Centralization of ulna with wrist fusion for failure of reconstructed distal radius by allograft bone or prosthesis

Abstract

Rationale: Centralization of the ulna is commonly used in the treatment of radius developmental deformity in children. The secondary distal radius deficiency in adults is different from the developmental deformity of the radius in children. There is no report on the ulna centralization with wrist fusion for the failure of the reconstructed distal radius by allograft bone or prosthesis for osteosarcoma in adults. Patient concerns: 2 patients with a bone tumor on the distal radius underwent tumor resection and distal radius reconstruction by allograft bone or prosthesis and suffered distal radius collapsed fracture and radiocarpal joint dislocation accompanied with moderate pain, severe deformity, and poor grip and pinching power several months follow primary surgery. Diagnoses: X-ray images revealed collapsed fracture of distal radius and dislocation of the radiocarpal joint. Interventions: The 2 patients were operated on by the same technique under brachial plexus anesthesia. The allograft bone or prosthesis and the lunate were removed. The capitate was trimmed with a groove, and the cartilage surface with the subchondral bone of the distal ulna was resected to match the groove of the capitate. A straight plate with screws was used for internal fixation. Outcomes: Bone healing was achieved at 3 to 4 months after the surgery. After a minimum of 1-year follow-up, pain symptom was relieved, palmar flexion deformity was corrected, and grip and pinch strength were restored. The 2 patients were both satisfied with the improvement in appearance and function. Lessons: For adult patients who have failed resection and reconstruction of giant cell tumors, osteosarcoma, and other tumors of bone on the distal radius, ulna centralization is a simple and effective option.

Isolated Osseous Excision in the Adult Carpus: A Narrative Review

“…35 Ulnar centralization via lunate excision as a salvage procedure for aggressive tumors of the distal radius that have failed prior resection and reconstruction is a niche but effective treatment to retain acceptable wrist function. 36 Chronic and degenerative pathologies treated with lunate excision include Kienbock's disease, isolated radiolunate arthritis, and chronic lunate dislocation. Management of stage IIIB and IV Kienbock's disease revolves around lunate excision combined with additional carpal stabilization procedures: STT arthrodesis, 37 SCA, [38][39][40] capitohamate arthrodesis, 41 vascularized bone grafting, [42][43][44] and distraction osteogenesis.…”