How to optimize the therapeutic effect of free autogenous fibula graft and wrist arthroplasty for giant cell tumors of distal radius?

• Published in: Japanese journal of clinical oncology Vol. 49; no. 7; pp. 656 - 663
• Main Authors: Liu, Qing, Luo, Wei, Zhang, Can, Liao, Zhan, Liu, Yupeng, He, Hongbo
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.07.2019
• Subjects: distal radius; free autogenous fibula graft; giant cell tumor of bone; wrist arthroplasty
• ISSN: 1465-3621; 1465-3621
• DOI: 10.1093/jjco/hyz045

How to optimize the surgical treatment strategy is the most important step in achieving excellent oncological prognosis and wrist joint function for patients with giant cell tumors of distal radius. Abstract Objective The purpose of this study is to retrospectively analyze the clinical efficacy of free fibula autograft and wrist arthroplasty in the treatment of giant cell tumors (GCT) of distal radius. Methods We retrospectively reviewed 26 patients with GCT of distal radius who underwent free autogenous fibula graft and wrist arthroplasty for repairing residual defect after en-block resection. The length of the fibula graft was 8.2 cm (6–10 cm). Postoperative follow-up regularly for an mean of 66.9 months. Bone healing was assessed by radiographs, pain was assessed by Visual Analog Scale (VAS) score and limb function was evaluated by Musculoskeletal Tumor Society (MSTS) score and disabilites of the arm, shoulder and hand (DASH) score. The range of motion (ROM) of wrist and grip strength were also evaluated. Result There were four males and 22 females with an mean age of 36.7 years (19–60 years); the mean length of lesions was 4.8 cm (2.3–6.6 cm); 21 primary cases and five recurrent cases; eight cases of Campanacci Grade II, 18 cases of Grade III. We had no postoperative lung metastasis and only one case had a local recurrence, three cases (11%) with subluxation of lower ulnoradial joints and five cases (19%) showed narrowing of wrist joint space. The mean postoperative VAS pain score was 0.7 ± 0.7 and grip strength retained 71% of the normal hand, MSTS score was 27.7 ± 1.1 and DASH score was 9.0 ± 3.7. The ROM of the involved wrist only slightly restricted and no donor complications. Postoperative wrist joint function was significantly improved. Conclusion Strict surgical resection boundary and solid reconstruction of wrist joint capsule are the key to achieving excellent oncological prognosis and function of distal radius GCT.