Wrist Arthrodesis with Vascularized Fibular Graft after Failed Allograft Replacement for Giant-Cell Tumor Resection

Giant-cell tumor (GCT) is locally aggressive bone neoplasm, with an unpredictable pattern of biological aggressiveness. The optimal treatment had to achieve a negligible local recurrence rate while maximizing musculoskeletal function. Numerous options for reconstruction are available, but in the literature there is a lack of salvage surgery data. We present a case of a 67-year-old woman who underwent complete wrist arthrodesis with vascularized fibular graft as salvage procedure for allograft necrosis, after excision of a distal radius GCT. The patient did not complain of any impairment in daily use, and the functional score was 22 points (73%) at latest follow-up of 14 months. Despite joint salvage remains the most favorable treatment with regard to functional outcome for aggressive tumors of the distal radius, vascularized fibular grafts is a valuable alternative especially in salvage procedures, where the use of another allograft could lead to higher complications rate. Keywords: Vascularized fibular graft, Wrist arthrodesis, Giant-Cell Tumor, Fibula free flap.

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Vascularized Fibular Graft after Excision of Giant-Cell Tumor of the Distal Radius: Wrist Arthroplasty versus Partial Wrist Arthrodesis

Plastic & Reconstructive Surgery ◽

10.1097/00006534-200207000-00020 ◽

2002 ◽

Vol 110 (1) ◽

pp. 112-117 ◽

Cited By ~ 70

Author(s):

Akio Minami ◽

Hiroyuki Kato ◽

Norimasa Iwasaki

Keyword(s):

Giant Cell Tumor ◽

Giant Cell ◽

Distal Radius ◽

Cell Tumor ◽

Fibular Graft ◽

Wrist Arthrodesis ◽

Vascularized Fibular Graft ◽

Wrist Arthroplasty

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Giant Cell Tumor of Distal Radius Treated by En-Bloc Resection and Reconstruction by Non Vascularized Fibular Graft

Electronic Journal of General Medicine ◽

10.15197/sabad.1.12.39 ◽

2015 ◽

Vol 12 (2) ◽

Cited By ~ 1

Author(s):

Basavraj Nagoba ◽

Rajendra G. Malu ◽

Chetan R. Jaju ◽

Vishav Goyal ◽

Santosh Mali

Keyword(s):

Giant Cell Tumor ◽

Giant Cell ◽

Distal Radius ◽

En Bloc Resection ◽

Bloc Resection ◽

Cell Tumor ◽

Fibular Graft ◽

En Bloc ◽

Vascularized Fibular Graft

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EXCISION OF GIANT CELL TUMOR FOLLOWED BY RECONSTRUCTION OF DISTAL RADIUS USING FREE VASCULARIZED FIBULAR GRAFT

Neurologico Spinale Medico Chirurgico ◽

10.15562/nsmc.v1i4.134 ◽

2019 ◽

Vol 1 (4) ◽

Author(s):

Prisca Oriana Sutanto ◽

Agus Roy Rusli Hamid ◽

Adinda Putra Pradhana

Keyword(s):

Giant Cell Tumor ◽

Giant Cell ◽

Distal Radius ◽

Tumor Resection ◽

Cell Tumor ◽

Wide Resection ◽

Fibular Graft ◽

Maximum Function ◽

Vascularized Fibular Graft ◽

Free Vascularized Fibular Graft

Giant cell tumor (GCT) of the distal radius is a rare and unpredictable lesion. The aim of treatment is complete removal of the tumor and preservation of the maximum function of the extremity. Lower rates of local recurrence have been noted after wide resection of the diseased bone. Its standard treatment has ranged from surgical curettage to wide resection. One method for closing the defect is using the head of the fibula as a substitute for the distal radius. The healing of vascularized fibular graft is very quick and without bone resorption. Thus, in the procedure for reconstruction and limb salvage after bone tumor resection of the distal radius, the free vascularized fibular graft with the fibular head is an ideal substitute. This case report will show a patient with GCT that successfully treated by an excision of GCT followed by reconstruction of distal radius using free vascularized fibular graft.

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Vascularized Fibular Graft After Excision of Giant Cell Tumor of the Distal Radius

Clinical Orthopaedics and Related Research ◽

10.1097/00003086-199902000-00020 ◽

1999 ◽

Vol 359 ◽

pp. 189-196 ◽

Cited By ~ 36

Author(s):

Koichiro Ihara ◽

Kazuteru Doi ◽

Kazuhiro Sakai ◽

Manabu Yamamoto ◽

Tsukasa Kanchiku ◽

...

Keyword(s):

Giant Cell Tumor ◽

Giant Cell ◽

Distal Radius ◽

Cell Tumor ◽

Fibular Graft ◽

Vascularized Fibular Graft

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Does Wrist Arthrodesis With Structural Iliac Crest Bone Graft After Wide Resection of Distal Radius Giant Cell Tumor Result in Satisfactory Function and Local Control?

Clinical Orthopaedics and Related Research ◽

10.1007/s11999-015-4678-y ◽

2016 ◽

Vol 475 (3) ◽

pp. 767-775 ◽

Cited By ~ 12

Author(s):

Tao Wang ◽

Chung Ming Chan ◽

Feng Yu ◽

Yuan Li ◽

Xiaohui Niu

Keyword(s):

Bone Graft ◽

Giant Cell Tumor ◽

Giant Cell ◽

Distal Radius ◽

Local Control ◽

Iliac Crest ◽

Cell Tumor ◽

Wide Resection ◽

Iliac Crest Bone Graft ◽

Wrist Arthrodesis

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Giant Cell Tumor of Distal Radius: En Bloc Resection and Partial Wrist Arthrodesis Using Non-Vascularized Fibular Autograft

Shafa Orthopedic Journal ◽

10.5812/soj.11774 ◽

2017 ◽

Vol 4 (2) ◽

Cited By ~ 1

Author(s):

Davod Jafari ◽

Hooman Shariatzadeh ◽

Mohammad Ali Okhovatpour ◽

Mehran Razavipour ◽

Farshad Safdari

Keyword(s):

Giant Cell Tumor ◽

Giant Cell ◽

Distal Radius ◽

En Bloc Resection ◽

Bloc Resection ◽

Cell Tumor ◽

En Bloc ◽

Wrist Arthrodesis ◽

Fibular Autograft

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Wrist Arthrodesis and Osteoarticular Reconstruction in Giant Cell Tumor of the Distal Radius

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2020.03.005 ◽

2020 ◽

Vol 45 (9) ◽

pp. 882.e1-882.e6

Author(s):

Giuseppe Bianchi ◽

Andrea Sambri ◽

Eleonora Marini ◽

Raimondo Piana ◽

Domenico Andrea Campanacci ◽

...

Keyword(s):

Giant Cell Tumor ◽

Giant Cell ◽

Distal Radius ◽

Cell Tumor ◽

Wrist Arthrodesis

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Giant cell tumor of distal radius treated with ulnar translocation and wrist arthrodesis

Journal of Orthopaedic Surgery ◽

10.1177/2309499016684972 ◽

2017 ◽

Vol 25 (1) ◽

pp. 230949901668497 ◽

Cited By ~ 6

Author(s):

Abhijeet Ashok Salunke ◽

Jaymin Shah ◽

Vikas Warikoo ◽

Amit Chakraborty ◽

Harshwardhan Pokharkar ◽

...

Keyword(s):

Giant Cell Tumor ◽

Giant Cell ◽

Distal Radius ◽

Functional Outcomes ◽

Soft Tissues ◽

Cell Tumor ◽

Musculoskeletal Tumor Society ◽

Wrist Arthrodesis ◽

The Mean

Introduction: The aim is to analyze the functional outcomes of patients of giant cell tumor (GCT) of distal radius treated with ulnar translocation and wrist arthrodesis. Methods: Study included 25 patients of aggressive GCT of distal radius, resected and reconstructed using ulnar translocation and wrist arthrodesis. The ulna-carpal radius fixation was performed with plate and screws. The patients were followed to bony union and minimum follow-up was 1 year. Result: Twenty-two patients were of Campanacci grade 3 and three patients were of Campanacci grade2. The mean follow-up was of 23 months (12–36). All patients had an excellent range of pronation and supination. The mean Musculoskeletal Tumor Society score was 24 (range 22–28). Grip strength of affected hand compared to the contra lateral hand was found good in 17 cases and average in 7 cases. The mean bone union time at ulna to radius junction was at 6.5 (5–8) months and ulna to carpal junction at 4.5 (4–6) months. The complications were surgical site infection (one case), recurrence (one case) and failure of union (one case), and ulna graft fracture with implant failure in (two cases). Conclusion: Reconstruction of distal end of radius using ulnar translocation and wrist arthrodesis provides excellent functional outcomes with preservation of rotational movement of forearm and hand function. Reconstruction of the distal radius by ulnar translocation without complete detachment from surrounding soft tissues functions like vascularized graft without use of microvascular techniques.

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