Letter to the Editor Regarding: “Radical Resection of a Recurrent Giant Cell Tumor of the Distal Ulna and Immediate Reconstruction With a Distal Radio-Ulnar Joint Implant Arthroplasty”

Abstract

We read with great enthusiasm the article published by Jones and Graham et al titled "Radical Resection of a Recurrent Giant Cell Tumor of the Distal Ulna and Immediate Reconstruction With a Distal Radio-Ulnar Joint Implant Arthroplasty." 1 The authors have succinctly reported their experience with a constrained prosthesis of the ulna after resection of a giant cell tumor (GCT) of the distal ulna. 1 Burke et al used a custom made ulnar prosthesis along with radius sigmoid notch implant and brachioradialis wrap, reporting excellent wrist function. 2 Nine months postoperatively, the patient had resumed all desired activities, including golf, without complaint. Although there is clear consensus in management of Campanacci grades I and II lesions of GCTs of the ulna with curettage, grade III lesions have been managed by wide resection of the ulna. 3 The literature provides a variety of management options post-resection of the distal ulna, either leaving the ulnar stump alone or with reconstruction by various techniques. Reconstruction options with allograft, prosthesis, or bone transport with Ilizarov have been reported. 2,4 While allograft reconstruction requires bone bank facilities, Ilizarov bone transport is time consuming, and use of a prosthesis is limited by its availability and cost effectiveness and possible complications like loosening. Hence in our patient with grade III GCT of the right ulna, we chose wide resection of the distal ulna along with ulnar stump stabilization with extensor carpi ulnaris (ECU) tenodesis (Figure 1). The ECU was longitudinally split, and part of it was rerouted through a drill hole made in the proximal ulnar stump (Figure 2). At 1-year follow-up, the functional outcome at the wrist was excellent. Hence, reconstruction options like ECU tenodesis after wide resection of the ulna can be considered as one of the treatment options in management of recurrent or high-grade 957732H ANXXX10.