Functional results of wrist arthrodesis versus arthroplasty with proximal fibula following giant cell tumour excision of the distal radius

Qu, Huayi; Guo, Wei; Li, Dasen; Yang, Yi; Wei, Ran; Xu, Jie

doi:10.1177/1753193418809785

Cited by 27 publications

(22 citation statements)

References 29 publications

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“… 21 , 37 Using proximal fibular heads as substitute for resected distal radius is reasonable because of similarity in shapes and availability of autografts. 8 , 40 However, comparable to osteoarticular allografts, using proximal fibular heads to form new articulations may result in instability and carpal translation, often resulting in radiocarpal osteoarthritis. Yet, moderate to good functional results are reported at short- to mid-term follow-up (mean 3 to 6 years).…”

Section: Discussionmentioning

confidence: 99%

Surgical challenges, novel techniques, and systemic treatment of giant cell tumour of bone of the distal radius

et al. 2022

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Aims Giant cell tumour of bone (GCTB) treatment changed since the introduction of denosumab from purely surgical towards a multidisciplinary approach, with recent concerns of higher recurrence rates after denosumab. We evaluated oncological, surgical, and functional outcomes for distal radius GCTB, with a critically appraised systematic literature review. Methods We included 76 patients with distal radius GCTB in three sarcoma centres (1990 to 2019). Median follow-up was 8.8 years (2 to 23). Seven patients underwent curettage, 38 curettage with adjuvants, and 31 resection; 20 had denosumab. Results Recurrence rate was 71% (5/7) after curettage, 32% (12/38) after curettage with adjuvants, and 6% (2/31) after resection. Median time to recurrence was 17 months (4 to 77). Recurrences were treated with curettage with adjuvants (11), resection (six), or curettage (two). Overall, 84% (38/45) was cured after one to thee intralesional procedures. Seven patients had 12 months neoadjuvant denosumab (5 to 15) and sixmonths adjuvant denosumab; two recurred (29%). Twelve patients had six months neoadjuvant denosumab (4 to 10); five recurred (42%). Two had pulmonary metastases (2.6%), both stable after denosumab. Complication rate was 18% (14/76, with 11 requiring surgery). At follow-up, median MusculoSkeletal Tumour Society score was 28 (18 to 30), median Short Form-36 Health Survey was 86 (41 to 95), and median Disability of Arm, Shoulder, and Hand was 7.8 (0 to 58). Conclusion Distal radius GCTB treatment might deviate from general GCTB treatment because of complexity of wrist anatomy and function. Novel insights on surgical treatment are presented in this multicentre study and systematic review. Intralesional surgery resulted in high recurrence-rate for distal radius GCTB, also with additional denosumab. The large majority of patients however, were cured after repeated curettage. Cite this article: Bone Jt Open 2022;3(7):515–528.

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Section: Discussionmentioning

confidence: 99%

Surgical challenges, novel techniques, and systemic treatment of giant cell tumour of bone of the distal radius

et al. 2022

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“…Bridging grafts include allograft, fibula autograft, and structure iliac crest bone grafts (ICBG) [15][16][17] . Total wrist arthrodesis with massive allograft possesses several advantages, such as being a simple surgical procedure and avoiding donor-site morbidity.…”

Section: Total Wrist Arthrodesismentioning

confidence: 99%

“…The autogenous grafts are more popular. Qu et al treated eight patients with a total wrist arthrodesis with the use of fibula autograft, and they reported that wrist arthrodesis provided better grip strength and functional outcomes than wrist arthroplasty 16 . However, such a reconstruction may bring complications associated with obtaining an autologous fibular graft 20 .…”

Section: Total Wrist Arthrodesismentioning

confidence: 99%

Wrist Reconstruction after En bloc Resection of Bone Tumors of the Distal Radius

Liu

Wang

Zhang

et al. 2021

Orthopaedic Surgery

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Wrist reconstruction after en bloc resection of bone tumors of the distal radius has been a great challenge. Although many techniques have been used for the reconstruction of long bone defects following en bloc resection of the distal radius, the optimal reconstruction method remains controversial. This is the first review to systematically describe various reconstruction techniques. We not only discuss the indications, functional outcomes, and complications of these reconstruction techniques but also review the technical refinement strategies for improving the stability of the wrist joint. En bloc resection should be performed for Campanacci grade III giant cell tumors (GCT) as well as malignant tumors of the distal radius. However, wrist reconstruction after en bloc resection of the distal radius represents a great challenge. Although several surgical techniques, either achieving a stable wrist by arthrodesis or reconstructing a flexible wrist by arthroplasty, have been reported, the optimal reconstruction procedure remains controversial. The purpose of this review was to investigate which reconstruction methods might be the best option by analyzing the indications, techniques, limitations, and problems of different reconstruction methods. With the advancement of imaging, surgical techniques and materials, some reconstruction techniques have been further refined. Each of the techniques discussed in this review has its advantages and disadvantages. Wrist arthrodesis seems to be preferred over wrist arthroplasty in terms of grip strength and long‐term complications, while wrist arthroplasty seems to be superior to wrist arthrodesis in terms of wrist motion. All things considered, wrist arthroplasty with a vascularized fibular head autograft might be a good option because of better wrist function, acceptable grip strength, and a relatively lower complication rate. Moreover, wrist arthrodesis is still an option if the fibular head autograft reconstruction fails. Orthopaedic oncologists should familiarize themselves with the characteristics of each technique to select the most appropriate reconstruction method depending on each patient's situation.

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“…4 Dado el grado funcional que presenta esta región, la reconstrucción del radio distal continúa siendo un desafío y aún no existe una técnica definida como estándar de oro, 5 por lo que se han desarrollado múltiples técnicas quirúrgicas tales como artrodesis parcial o total de muñeca y artroplastia de muñeca con ayuda de aloinjertos, impresiones en 3D o colgajos óseos vascularizados y no vascularizados. [6][7][8][9] Dentro de los colgajos vascularizados, el peroné continúa siendo una opción razonable, por lo que se ha llegado a convertir en uno de los más utilizados cuando se trata de reconstrucción a nivel del antebrazo; 8 sin embargo, se han descrito múltiples complicaciones tales como fracturas, parálisis del nervio peroneo común, aflojamiento del material de osteosíntesis, infecciones, inestabilidad articular y no unión. 5 De éstas, la que se presenta con mayor frecuencia es la no unión; 10 sin embargo, no hay estudios enfocados en el análisis de su tratamiento.…”

Section: Wwwmedigraphicorgmx Introducciónunclassified

Uso del colgajo vascularizado perióstico cubital pediculado de la arteria interósea anterior como tratamiento de la no unión de radio. Reporte de caso

Reyes¹,

Garza²,

Martínez³

2023

Ortho-Tips

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Introducción: el tumor de células gigantes representa de 10 a 12% de los tumores benignos de comportamiento agresivo con capacidad de invasión local o a distancia, misma que incrementa si se trata de un grado III de la clasificación de Campanacci. Estadio en el que se recomienda realizar resección en bloque, dado su alto grado de recurrencia. Debido al alto grado funcional que presenta esta región, la reconstrucción del radio distal continúa siendo un desafío y aún no existe una técnica definida como estándar de oro, por lo que se han desarrollado múltiples técnicas quirúrgicas, dentro de las cuales los colgajos vascularizados continúan siendo de las mejores opciones sobre todo si se trata del peroné; sin embargo, se han descrito múltiples complicaciones de éstas, la que se presenta con mayor frecuencia es la no unión; pero no hay estudios enfocados en el análisis de su tratamiento. En esta ocasión describimos una técnica modificada para la toma de un colgajo vascularizado perióstico cubital pediculado proveniente de la arteria interosea anterior, con abordaje dorsal para el tratamiento de la no unión de radio, después de una reconstrucción con peroné vascularizado. Objetivo: mostrar los resultados clínicos y radiográficos del uso del colgajo vascularizado perióstico cubital pediculado (CVPCP) proveniente de la arteria interósea anterior (AIA). Además de describir la técnica quirúrgica modificada a través de un abordaje dorsal en una paciente con no unión de radio. Presentación del caso: paciente de 45 años de edad con antecedente de tumor de células gigantes (TCG) de radio distal grado III de Campanacci tratada con resección en bloque y reconstrucción inmediata con peroné vascularizado que evolucionó con una no unión, que fue tratada con la colocación de un CVPCP con una evolución satisfactoria clínica y radiográficamente. Conclusión: el CVPCP puede considerarse una opción confiable y útil para el tratamiento de complicación post-reconstrucción en antebrazo en adultos.Palabras clave: tumor de células gigantes, no unión, reconstrucción de muñeca, colgajo perióstico vascularizado, arteria interósea anterior.

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Functional results of wrist arthrodesis versus arthroplasty with proximal fibula following giant cell tumour excision of the distal radius

Cited by 27 publications

References 29 publications

Surgical challenges, novel techniques, and systemic treatment of giant cell tumour of bone of the distal radius

Surgical challenges, novel techniques, and systemic treatment of giant cell tumour of bone of the distal radius

Wrist Reconstruction after En bloc Resection of Bone Tumors of the Distal Radius

Uso del colgajo vascularizado perióstico cubital pediculado de la arteria interósea anterior como tratamiento de la no unión de radio. Reporte de caso

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