How to optimize the therapeutic effect of free autogenous fibula graft and wrist arthroplasty for giant cell tumors of distal radius?

2019 ◽  
Vol 49 (7) ◽  
pp. 656-663 ◽  
Author(s):  
Qing Liu ◽  
Wei Luo ◽  
Can Zhang ◽  
Zhan Liao ◽  
Yupeng Liu ◽  
...  
Keyword(s):  
Grip Strength ◽  
Giant Cell ◽  
Distal Radius ◽  
Wrist Joint ◽  
Dash Score ◽  
Giant Cell Tumors ◽  
Fibula Graft ◽  
Msts Score ◽  
The Mean ◽  
Wrist Arthroplasty

AbstractObjectiveThe purpose of this study is to retrospectively analyze the clinical efficacy of free fibula autograft and wrist arthroplasty in the treatment of giant cell tumors (GCT) of distal radius.MethodsWe retrospectively reviewed 26 patients with GCT of distal radius who underwent free autogenous fibula graft and wrist arthroplasty for repairing residual defect after en-block resection. The length of the fibula graft was 8.2 cm (6–10 cm). Postoperative follow-up regularly for an mean of 66.9 months. Bone healing was assessed by radiographs, pain was assessed by Visual Analog Scale (VAS) score and limb function was evaluated by Musculoskeletal Tumor Society (MSTS) score and disabilites of the arm, shoulder and hand (DASH) score. The range of motion (ROM) of wrist and grip strength were also evaluated.ResultThere were four males and 22 females with an mean age of 36.7 years (19–60 years); the mean length of lesions was 4.8 cm (2.3–6.6 cm); 21 primary cases and five recurrent cases; eight cases of Campanacci Grade II, 18 cases of Grade III. We had no postoperative lung metastasis and only one case had a local recurrence, three cases (11%) with subluxation of lower ulnoradial joints and five cases (19%) showed narrowing of wrist joint space. The mean postoperative VAS pain score was 0.7 ± 0.7 and grip strength retained 71% of the normal hand, MSTS score was 27.7 ± 1.1 and DASH score was 9.0 ± 3.7. The ROM of the involved wrist only slightly restricted and no donor complications. Postoperative wrist joint function was significantly improved.ConclusionStrict surgical resection boundary and solid reconstruction of wrist joint capsule are the key to achieving excellent oncological prognosis and function of distal radius GCT.

The proximal fibular free flap - an ideal material for reconstructing distal radius defect after Giant tumor cell resection. A case report

2021 ◽  
Vol 148 (12) ◽  
pp. 96-101
Author(s):  
Duong Manh Chien ◽  
Hoang Tuan Anh ◽  
Nguyen Tran Quang Sang ◽  
Phan Van Tan ◽  
Nguyen Huu Trong ◽  
...  
Keyword(s):  
Giant Cell Tumor ◽  
Giant Cell ◽  
Distal Radius ◽  
Free Flap ◽  
Wrist Joint ◽  
Cell Tumor ◽  
Joint Function ◽  
Giant Cell Tumors ◽  
Tumor Excision ◽  
Fibular Free Flap

Giant cell tumors (GCT) of the distal end of radius are relatively common tumors, representing approximately 5% of all primary bone tumors. It is the third most common location for GCT following distal femur and proximal tibia. In general, treatment includes thorough tumor excision, reconstruction of the defect, and wrist joint rehabilitation. The proximal fibular free flap is an ideal material for distal radius reconstruction after giant cell tumor excision. We present a case of a 57-year-old female, admitted to the hospital due to painful and limited proper wrist movement. Based on X-ray and Magnetic resonance imaging (MRI) images and histopathology findings, the patient was diagnosed with a stage 3 giant cell tumor of the distal radius. The patient underwent a one-step surgery of tumor excision and distal radius reconstruction by a vascularized proximal fibular free flap. 2 years follow-up post-surgery showed that the patient had no pain of the wrist, improved wrist joint function, no sign of recurrence, and good flap vitality and the knee joint remains normal. In conclusion, the surgery was successful with no further prolonged pain, improvement of the wrist joint function and overall improvement of the patient quality of life.

scholarly journals Joint preservation surgery in grade 2 and 3 giant cell tumors of bone around the knee

SICOT-J ◽  
2021 ◽  
Vol 7 ◽  
pp. 49
Author(s):  
Saurabh Singh ◽  
Alok Rai ◽  
R Dinesh Iyer ◽  
Rishabh Surana ◽  
Divyansh Sharma
Keyword(s):  
Giant Cell ◽  
Functional Outcomes ◽  
Distal Femur ◽  
Proximal Tibia ◽  
High Grade ◽  
Giant Cell Tumors ◽  
Joint Preservation ◽  
Msts Score ◽  
Tumors Of Bone ◽  
The Mean

Objective: To evaluate the clinical and functional outcomes of joint preservation surgery in high-grade giant cell tumors (GCT) around the knee joint. Methods: A retrospective review of 25 patients of high-grade GCT (Campanacci grade 2 and 3) involving proximal tibia or distal femur managed by extended curettage, bone grafting, and stabilization with knee spanning external fixator between 2016 and 2018 was done. The radiographic outcomes, functional outcomes (Musculoskeletal Tumor Society [MSTS] score for lower limb), and complications including donor site morbidity were evaluated. Results: The mean age of the patient population was 24.04 years with an average follow-up period of 30.24 months. Fourteen patients had involvement of distal femur, and 11 involved proximal tibia. There were 16 cases of grade 2 lesions and 9 cases of grade 3 lesions. Twenty-four out of the 25 patients had radiological consolidation of graft, while one patient had graft subsidence. Twenty-two out of 25 patients had full extension and knee flexion more than 100 degrees. The mean MSTS score was 25.2. Three patients had an MSTS score under 20. All three patients had an extension lag with a restricted range of motion. Conclusion: Joint preservation surgery, when done in line with the basic principles of tumor surgery, gives good radiographic and functional outcomes even in grade 2 and 3 giant cell tumors of bone around the knee and should be attempted before replacement surgeries.

scholarly journals Evaluation of Results of Resection-Reconstruction Using Autologous Non-Vascularized Fibular Graft in Giant Cell Tumour Affecting Distal Radius - A Prospective Study

2020 ◽  
Vol 7 (44) ◽  
pp. 2534-2538
Author(s):  
Manoranjan Mallik ◽  
Satyajeet Ray ◽  
Ramesh Chandra Maharaj ◽  
Gaurav Kumar Singh ◽  
Debi Prasad Nanda
Keyword(s):  
Prospective Study ◽  
Grip Strength ◽  
Giant Cell ◽  
Distal Radius ◽  
Giant Cell Tumour ◽  
Cell Tumour ◽  
Fibular Graft ◽  
Age Group ◽  
Fibula Graft ◽  
A Prospective Study

BACKGROUND Giant Cell Tumour (GCT) is a locally aggressive benign bone neoplasm characterized by proliferation of mononuclear stromal cells and many osteoclastlike multinucleated large giant cells affecting the epiphyseal segments of long bones mostly in females of 20 - 40 years age group. Distal radius is the third most common site of occurrence of GCT next to distal femur and proximal tibia. Resection or extended curettage remain the main modalities of treatment in Campanacci Grade I and II while en-bloc excision with reconstructive procedures, arthrodesis or amputation are the treatments of choice in Grade III with the latter two procedures leading to loss of joint function. Fibula being a non-weight transmitting bone of the lower limb, can be harvested in its proximal 1 / 3 rd and used for the reconstruction of the distal radius. In this study, we evaluate the functional and clinical results of resection and reconstruction using a nonvascularized fibula graft in the distal radius GCT. METHODS This is a prospective study of 20 patients diagnosed with GCT of distal radius either treated primarily at our institution or reviewed here after having been treated elsewhere. After confirmation of diagnosis, the patients underwent resection of the tumour and reconstruction of the distal radius using ipsilateral non vascularized fibula graft, fixed with dynamic compression plate. Follow-ups were done at regular intervals and radiological signs of graft healing, recurrence of tumour, wrist range of motion, and revised Musculoskeletal Tumour Rating Scale (MSTS) was used for assessing the functional outcome. RESULTS In our study, it was found that mostly females 13 (66.6 %) of the age group 30 - 35 yrs. were affected. The average grip strength achieved was 71 % (42 - 86 %) & average combined movements of 64 % (29 - 78 %) of contralateral normal side. Mean duration of union was 24 weeks (14 - 42 weeks). One case of non-union was seen which eventually achieved union with bone grafting. There was one case of soft tissue recurrence but the patient refused any further procedure. Complications were seen in 8 cases (41.6 %). We achieved excellent results in 15 (75 %), good in 2 (10 %), satisfactory in 2 (10 %) and poor in 1 (5 %) case. CONCLUSIONS We found that in GCT resection of the distal radius and reconstruction arthroplasty using autologous non-vascularized proximal fibular graft is useful in preserving the functional status as well as achieving satisfactory range of movement and grip strength with lesser chances of tumour recurrence. KEYWORDS Distal Radius, Giant Cell Tumour, Resection Reconstruction, Fibula

scholarly journals Surgical Treatment of Giant-Cell Tumors of the Distal Epiphysis of the Radius

2018 ◽  
Vol 1 (Supplement) ◽  
pp. 19
Author(s):  
D. Rădulescu ◽  
A. Bădilă ◽  
O. Nuțiu ◽  
R. Manolescu ◽  
T. Ciobanu ◽  
...  
Keyword(s):  
Giant Cell Tumor ◽  
Giant Cell ◽  
Bone Defect ◽  
Distal Radius ◽  
Wrist Joint ◽  
Cell Tumor ◽  
Segmental Resection ◽  
Giant Cell Tumors ◽  
Distal Epiphysis ◽  
Distal Migration

Abstract Introduction. Giant-cell tumor of the bone is a benign tumor, but with high local aggressiveness, even with risk of remote metastasis. Material and methods. We present the case of a 57-year-old woman, without significant pathological history, who, after clinical, imagistic and anatomopathological investigations, was diagnosed with giant cell tumor of the right distal radius. The patient underwent surgery and due to the size of the tumor and destruction of the surrounding cortical bone, segmental resection of the tumor in oncological limits was performed. The bone defect was filled with the proximal one third of the ipsilateral fibula, fixed to the remaining radius diaphysis with a plate and screws. Also, the autograft was stabilized to the proximal row of the carpal bones with 2 k-wires for 6 weeks. Postoperatively, clinical and X-ray check-ups were performed at 6, 12, 24 weeks and 1 year after surgery. Results. According to Mayo functional assessment score, the results were good. At 1 year after surgery, the patient gained 85 points, representing a good functional outcome of the surgery. This way, the wrist joint mobility and the carpal cartilage were preserved, providing a barrier against distal migration of any remaining tumoral cells, as well. Conclusions. It can be stated that in aggressive giant cell tumors located at the distal radius, the best therapeutic option is a segmental resection of the lesion followed by the replacement of the bone defect with a proximal fibular autograft. This method provides the best postoperative functional results with a lower risk of local recurrence and does not require microvascular surgery or access to a bone bank.

scholarly journals Antegrade intramedullary fixation for adolescent fifth metacarpal neck fracture and its impact on epiphyseal growth

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Xiao-Lei Fan ◽  
Jian Wang ◽  
De-Hua Zhang ◽  
Feng Mao ◽  
Yi Liao ◽  
...  
Keyword(s):  
Grip Strength ◽  
Skeletal Maturity ◽  
Kirschner Wire ◽  
Intramedullary Fixation ◽  
Dash Score ◽  
Reliable Technique ◽  
Dorsal Angulation ◽  
Neck Fracture ◽  
The Mean ◽  
The Impact

Abstract Background Antegrade intramedullary nailing (AIMN) with Kirschner wire (K-wire) is a minimally invasive osteosynthesis technique. This procedure has been widely performed to treat the fifth metacarpal neck fracture (FMNF) in adults. This study was performed to determine whether using AIMN with a single K-wire to treat FMNF in adolescents would have good clinical and radiographic outcomes. Methods In this retrospective study, 21 children (aged 11–16 years) with FMNF were treated using AIMN with a single K-wire from May 2017 to January 2020 in our hospital. Indications for intervention were severe displacement with malrotation deformity, apex dorsal angulation of greater than 40°, or both. Collected data included apex dorsal angulation, range of motion (ROM) in the fifth metacarpophalangeal (MCP) joint, Visual Analog Scale (VAS) for pain, grip strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Results All patients were followed up for 12–24 months (average, 16.57 months), and all patients obtained anatomical reduction postoperatively. The healing time was 2.69 ± 0.83 months (range, 2–4 months). Average apex dorsal angulation was reduced significantly from 44.49°±2.64° to 15.74°±2.47° (P < 0.001). The average ROM in the MCP joint and apex dorsal angulation of the injured side were not significantly different from those of the uninjured side. The average DASH score was 1.76 ± 1.48 (range, 0–4), the mean VAS was 0.19 ± 0.60 (range, 0–2), and the mean grip strength was 91.55 %±4.52 % (range, 85–101 %). No secondary displacement, dysfunction, nonunion, infection, or osteonecrosis was observed during the follow-up. Although premature epiphyseal closure was found in one patient, no long-term clinical finding of angulation or shortening was identified. Conclusions Antegrade intramedullary fixation with single K-wire was an effective and reliable technique that successfully resulted in good functional and cosmetic outcomes for treating adolescents with FMNF. The impact on the growth plate was low in this population given that most patients were at or approaching skeletal maturity. Level of evidence Level IV.

Vascularized Medial Femoral Condyle Bone Graft for Resistant Nonunion of the Distal Radius

2017 ◽  
Vol 22 (01) ◽  
pp. 23-28 ◽  
Author(s):  
Mark Henry
Keyword(s):  
Distal Radius ◽  
Femoral Condyle ◽  
Difficult Problem ◽  
Medial Femoral Condyle ◽  
Dash Score ◽  
Structural Block ◽  
Surgical Interventions ◽  
Paired Student ◽  
Co Morbidity ◽  
The Mean

Background: Nonunion involving the metaphyseal region of the distal radius is exceedingly rare, usually involving co-morbidity. Patients that have failed multiple prior conventional surgical interventions represent an even more difficult subset to treat; this investigation examined the utility of a specially designed free vascularized medial femoral condyle flap consisting of a central structural block graft with an extended corticoperiosteal sleeve to wrap around the junctions. Methods: Six patients (5 males, 1 female) with a mean age of 52 years had failed to achieve union involving the distal radius metaphysis after a mean of 3.7 prior surgeries occurring over a mean period of 24 months. Comorbidities included smoking, alcoholism, chronic nutritional deficiency, and prior osteomyelitis. The unique descending genicular artery medial femoral condyle flap designed to address these patients consisted of a central structural block graft in continuity with an extended corticoperiosteal sleeve. The structural block filled the bone defect, and the corticoperiosteal sleeve wrapped around the bone junctions and the neighboring bone margins. The mean flap size was 5.3 (+/- 1.3) cm long by 4.5 (+/- 0.9) cm wide. Pre-operative to post-operative DASH scores were compared using the paired student’ s t-test, with p < 0.05. Results: All flaps achieved union at a mean of 6.8 (+/- 2.1) weeks following surgery, using the criteria of bridging trabeculae on all 3 radiographs: coronal, sagittal, and oblique. The mean pre-operative DASH score of 63 (+/- 10) was statistically significantly different compared to the mean post-operative DASH score of 18 (+/- 8). Conclusions: With few alternative solutions able to address this unique and difficult problem, the structural block of vascularized bone with the extended corticoperiosteal sleeve proved able to achieve a union that had failed multiple previous attempts and able to resist reactivation of infection, in a challenging group of patients with comorbidities.

Functional results of wrist arthrodesis versus arthroplasty with proximal fibula following giant cell tumour excision of the distal radius

2018 ◽  
Vol 44 (4) ◽  
pp. 394-401 ◽  
Author(s):  
Huayi Qu ◽  
Wei Guo ◽  
Dasen Li ◽  
Yi Yang ◽  
Ran Wei ◽  
...  
Keyword(s):  
Grip Strength ◽  
Giant Cell ◽  
Distal Radius ◽  
Giant Cell Tumour ◽  
Functional Results ◽  
Cell Tumour ◽  
Musculoskeletal Tumor Society ◽  
Wrist Arthrodesis ◽  
Proximal Fibula ◽  
Radiocarpal Joint

Twenty-one patients underwent excision of a Campanacci grade III giant cell tumour of the distal radius and had reconstruction using a proximal fibula autograft. We compared the functional results of wrist arthrodesis versus arthroplasty. All 21 patients healed in an average of 8 months, and all have remained disease free. The Musculoskeletal Tumor Society 93, the Disabilities of the Arm, Shoulder, and Hand scores and the grip strength of the operated wrist compared with the contralateral wrist were 93%, 7, and 71% for the arthrodesis group and 83%, 17, and 40% for the arthroplasty group. Arthrodesis of the reconstructed radiocarpal joint provided better grip strength and functional outcomes than arthroplasty. Level of evidence: III

scholarly journals A Systematic Review and Meta-Analysis of En-Bloc vs Intralesional Resection for Giant Cell Tumor of Bone of the Distal Radius

2013 ◽  
Vol 7 (1) ◽  
pp. 103-108 ◽  
Author(s):  
Theresa J.C Pazionis ◽  
Hussain Alradwan ◽  
Benjamin M Deheshi ◽  
Robert Turcotte ◽  
Forough Farrokhyar ◽  
...  
Keyword(s):  
Giant Cell Tumor ◽  
Giant Cell ◽  
Distal Radius ◽  
Wrist Joint ◽  
Meta Analysis ◽  
En Bloc Resection ◽  
Cell Tumor ◽  
En Bloc ◽  
Intralesional Curettage ◽  
Functional Benefit

Introduction: Surgical management of Giant Cell Tumor of Bone of the distal radius (GCTDR) remains controversial due to risk of local recurrence (LR) offset by functional limitations which result from en-bloc resection. This study aims to determine the oncologic and functional outcomes of wide excision (WE) vs intralesional curettage (IC) of GCTDR. Methods: A complete search of the applicable literature was done. Included studies reported on patients from the same cohort who were surgically treated for GCTDR with WE or IC. Two reviewers independently assessed all papers. The primary outcome measure was LR. Results: One-hundred-forty-one patients from six studies were included: 60 treated with WE, and 81 with IC. Five WE patients (8%) suffered LR whereas 25 IC patients (31%) did. The odds of LR were three times less in the WE group vs the IC group. MSTS1993 scores, where available, were on average 'good' with WE and 'excellent' with IC. Conclusions: Within statistical limitations the data support an attempt, where feasible, at wrist joint preservation and superior function with IC. Intralesional curettage is reasonable when the functional benefit outweighs the risk of recurrence as is the case in many cases of GCT of the distal radius.

scholarly journals Outcome of modular megaprosthesis in management of Campanacci stage III giant cell tumor around the knee: a prospective study

2021 ◽  
Vol 8 (9) ◽  
pp. 2618
Author(s):  
Ritwika Nandi ◽  
Pinaki Das ◽  
Sujit Narayan Nandi
Keyword(s):  
Functional Outcome ◽  
Giant Cell ◽  
Giant Cell Tumors ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Tumor Excision ◽  
Bone Segment ◽  
The Mean ◽  
A Prospective Study ◽  
Large Bone

Background: Juxta articular giant cell tumors around the knee constitute 50-60% of the total cases reported. If the disease is detected at an advanced stage, reconstruction of the joint after tumor excision poses problems and has poor functional outcome. The aim of the study was to determine the functional outcome after resection of juxta-articular giant cell tumors around the knee and its reconstruction with mega prosthetic arthroplasty will be analyzed.Methods: Between January 2017 and March 2021, 14 patients in the age group of 28-48 years (mean=42.85 years) with Campanacci stage three giant cell tumors around the knee were studied (12-distal femur patients, 2-proximal tibia). Patients underwent tumor excision and reconstruction with modular megaprosthesis. They were evaluated post-operatively using the Revised Musculoskeletal Tumor Society Score (MSTS) for lower limb.  Results: All the patients were followed up for 12-44 months (mean=29.5 months), the average knee flexion at 6 months being 116.4 degrees. The mean MSTS at 6, 12, 18 and 24 months are 19.45, 23.23, 26.61 and 28.77 respectively. Complications observed were infection and tumor recurrence.  Conclusions: In advanced cases where tumor excision leaves large bone segment loss, reconstruction with megaprosthesis can give desirable functional outcome.

Sign in / Sign up

Export Citation Format

Share Document