,16 . However in a recent series by Abuhejleh et al, 19 the authors noted improved functional outcomes with joint salvage.…”

“…Reconstruction of the distal radius following resection of a GCT of bone can be classified as either joint sparing or joint sacrificing, with joint sparing procedures allowing for a greater range of motion, while joint sacrificing procedures allow for greater grip strength and fewer complications. [16][17][18] Extended intralesional curettage with the use of adjuvants and bone grafting or cement augmentation has become the standard treatment for patients with Campanacci Grade 1 or 2 tumors of the distal radius, however in the setting of a Campanancci Grade 3 tumor, en-bloc resection and reconstruction is recommended when there is articular destruction; however, there is current debate on the ideal form of reconstruction. [16][17][18][19] The use of osteoarticular allografts and wrist arthrodesis has become a primary means of treatment.…”

“…[16][17][18] Extended intralesional curettage with the use of adjuvants and bone grafting or cement augmentation has become the standard treatment for patients with Campanacci Grade 1 or 2 tumors of the distal radius, however in the setting of a Campanancci Grade 3 tumor, en-bloc resection and reconstruction is recommended when there is articular destruction; however, there is current debate on the ideal form of reconstruction. [16][17][18][19] The use of osteoarticular allografts and wrist arthrodesis has become a primary means of treatment. [16][17][18] In a recent series by Lans et al, 20 the authors noted a high rate of revision with osteoarticular allografts, namely due to allograft fracture.…”

“…[16][17][18][19] The use of osteoarticular allografts and wrist arthrodesis has become a primary means of treatment. [16][17][18] In a recent series by Lans et al, 20 the authors noted a high rate of revision with osteoarticular allografts, namely due to allograft fracture. This was also observed in a comparative series by Bianchi et al 18 where the authors compared osteoarticular allografts to wrist arthrodesis and noted complications following reconstruction were specifically related to the type of reconstruction utilized, with a high rate of fracture in the osteoarticular allograft group, leading to arthrodesis for salvage.…”