Non-Vascularised Ipsilateral Fibular strut - A Modality to Treat Giant cell tumor of lower end radius using Anterior Approach

Abstract

Introduction: Giant cell tumor is a benign bone tumor, locally aggressive with low malignant potential. The goal of treatment of this tumor at the distal radius is complete removal of the tumor and reconstruction of the bone defect in order to preserve maximum function of the wrist joint.Case Series: This is a retrospective study conducted in 5 consecutive patients of GCT of distal radius. All patients presented with pain and swelling over distal end radius and were assessed clinically and radiographically. X-ray showed lytic lesion at lower end of radius suggestive of GCT. Histopathological examination and FNAC was done to confirm the diagnosis. Once the patient was fit for Surgery, wide excision of tumor and reconstruction with ipsilateral non-vascularised proximal fibula was performed. DCP plating was done to secure the fibular graft to the radius. 2 K -wires, 1 transverse through the fibula and ulna and 1 through fibula into the carpals were used for additional fixation and to help maintain the fibula and ulna in close approximation. Results: final minimum 1 Atfollow up of year, all cases had good graft union with no recurrence. The range of motion of the wrist was near normal with no instability and good grip strength. Although this is an early follow up no graft collapse and no arthritic changes were noted. There were no complications both at donor and recipient graft sites. Conclusion:Autogenous non-vascularised fibular graft for reconstruction of distal radius GCTcan be considered as a reasonable option for treating such conditions. Long term follow up will be needed to assess temporal complications and long term survival of the graft.