Functional Outcome after Treatment of Aggressive Tumours in the Distal Radius: Comparison between Reconstruction using Proximal Fibular Graft and Wrist Fusion

CY, Choo; Saad, Arman Zaharil Mat; WS, Wan-Azman; Wan, Zhinian; MZ, Nor-Azman; Yahaya, Sahran; Ismail, Wan Faisham Wan

doi:10.5704/moj.1811.004

Cited by 9 publications

(9 citation statements)

References 14 publications

(13 reference statements)

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“…Recent literature has shown that there is no difference in long-term functional outcome between reconstruction and fusion group [2]. Translocations of ulna, wrist arthrodesis using segmental iliac crest graft and complex procedure of segmental double barrel ulnar graft arthrodesis with Sauve-Kapandji procedure also produce equally long-term outcome [7][8][9].…”

Section: Discussionmentioning

confidence: 99%

“…Joint reconstruction after resection of aggressive tumors remains a popular alternative in order to reduce the local recurrence rate while maintain wrist motion and ideally improving function compared to arthrodesis. The use of free vascularized proximal fibula graft is attractive because of its similarity in shape to the distal radius [2]. However, some major postoperative complications were reported including progressive degenerative changes, bony collapse secondary to poor vascularity of the fibular head, and volar subluxation resulting from incongruity between the fibular head and the proximal carpal row.…”

Section: Discussionmentioning

confidence: 99%

“…Complete arthrodesis produces a painless and stable wrist, though absence of motion, with minimal disability [10]. Moreover, the grip strength after wrist fusion is usually stronger compared to reconstruction [2]. A stable and painless wrist is attributed to better tendon excursion and muscle strength for the grip, and allows earlier rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

“…By definition, arthroplasty is performed to obtain wrist mobility. After radio-carpal arthrodesis, midcarpal motion is preserved, and after total wrist arthrodesis, no mobility is left [2]. The bone used to bridge the gap may be allograft [3], non-vascularized [4] or vascularized autograft [5].…”

Section: Introductionmentioning

confidence: 99%

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

Lucattelli¹,

Bastoni²,

Delcroix³

et al. 2021

J. Adv. Plast. Surg. Res.

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Lucattelli¹,

Bastoni²,

Delcroix³

et al. 2021

J. Adv. Plast. Surg. Res.

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“…Wrist arthroplasty using proximal fibular head arthroplasty [21,23,32], osteoarticular grafting [7,22,25], or prosthetic hemiarthroplasty [14,30] offers the advantage of wrist movement but carries an associated risk of wrist subluxation, pain, and limited pronosupination [7, 14, 21-23, 30, 34]. Wrist fusion using an autograft [5,23,27] or allograft [28] provides long-term wrist stability at the cost of movement. Recent publications have shown that wrist fusion is superior to other reconstruction options in the distal radius [5,21,29].…”

Section: Introductionmentioning

confidence: 99%

Does a Modified Technique to Achieve Arthrodesis of the Wrist After Resection of the Distal Radius and Translocating the Ipsilateral Ulna as a Vascularized Graft to Reconstruct the Defect Improve Grip Strength and Outcomes Scores?

Gundavda

Agarwal

Reddy

et al. 2021

Clin Orthop Relat Res

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Background Ten years ago, we reported the results of a procedure in which we translocated the ipsilateral ulna as a vascularized autograft to reconstruct defects of the distal radius after tumor resection, with excellent functional results. At that time, wrist arthrodesis was achieved by aligning the translocated ulna with the scapholunate area of the carpus and usually the third metacarpal. This resulted in wrist narrowing. We then wondered if aligning the translocated ulna with the scaphoid and the second metacarpal would result in ulnar deviation and thereby improve grip strength. We believed lateralization would reduce the wrist narrowing that occurs with fusion to the third metacarpal and would make the cosmesis more acceptable. We also modified the incision to dororadial to make the scar less visible and thus improve the cosmesis. Questions/purposes (1) Is there an objective improvement in grip strength and functional scores (Musculoskeletal Tumor Society [MSTS] and Mayo wrist) when the translocated ulna is lateralized and the wrist is fused with the translocated ulna and aligned with the second metacarpal versus when the translocated ulna is aligned with the third metacarpal? (2) Did lateralization caused by the wrist fusion aligned with the second metacarpal minimize wrist narrowing as measured by the circumference compared with the fusion aligned with the third metacarpal? Methods From 2010 and 2018, we treated 40 patients with distal radius tumors at our institution, 30 of whom had a distal radius enbloc resection. Twenty-eight patients had an ipsilateral ulna translocation and wrist arthrodesis in which the radius and translocated ulna were aligned with either the second (n = 15) or the third (n = 13) metacarpals. Two patients in the second metacarpal group and three patients in the third metacarpal group were lost to follow-up before 24 months after surgery and were excluded. A retrospective analysis of 23 patients (20 with giant cell tumors and three with malignant bone tumors) included a review of radiographs and institutional tumor database for surgical and follow-up records to study oncologic (local disease recurrence), reconstruction (union of osteotomy junctions, implant breakage or graft fracture, and wrist circumference), and functional outcomes (MSTS and Mayo wrist scores and objective grip strength assessment compared with the contralateral side). The results were compared for each study group (second metacarpal versus third metacarpal). There was no difference in the incidence of local recurrence or the time to union between the two groups. There were no implant breakages or graft fractures noted in either group. Results Patients in the second metacarpal group lost less grip strength compared with the unoperated side in the third metacarpal group (median 12% [range -30% to 35%] versus median 28% [15% to 42%], difference of medians 16%; p = 0.006). There were no between-group differences in terms of MSTS (median 30 [24 to 30] versus median 26.5 [22 to 30], difference of medians 3.5; p = 0.21) or Mayo wrist scores (median 83 [65 to 100] versus median 72 [50 to 90], difference of medians 11; p = 0.10). The second metacarpal group also had less wrist narrowing as seen from the median difference in circumference between the operated and unoperated wrists (median narrowing 10 mm [3 to 35 mm] in the second metacarpal group versus median 30 mm [15 to 35 mm] in the third metacarpal group, difference of medians 20 mm; p = 0.04). Conclusion Wrist arthrodesis after ulna translocation with alignment of the translocated ulna and the second metacarpal provides a functional position with ulnar deviation that offers some improvement in grip strength but no improvement in the MSTS or Mayo scores. Radialization/lateralization of the translocated ulna achieved from the alignment with the second metacarpal decreases the reduction in the wrist circumference and therefore reduces wrist narrowing. Level of Evidence Level III, therapeutic study.

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Outcomes of En bloc resection followed by reconstruction of giant cell tumor around knee and distal radius. A case series

Kamal

Muhamad

2020

Annals of Medicine and Surgery

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IntroductionThis study is to evaluate the outcomes of En bloc resection and reconstruction in patients with GCT of the bone around the knee and in the distal radius.Materials and methodsWe reviewed 41 cases of GCT of the bone that was treated by En bloc resection around the knee joint and in the distal radius from 2011 to 2018. The local recurrence, metastases, complications and functional score were evaluated for each operation technique.ResultsThe average of MSTS score for all group was 78% (excellent). In the knee joint, the megaprostheses group had an excellent MSTS score of78.9% and good 21.1%. The MAMC group had an excellent MSTS score of40.0%, good 50.0% and fair 10.0%. One patient in the megaprostheses group had metastasis to the lung and 1 patient in the knee arthrodesis group has a recurrence. Infection occurred in 2 cases of megaprostheses while only 1 case in MAMC. Both of the groups in knee joint GCT had 1 patient with implant loosening. In the distal radius, FVFG group had an excellent MSTS score 100% and NVFG group had an excellent score 77.7%, good 11.1% and fair 11.1%. One patient in the NVFG group had an infection, 1 patient has implant loosening and another one patient had graft failure. Two patients in the NVFG group had a recurrence. No metastasis was found in both of the group types of surgery in distal radius GCT.ConclusionFunctional outcome of a patient with GCT of the bone after En bloc resection and reconstruction with the above techniques had comparable results with previous studies.

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Functional Outcome after Treatment of Aggressive Tumours in the Distal Radius: Comparison between Reconstruction using Proximal Fibular Graft and Wrist Fusion

Cited by 9 publications

References 14 publications

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

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

Does a Modified Technique to Achieve Arthrodesis of the Wrist After Resection of the Distal Radius and Translocating the Ipsilateral Ulna as a Vascularized Graft to Reconstruct the Defect Improve Grip Strength and Outcomes Scores?

Outcomes of En bloc resection followed by reconstruction of giant cell tumor around knee and distal radius. A case series

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