Vascularized Ulnar Transposition and Radioulnoscapholunate Fusion With Volar Locking Plate in a Dorsal Position Following Resection of Giant Cell Tumor of the Distal Radius

Abstract

Giant cell tumor of the distal radius is a rare, locally destructive, and frequently recurrent tumor. We present a case of Campanacci Grade III giant cell tumor of the distal radius with pathologic fracture and cortical destruction which was treated with neoadjuvant denosumab. This facilitated en-bloc resection of the entire distal radius, including the articular surface, while minimizing tumor contamination. Reconstruction was accomplished using a vascularized ulnar transposition flap to facilitate radioulnoscapholunate fusion, which was fixated using a long-stem contralateral variable angle locking volar distal radius plate in a dorsal position. This case illustrates multidisciplinary management of a challenging reconstructive problem and demonstrates a novel strategy for fixation which repurposes familiar and readily available hardware to provide optimal osteosynthesis.

En-bloc excision of Giant Cell Tumors of the distal radius and arthrodesis of the translocated ipsilateral ulna: A report of two cases

“…GCTB of GCTB of the distal radius is the third most common site of this relatively rare neoplasm, corresponding to 10% of all cases [2, 4-7, 17, 18] . Despite its benign label, the distal radius is the most common primary site responsible for metastases and a high focus on ruling out pulmonary metastasis is mandatory in the pre-operative assessment [9,10,12,19] . In well-marginated cortical borders, curettage with bone grafting/cement packing is acceptable despite the recurrence rates up to 50% [4,5,7,17,19] .…”

“…No less important is the role of denosumab, used as neoadjuvant therapy, in making tumor dissection viable. The massive cortical destruction and friable nature of GCTB benefit from this chemotherapeutic agent in reducing pain and suppressing the tumor [1,10] . In conclusion, although treatment of Campanacci grade III GCTB of the distal radius remains a challenge, the combination of neoadjuvant denosumab therapy and tumor en-bloc resection have a good prognosis.…”

“…The distal radius is the third most common site of GCTB after distal femur and proximal tibia [1,[4][5][6][7] . Local recurrences occur in 70% of the cases within 24 months after excision and lung metastasis in 2% of the patients [7][8][9][10] . Typically, local pain with an increased swelling is reported and a pathological fracture occurs in 10% of the patients because of the tumor's osteolytic nature [3,11] .…”

“…Although adjuvant agents decrease the recurrence rates of intralesional curettage, this primary option has higher recurrence rates (up to 27%) than wide resection (0 to 12%) [6,8,15,16] . Denosumab, a human monoclonal antibody against RANKL (receptor activator of nuclear factor-kB ligand), contains tumor growth and facilitates resection without contamination when used as neoadjuvant therapy in aggressive lesions [1,10] .…”

Vascularized Ulnar Transposition and Ulno-scapholunate Fusion for Reconstructing Campanacci Grade 3 Giant Cell Tumor of Distal Radius: Technique and a Series of 5 Cases

“…Instead of doing a total wrist fusion as suggested by many of the authors, we feel that it is better to do a partial wrist fusion. 20 Van Handel and colleagues published the results of a similar procedure using a long contralateral variable angle distal radius plate. According to them this provided rigid fixation at the wrist and in proximal ulno-radial junction as well.…”