Functional Outcome of Treating Giant Cell Tumour of Distal Ulna With Wide Excision and Wrist Reconstruction With Iliac Crest Bone Graft

Abstract

Background: Giant cell tumours of bone are aggressive, potentially malignant lesions. Juxta articular giant cell tumours of lower end ulna are rare and present a special problem of reconstruction after tumour excision. Out of the various treatment procedures described, use of iliac crest bone graft for wrist reconstruction after wide resection of the tumour is done with satisfactory functional results. Methods: Six patients with a mean age of 21 years, with proven giant cell tumours of distal end ulna were treated with wide excision and reconstruction with tricortical iliac crest graft. Wrist reconstruction and xation of graft was done with 4.o mm cancellous screws and K wire. The distal stump of resected ulna was stabilised by Extensor carpi ulnaris tendon slip. Results: The follow up ranges from 3 years (mean 30 months). At last, follow up, the mean MSTS was 71 and mean grip strength improved from 28 kg. to 37 kg. with an attainment of mean grip strength of 80% as compared with the contra lateral hand and a fair range of movements. There was no incidence of recurrence, any malignant transformation, loss of function, neurovascular decit. There were no cases with any infection or wound dehiscence. Conclusions: Distal ulna can be replaced with xation iliac crest bone graft provided it is attached to the triangular bro cartilage and ulnar collateral ligament which results in restoration of the anatomy and stability of distal radioulnar joint respectively. The distal resected stump of the ulna should be stabilised with ECU by tenodesis to prevent impingement which gave a good result in our cases.