An Unusual and Complicated Course of a Giant Cell Tumor of the Capitate Bone

Abstract

A 51-year-old female patient presented with a carpal giant cell tumor (GCT) of the right capitate bone. The lesion was initially misdiagnosed as having an osteomyelitis. First, the diagnosis of a benign GCT was confirmed by histological examination. Second, an intralesional curettage and packing of the cavity with cancellous iliac crest bone grafts combined with a fusion of the third carpometacarpal (CMC III) joint were carried out. Third, due to a secondary midcarpal osteoarthritis and a secondary scaphoid nonunion, the CMC III joint fusion plate was removed and the midcarpal joint completely excised. Fourth, in the absence of recurrence of GCT, a four-corner fusion (4CF) with a corticocancellous iliac crest bone graft and complete excision of the scaphoid bone had to be performed. Fifth, a total wrist arthroplasty (TWA) was performed due to hardware failure of 4CF with migration of a headless compression screw into radiocarpal joint which led to erosion of articular surface of the distal radius. At the 3-year follow-up that includes a 1-year follow-up after TWA, there was no recurrence of GCT, and the TWA was not failed. The patient reported that she would have the motion-preserving TWA again.

RE-MOTIONTM total wrist arthroplasty for treatment of advanced stage of scaphoid non-union advanced collapse. Does excision of the entire scaphoid bone prevent impingement at terminal range of radial deviation?

“…However, this procedure is not without complications such as migration of a headless compression screw. It has been also observed in the wrist in 14% of patients who underwent carpal fusions despite complete union [2], and can lead in single case to a TWA [3]. TWA has proven to be useful as a motion-preserving alternative to total wrist fusion (TWF) for treatment of posttraumatic wrist joint OA, and TWA revealed a significantly better outcome than in patients who underwent a primary TWF [4][5][6].…”

“…Probably with the use of the other two bigger sizes (M, L) of the implant, the carpal plate would not have a sufficient bony support at the radial column. The disadvantage of the RE-MOTION TM total wrist is that its carpal plate is not available with various scaphoid augments such as the Maestro TM TWA that provides a sufficient bony support onto the base of trapez bone when the entire scaphoid bone had to be excised [3,5,15]. May be that the resectionrelated loss of carpal height using the RE-MOTION TM total wrist would be better compensated by introducing of another extended third PE insert ("size plus-plus") by the manufacturer.…”

Kienbck's disease mimicing gouty monoarthritis of the wrist

“…An option for surgical treatment of stage IIIA (lunate collapse without scaphoid rotation) is callotasis lengthening of the capitate bone [9]. Another option for treatment of advanced stage of Kienböck's disease is motion-preserving TWA ( Figure 2A-B) with a portion of 2% of all TWAs performed by surgeons who have published their experiences with this procedure [10], and the relatively new angle-stable MaestroTM WRS that was used in our case presentation, is one of the modern biaxial-anatomical third generation type that is currently in use [11][12][13][14].…”

The MaestroTM Wrist Reconstructive System for treatment of posttraumatic wrist joint osteoarthritis after a devasting course of a distal radius fracture: Case presentation and technical note to the implant

“…Demanding physical occupations are not generally considered a contraindication for TWA [7,15]. The relatively new angle-stable Maestro TM WRS that was used in our case, is one of the modern biaxial-anatomical third generation type that is currently in use [7,8,[16][17][18]. This type is the further development of the non-angle stable Maestro TM Total Wrist that was developed in 2002 by Strickland / Palmer / Graham.…”

“…Thus, it is not always necessary to attempt fusion of the distal pole of scaphoid bone to the surrounding carpal bones, and the carpal plate has a sufficient support onto the base of trapez bone Intraoperative clinical photograph and postoperative PA radiograph demonstrating uneventful TWA, note the use of carpal plate with scaphoid augment after excision of the entire scaphoid bone (arrows), the angle-stable carpal plate is inserted with a green coloredpolyaxial screw into the 2nd metacarpal bone and with a blue coloredmonoxial screw into the hamate bone, and the intercalated cobalt-chrome carpal head is to be inserted externally onto the conus of carpal plate after its insertion; (B) PA radiograph one year after TWA demonstrating bony resorption of sigmoid notch resulting in impingement between the ulnar head and radial component of TWA (arrow) without loosening or subsidence of radial component; (C) PA radiograph two years after TWA demonstrating unchanged correct positioning of TWA, there was no convergence instability of the distal ulnar stump nor radioulnar impingement one year after Bowers procedure. [18,19]. In a single-center study, published in 2015, the cumulative implant survival after eight years (N=68) is reported to be 95%, and at the 5-year follow-up radiographic loosening was present in 2% of all cases only [20].…”