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

Abstract

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