Publication:

Functional outcome of wide resection and autologous avascular proximal fibular graft arthroplasty in distal radius GCT

Background Giant cell tumor (GCT) of distal radius usually presents in late stages with aggressive progression. Extended curettage alone is usually inadequate and wide resection is the most common surgery performed. Reconstruction of the resulting defect poses significant challenges.

Methods 11 patients with distal radius GCT treated with wide resection and autologous avascular proximal fibular graft arthroplasty were studied retrospectively. One patient was Campanacci grade II and the rest 10 were Campanacci grade III. All patients underwent a standard preoperative workup and underwent a standard procedure. Patients were followed up for a mean period of 33 months (range: 1 year–7 years). Wrist movements were documented and functional outcome was scored using revised musculoskeletal tumor society scoring (MSTS).

Results Of the 11 patients, eight had excellent outcome, two had good outcome and one had satisfactory outcome according to MSTS scoring. Mean dorsiflexion, palmar flexion, supination and pronation was 44 degrees (range 10-80), 34 degrees (range 10-70), 60 degrees (range 20-80), 54 degrees (range 15-70) respectively. The complications encountered were fibulo-ulnar diastasis in 3 patients, fibulo-carpal subluxation in 2 patients, soft tissue recurrence in 1 patient and graft site non-union in 1 patient. Despite fibula-ulnar and fibula-carpal instability functional outcomes were seen to be excellent (4 patients) or good (1 patient).

Conclusions Avascular autologous proximal fibular arthroplasty provides for excellent to good functional outcomes after wide resection in distal radius GCT even if radiological appearances are suboptimal.