Unusual case of giant cell tumor in distal ulna

Pathak, Aditya C; Shahane, Sunil M.; Samant, Ashwin; Kapopara, Hardik

doi:10.4103/2349-0977.161649

Cited by 3 publications

(2 citation statements)

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“…GCT is essentially a benign tumor that is locally aggressive in nature and has the potential to metastasize to the lungs. 12 GCT at distal ulna although rarer yet more aggressive than GCT of the distal radius. 2,13 Therefore, en bloc excision is recommended especially for Campanacci grade III GCT ulna.…”

Section: Discussionmentioning

confidence: 92%

Clinical and functional outcomes of reconstruction following en bloc resection for the Campanacci grade III distal ulnar giant cell tumors

Kumar

Rustagi

Talwar

et al. 2022

Journal of Orthopaedics, Trauma and Rehabilitation

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Background: Wide resection of the tumor is essential for the treatment of Campanacci grade III giant cell tumor of the distal ulna but radioulnar convergence and dorsal displacement of the ulnar stump are known complications. Various reconstructive options to reduce these complications have been described in the literature. Methods: Seven patients with Campanacci grade III giant cell tumor distal end of the ulna were treated at our institute by extra-periosteal wide local excision of the tumor followed by reconstruction of the distal radioulnar joint by fixation of tricortical iliac crest graft to the distal end radius using two cancellous screws and extensor carpi ulnaris (ECU) tenodesis for stabilizing the residual ulnar stump. All patients were followed up for an average period of 3.5 years (32–48 months) at regular intervals. Functional outcome and complications if any, were recorded at every follow-up. Results: At final follow-up, the mean range of motion of wrist with 42.1° ± 5.9° of flexion, 72.9° ± 6.4° of extension, 82.1° ± 8.1° of supination and 85.0° ± 5.8° of pronation was achieved. The mean visual analog scale score at the final follow-up was 0.9 ± 0.9. The mean modified Mayo wrist score was 71.4 ± 6.4 with a mean modified Musculoskeletal Tumor Society score of 25.9 ± 0.8 and a mean Disability of Arm, Shoulder, and Hand score of 17.9 ± 1.6 at the final follow-up. The average time for the radiological union of iliac crest graft with the distal end radius was 13.3 weeks. None of the patient reported any complication or recurrence. Conclusion: The reconstruction of distal radioulnar joint by fixation of tricortical iliac crest graft with distal end radius and stabilization of ulnar stump by extensor capi ulnaris tenodesis after the wide resection of distal ulna giant cell tumor is recommended for good to excellent functional outcomes.

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Section: Discussionmentioning

confidence: 92%

Clinical and functional outcomes of reconstruction following en bloc resection for the Campanacci grade III distal ulnar giant cell tumors

Kumar

Rustagi

Talwar

et al. 2022

Journal of Orthopaedics, Trauma and Rehabilitation

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“…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.…”

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confidence: 99%

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”

Sharma

2020

Hand (New York, N,Y.)

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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.

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A Comparison of Outcomes of ‘Extensor Carpi Ulnaris Tenodesis’ versus ‘No Tenodesis’ after Resection of the Distal Ulna in Patients with Giant Cell Tumor

Sahito

Ali

QAMAR

et al. 2022

J Hand Surg Asian-Pac Vol

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Background: One of the methods of stabilizing the stump of the ulna following resection of the distal ulna is tenodesis of the extensor carpi ulnaris (ECU). Some studies have recommended stabilization, whereas others have not found it useful. Most of these studies have a mix of different pathologies and often do not have a control group. The aim of this study is to compare the outcomes of ECU tenodesis versus no tenodesis after resection of the distal ulna in patients with grade III giant cell tumor (GCT) of the distal ulna. Methods: The retrospective study included 10 patients with Campanacci grade III GCT of the distal ulna treated by resection of the distal ulna between 2014 and 2019. Patients were stratified into two groups based on whether they underwent ECU tenodesis (n = 5) or no tenodesis (n = 5). The patients were assessed at 6 weeks, 6 months, and 12 months for complications and outcomes using the Mayo wrist score (MWS) and the revised musculoskeletal tumor society score (MSTS). Results: The MWS and the MSTS were significantly better in the ECU tenodesis group at 6 weeks. At 6 months, MWS was similar in both groups, but MSTS continued to be significantly better in ECU tenodesis group. At 12 months, both groups reported similar MWS and MSTS. There were no recurrences in either groups. One patient in the ECU tenodesis group developed ECU tendonitis that resolved with conservative treatment. Conclusions: The outcomes of ECU tenodesis were better in the short term (6 months), although both groups reported similar outcomes at 12 months. Level of Evidence: Level III (Therapeutic)

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Unusual case of giant cell tumor in distal ulna

Cited by 3 publications

References 1 publication

Clinical and functional outcomes of reconstruction following en bloc resection for the Campanacci grade III distal ulnar giant cell tumors

Clinical and functional outcomes of reconstruction following en bloc resection for the Campanacci grade III distal ulnar giant cell tumors

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”

A Comparison of Outcomes of ‘Extensor Carpi Ulnaris Tenodesis’ versus ‘No Tenodesis’ after Resection of the Distal Ulna in Patients with Giant Cell Tumor

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