Evaluation of Results of Resection-Reconstruction Using Autologous Non-Vascularized Fibular Graft in Giant Cell Tumour Affecting Distal Radius - 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