Reconstruction of the Distal Radius with Non-Vascularised Fibular Graft after Resection of Giant Cell Tumour of Bone

Abstract

Purpose. To evaluate outcomes of wide resection and reconstruction of the distal radius with nonvascularised autogenous fibular grafts for giant cell tumour (GCT) of bone. Methods. Medical records of 7 men and 5 women aged 22 to 47 (mean, 31) years who underwent wide resection of the distal radius and reconstruction with non-vascularised autogenous fibular grafts for GCT of bone were reviewed. The mean length of the resected radius was 9 (range, 7-11) cm. The ipsilateral proximal fibula with a small portion of attached ligament was harvested. The articular surface of the graft was fixed to the scapholunate articular surface by Kirschner wires, and the ligament of the fibular head was sutured to the carpal ligaments. The graft was fixed to the proximal radius with a small dynamic compression plate. Iliac cancellous bone graft was added. Pain, instability, and functional status were assessed. Wrist joint movements were measured using a goniometer. The grip strength was measured.Reconstruction of the distal radius with nonvascularised fibular graft after resection of giant cell tumour of bone Journal of Orthopaedic Surgery 2014;22(3):356-9The operated and contralateral sides were compared. Results. The mean follow-up was 24 (range, 20-27) months. All patients achieved radiological union after a mean of 16 (range, 14-20) weeks. The mean active range of movement in the operated wrists was 32º dorsiflexion, 38º palmar flexion, 15º radial deviations, 12º ulnar deviations, 50º supination, and 60º pronation. Compared with the contralateral wrists, the operated wrists regained 60% of the function, with satisfactory grip strength, and normal finger and thumb movements and hand sensation. No patient had recurrence after 2 years. Two patients had minor dorsal subluxation, which was resolved with a wrist brace. Three patients had superficial infection, which was resolved with intravenous antibiotics and dressings. Two patients had peroneal nerve palsy, which recovered completely in 12 weeks. Conclusion. Non-vascularised fibular grafts for reconstruction of the distal radius after resection of a GCT of bone achieved good cosmetic and functional outcomes.

What are the Functional Results, Complications, and Outcomes of Using a Custom Unipolar Wrist Hemiarthroplasty for Treatment of Grade III Giant Cell Tumors of the Distal Radius?

“…Since Gold's report in 1957 [12], many types of prostheses have been used for reconstructing defects after en bloc resection of the distal radius, which obtained reasonable functional outcome (Table 3). Although our results were encouraging, reconstruction with the custom unipolar prosthesis did not produce functional outcomes similar to those reported for fibular autograft or osteoarticular allograft [3,9,16,19,29]. Numerous reconstructive methods for large bone defects after en bloc resection of the distal radius have been described, including arthrodesis of the wrist; osteoarticular allograft; nonarthrodesed, nonvascularized or vascularized fibula graft; and prosthetic arthroplasty [6,8,9,11,14,19,25,29,32].…”

Clinical and Radiographic Results of Reconstruction with Fibular Autograft for Distal Radius Giant Cell Tumor

“…At the most recent follow-up, the mean MSTS score was 25.25 AE 2.38 (range, [22][23][24][25][26][27][28][29] and the mean DASH score 13.0 (SD, 7.5; range, 6.7-33.3). The average ROMs of the wrist were as follows (…”

“…Many techniques have been used to reconstruct the defects, including vascularized/non‐vascularized fibular grafts, osteoarticular allografts, partial/total wrist arthrodesis and custom‐made prostheses. Each technique has its own unique possible advantages and disadvantages, which has been thoroughly discussed and debated . However, no consensus on the optimal procedure has yet been reached.…”

“…En bloc resection of the distal radius must be followed by meticulous reconstruction of the bone defect to preserve the wrist function and alignment. Many techniques have been used to reconstruct the defects, including vascularized 27 /non-vascularized fibular grafts 28,29 , osteoarticular allografts 30 , partial/total wrist arthrodesis and custom-made prostheses 8,10,11,14,16,[28][29][30][31][32] . Each technique has its own unique possible advantages and disadvantages, which has been thoroughly discussed and debated 11,20,27,28,30,[32][33][34] .…”

“…Reported ROMs of the wrist have ranged from 28 to 32 of extension, 21 to 38 of flexion, 15 to 21 of radial deviation, 8 to 12 of ulnar deviation, 50 to 61 of pronation and 27 to 60 of supination. Mean reported MSTS scores are 25.9-27.9 2,28,29,35 . Although postoperative motion is inferior to normal wrist function, most patients were satisfied with their postoperative function.…”