Vascularized Fibular Graft for Reconstruction of the Wrist after Excision of Giant Cell Tumor

Ono, Hiroshi; Yajima, Hiroshi; Mizumoto, Sigeru; Miyauchi, Yoshimasa; Mii, Yoshio; Tamai, Susumu

doi:10.1097/00006534-199704000-00026

Cited by 53 publications

(63 citation statements)

References 13 publications

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“…Sheth et al [36] found comparable MSTS scores and grip strength when comparing intralesional excision and resection arthrodesis, respectively, for giant cell tumor of the distal radius in 26 patients. Some favorable functional results also have been reported for osteoarticular allograft reconstruction using proximal fibular autograft, however none were performed in our patients and there are concerns with high complication rates [1,3,6,23,24,26,31].…”

Section: Discussionmentioning

confidence: 55%

“…McGough et al [28] reported 30% recurrence in 33 patients, Harness and Mankin [18] reported 42% recurrence in 26 patients, Sheth et al [36] reported 25% recurrence in 12 patients, and O'Donnell et al [30] reported 50% recurrence in 10 patients. Conversely, en bloc resection of the distal radius with either arthrodesis or osteoarticular allograft has reported low recurrence rates of 0% [1,4,5,13,19,31,36,39], with few studies showing recurrence in greater than 25% [26,29].…”

Section: Discussionmentioning

confidence: 99%

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Is Intralesional Treatment of Giant Cell Tumor of the Distal Radius Comparable to Resection With Respect to Local Control and Functional Outcome?

Wysocki

Soni

Virkus

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background A giant cell tumor is a benign locally aggressive tumor commonly seen in the distal radius with reported recurrence rates higher than tumors at other sites. The dilemma for the treating surgeon is deciding whether intralesional treatment is adequate compared with resection of the primary tumor for oncologic and functional outcomes. More information would be helpful to guide shared decision-making. Questions/purposes We asked: (1) How will validated functional scores, ROM, and strength differ between resection versus intralesional excision for a giant cell tumor of the distal radius? (2) How will recurrence rate and reoperation differ between these types of treatments? (3) What are the complications resulting in reoperation after intralesional excision and resection procedures? (4) Is there a difference in functional outcome in treating a primary versus recurrent giant cell tumor with a resection arthrodesis? Methods Between 1985 and 2008, 39 patients (39 wrists) were treated for primary giant cell tumor of the distal radius at two academic centers. Twenty patients underwent primary intralesional excision, typically in cases where bony architecture and cortical thickness were preserved, 15 underwent resection with radiocarpal arthrodesis, and four had resection with osteoarticular allograft. Resection regardless of reconstruction type was favored in cases with marked cortical expansion. A specific evaluation for purposes of the study with radiographs, ROM, grip strength, and pain and functional scores was performed at a minimum of 1 year for 21 patients (54%) and an additional 11 patients (28%) were available only by phone. We also assessed reoperations for recurrence and other complications via chart review.

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Is Intralesional Treatment of Giant Cell Tumor of the Distal Radius Comparable to Resection With Respect to Local Control and Functional Outcome?

Wysocki

Soni

Virkus

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…These differ by the type of graft replacing the resected bone and whether an attempt is made to preserve the radiocarpal articulation. The autogenous grafts described include free vascularized fibula graft [20,25,33,35,38], nonvascularized fibula [6,37,44], vascularized structural iliac crest bone graft (ICBG) [21], nonvascularized ICBG [8], nonvascularized corticocancellous tibial struts [11,46], and use of the ulna adjacent to the involved radius [36,39]. Structural allograft [2,41,45] is a popular alternative in certain countries as well.…”

Section: Introductionmentioning

confidence: 99%

Does Wrist Arthrodesis With Structural Iliac Crest Bone Graft After Wide Resection of Distal Radius Giant Cell Tumor Result in Satisfactory Function and Local Control?

Wang

Chan

Yang

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Many techniques have been described for reconstruction after distal radius resection for giant cell tumor with none being clearly superior. The favored technique at our institution is total wrist fusion with autogenous nonvascularized structural iliac crest bone graft because it is structurally robust, avoids the complications associated with obtaining autologous fibula graft, and is useful in areas where bone banks are not available. However, the success of arthrodesis and the functional outcomes with this approach, to our knowledge, have only been limitedly reported. Questions/purposes (1) What is the success of union of these grafts and how long does it take? (2) How effective is the technique in achieving tumor control? (3) What complications occur with this type of arthrodesis? (4) What are the functional results of wrist arthrodesis by this technique for treating giant cell tumor of the distal radius? Methods Between 2005 and 2013, 48 patients were treated for biopsy-confirmed Campanacci Grade III giant cell tumor of the distal radius. Of those, 39 (81% [39 of 48]) were treated with wrist arthrodesis using autogenous nonvascularized iliac crest bone graft. Of those, 27 (69% [27 of 39]) were available for followup at a minimum of 24 months (mean, 45 months; range, 24-103 months). During that period, the general indications for this approach were Campanacci Grade III and estimated resection length of 8 cm or less. Followup included clinical and radiographic assessment and functional assessment using the Disabilities of the Arm, Shoulder and Hand (DASH) score, the Musculoskeletal Tumor Society (MSTS) score, grip strength, and range of motion at every followup by the treating surgeon and his team. All functional results were from the latest followup of each patient. Results Union of the distal junction occurred at a mean of 4 months (± 2 months) and union of the proximal junction occurred at a mean of 9 months (± 5 months). Accounting for competing events, at 12 months, the rate of proximal junction union was 56% (95% confidence interval [CI], 35%-72%), whereas it was 67% (95% CI, 45%-82%) at 18 months. In total, 11 of the 27 patients (41%) underwent repeat surgery on the distal radius, including eight patients (30%) who had complications and three (11%) who had local recurrence. The mean DASH score was 9 (± 7) (value range, 0-100, with lower scores representing better function), and the mean MSTS 1987 score was 29 (± 1) (value range, 0-30, with higher scores representing better function) as well as 96% (± 4%) of mean MSTS 1993 score (value range, 0%-100%, with higher scores representing

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“…Thorough curettage combined with cryosurgery and the packing of bone cement is generally considered the standard treatment for grade I lesions, and can preserve good joint function [8,14]. For grade II or III lesions, or recurrent lesions after curettage, en bloc resection is required because the tumours can only be controlled by wide excision [15,16]. However, large bone defects can result after wide resection of the tumour.…”

Section: Discussionmentioning

confidence: 99%

“…Ono et al [15] suggested that performing wrist arthroplasty with a vascularised fibular head graft is the best surgical approach in the treatment of grade II GCT of the distal radius. Moreover, Saini et al [17] reported a satisfactory clinical outcome after reconstructing bone defects with a non-vascularised proximal fibula graft in 12 cases of GCT of the distal radius after tumour resection.…”

Section: Discussionmentioning

confidence: 99%

Partial wrist arthrodesis versus arthroplasty for distal radius giant cell tumours

Zhu

Zhang

Zhao

et al. 2013

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to evaluate the clinical efficacy of using the proximal fibular graft for partial wrist arthrodesis or arthroplasty after the resection of giant cell tumours of the distal radius. Methods Between February 2006 and August 2010, 14 patients (seven males, seven females; average age, 35.7 years) with grade II and III giant cell tumours of the distal radius were treated by tumour resection and autologous proximal fibular grafts to reconstruct the wrist in our hospital. Seven patients each were treated by wrist arthroplasty and partial wrist arthrodesis, and were followed up for 2.2-6.8 years (average, 3.9 years).

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Vascularized Fibular Graft for Reconstruction of the Wrist after Excision of Giant Cell Tumor

Cited by 53 publications

References 13 publications

Is Intralesional Treatment of Giant Cell Tumor of the Distal Radius Comparable to Resection With Respect to Local Control and Functional Outcome?

Is Intralesional Treatment of Giant Cell Tumor of the Distal Radius Comparable to Resection With Respect to Local Control and Functional Outcome?

Does Wrist Arthrodesis With Structural Iliac Crest Bone Graft After Wide Resection of Distal Radius Giant Cell Tumor Result in Satisfactory Function and Local Control?

Partial wrist arthrodesis versus arthroplasty for distal radius giant cell tumours

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