Functional outcome of en bloc excision and osteoarticular allograft replacement with the Sauve-Kapandji procedure for Campanacci grade 3 giant-cell tumor of the distal radius

PURPOSE: Multiple options have been reported for reconstruction of Campanacci grade 3 giant-cell tumor of the distal radius after resection. In 1990, the senior author described an allograft reconstruction combined with a Sauve-Kapandji procedure after distal radius resection and reported preliminary results in 3 patients. The purpose of this study was to assess with validated patient outcome surveys the intermediate to long-term outcomes of all patients treated with this surgery and to analyze their functional results and document tumor control. METHODS: All cases of distal radius osteoarticular allograft combined with the Sauve-Kapandji reconstruction for Campanacci grade 3 giant-cell tumors performed from 1986 to 2000 by a single surgeon were evaluated by clinical and radiologic examinations; the Disabilities of the Arm, Shoulder, and Hand questionnaire; the Short Form-36; and Mayo Wrist scores. RESULTS: Nine consecutive patients (7 women, 2 men) with an average age at follow-up evaluation of 42 years and with a Campanacci grade 3 giant-cell tumor of the distal radius formed the study population. Clinical follow-up time after reconstruction averaged 7 years. Examination showed an average of 51 degrees of extension and 19 degrees of flexion of the wrist and 63 degrees of supination and 79 degrees of pronation of the forearm. Grip strength measured in 5 patients averaged 23 kg. The Disabilities of the Arm, Shoulder, and Hand questionnaire; the Short Form-36; and the Mayo Wrist scores averaged 15, 72, and 73, respectively. These scores indicate modest functional impact. No patient had tumor recurrence, metastases, nonunion, or proximal ulna instability. CONCLUSIONS: En bloc resection of a Campanacci grade 3 giant-cell tumor of the distal radius followed by reconstruction with an osteoarticular allograft and a Sauve-Kapandji procedure with autogenous bone graft results in a reasonable functional outcome at intermediate to long-term follow-up evaluation. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.     

Custom-made wrist prosthesis in a patient with giant cell tumor of the distal radius

Introduction

Treatment for giant cell tumors of the distal radius is challenging when motion is to be preserved. As standard wrist prostheses typically do not achieve favorable results, we treated a 36-year-old man with giant cell tumor of the distal radius with a new, custom-made implant.

Methods

A custom-made wrist prosthesis with a long shaft was designed according to the patient’s X-ray findings. After complete tumor resection, the prosthesis was subsequently implanted into the distal radius without complications.

Results

Two months after surgery, range of motion was 30°-0-25° for extension/flexion, 10°-0-5° for ulnar/radial abduction, 80°-0-0 for pronation/supination, complete range of motion for the fingers, and a grip strength of 6 kg. Two years after surgery, implant position was still correct and range of motion was 45°-0-10° for extension/flexion, 10°-0-20° for ulnar/radial abduction, and 80°-0-10° for pronation/supination. Grip strength was 16 kg, and DASH score was 25 compared to 39 before surgery. The patient returned to work as a craftsman.

Conclusion

Custom-made wrist prostheses could become a practical option in patients with large defects of the distal radius who desire to preserve wrist motion.     

带血管蒂腓骨瓣移植重建CampanacciⅢ级桡骨远端骨巨细胞瘤切除术后桡腕关节的远期疗效

目的总结CampanacciⅢ级桡骨远端骨巨细胞瘤(giant cell tumor,GCT)瘤段切除后,采用带血管蒂自体腓骨瓣移植重建桡腕关节的远期疗效。方法2010年12月-2014年12月,收治10例CampanacciⅢ级桡骨远端GCT患者。其中男6例,女4例;年龄22~65岁,平均39.9岁。病程1.5~6.0个月,平均2.6个月。4例合并病理性骨折。肿瘤切除后桡骨远端骨缺损长度为6.0~12.5 cm,平均8.4 cm。采用自体腓骨瓣移植重建桡腕关节,6例吻合膝下外侧血管,4例吻合膝下外侧血管+腓血管双套血管蒂。结果术后切口均Ⅰ期愈合。患者均获随访,随访时间4.4~8.3年,平均6.0年。随访期间肿瘤无复发。末次随访时,腕关节活动范围:背伸25~85°,平均55.0°;掌屈15~40°,平均26.5°;桡偏5~25°,平均12.0°;尺偏10~30°,平均19.6°;前臂旋前5~90°,平均50.5°;旋后20~90°,平均66.5°。患侧握力达健侧60%~85%,平均75%。美国骨与软组织肿瘤协会(MSTS)评分为75%~90%,平均82.7%。X线片复查示移植腓骨瓣均愈合,愈合时间12~16周,平均14.1周;9例出现影像学并发症。结论CampanacciⅢ级桡骨远端GCT切除后,采用带血管蒂腓骨瓣移植重建桡腕关节,能够有效保留腕关节功能。     

Handgelenksarthrodese mit gef??gestieltem Fibulasegment bei handgelenksnahen Unterarmtumoren

Objective

Total tumor resection and defect resconstruction by vascularized fibula graft and total wrist fusion.

Indications

Primary extended bone tumors of the distal radius.

Contraindications

Tumor infiltration of the whole carpus or of the neurovascular structures.

Surgical technique

En bloc resection of the tumor including the biopsy scar. Raising of a microvascular fibula graft including the peroneal vessels. Defect reconstruction using the fibula and stabilization of the total wrist fusion with a locking compression plate (LCP).

Postoperative management

Functional therapy of the fingers is possible, below elbow cast for 6 weeks. Weight bearing after 12 weeks according to bone healing.

Results

The operation technique described for preservation of the extremity in primary extended bone tumors of the distal radius was performed in our clinic in 2?patients since 2009. Tumor-free and pain-free hand function was found at the 2.5-year follow-up examinations. The patients had free range of motion of the fingers and preserved sensorimotor function. The MSTS (Musculoskeletal Tumour Society) scores by Enneking were 80% and 70%.     

桡骨远端巨细胞瘤切除自体腓骨头移植重建的远期疗效观察

目的 观察桡骨远端巨细胞瘤切除后取自体腓骨头移植重建的远期疗效.方法 对1994年3月至2004年11月31例桡骨远端巨细胞瘤患者行肿瘤大段切除,取自体腓骨上段移植重建.其中男性12例,女性19例;年龄19～48岁,平均31岁.Campanacci分期Ⅲ期24例,Ⅱ期7例.采用吻合血管的腓骨移植6例,其余25例行单纯腓骨移植.对本组患者进行临床及影像学评估,测量患者腕关节活动度、前臂旋前及旋后的活动度,测量患肢的握力.分别以MSTS评分及Mayo腕关节评分系统评价上肢及腕关节功能.结果 随访时间41～169个月,平均86.3个月.吻合血管的腓骨移植骨愈合时间为3～9个月,平均5.1个月.单纯腓骨移植患者骨愈合时间为7～15个月,平均10.3个月.1例单纯腓骨移植患者术后出现骨不愈合.1例患者术后出现肿瘤局部复发,复发率为3.2%.5例患者术后出现桡腕关节脱位.患者术后腕关节活动度为背伸(67.3±9.4)°、掌屈(31.2±5.1)°、桡偏(14.1±4.7)°、尺偏(19.4±3.9)°、前臂旋前(33.8±6.6)°、前臂旋后(15.3±4.0)°.对桡腕关节成型的28例患者进行握力测量为15.5～52.1 kg,平均33.1 kg,占健侧握力的73%.MSTS评分为23～29分,平均25.5分,Mayo腕关节功能评分40～65分,平均56分.结论 取自体腓骨上端移植重建是治疗桡骨远端巨细胞瘤的有效方法,术后患者腕关节功能恢复理想.腕关节囊的重建对于维持桡腕关节的术后稳定具有重要意义.     

Treatment of giant cell tumor of the distal radius

The results of surgical treatment of giant cell tumors of the distal radius were reviewed in 12 patients between 1982 and 1995. All 12 patients had Grade III lesions. Six of the 12 patients were treated using intralesional curettage with local excision, and the other six patients underwent en bloc resection with total condyle (four of the six by osteoarticular allograft, and the other two by fibular autograft) reconstruction with the aim of preserving the functional joint. There were no early or late complications such as infection, graft fracture, implant failure, or nonunion. No local tumor recurrence was seen in either group during the average followup of 6 years (range, 3-16 years). The best functional result was seen in the patients treated with intralesional curettage. The functional result of the resection group was good, achieving an average of 69% (range, 56%-83%) of their range of motion and 70% (range, 63%-77%) of their grip strength on the contralateral side. Intralesional excision should not be excluded as a possible treatment of Grade III lesions, although en bloc resection was used more commonly for these lesions because of tumor surgery reasons. Grade III lesions were treated with curettage when the tumor did not invade the wrist, destroy more than 50% of the cortex, or break through the cortex with an extraosseous mass in more than one plane. Reconstruction with osteoarticular allograft after en bloc resection is recommended in this non-weightbearing joint when there is contraindication for curettage of the lesion.     

Partial wrist arthrodesis versus arthroplasty for distal radius giant cell tumours

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).

Results

All patients achieved primary healing. No tumour recurrence was observed during follow-up in any of the patients. No statistically significant difference in forearm rotation was observed between patients undergoing the two different treatments. However, wrist flexion-extension activities were significantly better and the wrist grip strengths were significantly worse in the arthroplasty group than in the arthrodesis group. The Musculoskeletal Tumour Society score did not significantly differ between the groups.

Conclusions

Overall, joint arthroplasty remains a favourable treatment with regard to the functional outcome for giant cell tumours of the distal radius; however, some of these patients may have a weaker grip strength. In comparison, partial wrist fusion appears to provide a durable and stable wrist with good long-term functional outcome.     

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

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.

Results

With the numbers available, there were no differences in pain or functional scores or grip strength between groups; however, there was greater supination in the intralesional excision group (p = 0.037). Tumors recurred in six of 17 wrists after intralesional excision and none of the 15 after en bloc resection (p = 0.030). There was no relationship between tumor grade and recurrence. There were 12 reoperations in eight of 17 patients in the intralesional excision group but only one of 11 patients (p = 0.049) who underwent resection arthrodesis with distal radius allograft had a reoperation. There were no differences in functional scores whether resection arthrodesis was performed as the primary procedure or to treat recurrence after intralesional excision.

Conclusions

Resection for giant cell tumor of the distal radius with distal radius allograft arthrodesis showed a lower recurrence rate, lower reoperation rate, and no apparent differences in functional outcome compared with joint salvage with intralesional excision. Because an arthrodesis for recurrence after intralesional procedures seems to function well, we believe that intralesional excision is reasonable to consider for initial treatment, but the patient should be informed about the relative benefits and risks of both options during the shared decision-making process. Because arthrodesis after recurrence functions similar to the initial resection and arthrodesis, an initial treatment with curettage remains a viable, and likely the standard, mode of treatment for most giant cell tumors of the distal radius unless there is extensive bone loss.

Level of Evidence

Level III, therapeutic study.     

Giant cell tumor - distal end radius: Do we know the answer?

Background:

The distal end of the radius is one of the common sites of involvement in giant cell tumors (GCTs) with reportedly increased propensity of recurrence. The objective of the present analysis was to study the modalities of management of the different types of distal end radius GCTs so as to minimize the recurrence rates and retain adequate function.

Materials and methods:

Twenty-four patients of distal end radius GCTs treated between January 2000 and December 2004 were retrospectively reviewed. Nineteen cases were available for follow-up with an average follow-up of 37.5 months. There was one Campanacci Grade 1 lesion, nine Grade 2 and 14 Grade 3 lesions. Thirteen (54%) of these patients were treated elsewhere earlier and presented with recurrence. The operative procedures that were performed were: curettage and cementing (five), curettage and bone grafting (seven), excision and proximal fibular arthroplasty (two), excision and wrist arthrodesis (nine) and excision of soft tissue recurrence (one).

Results:

Functional status was evaluated using Musculo Skeletal Tumor Society scoring system which averaged 78%. The recurrence rate was 32%. Complications included local recurrence (six), nonunion at the graft bone junction (one), infection (one), deformity (two), stiffness (two), subluxation (two) and bony metastasis (one).

Conclusions:

The majority of patients undergoing curettage were either Campanacci Grade 1 or 2. Patients undergoing curettage and reconstruction had a better functional result (82%) as compared to arthrodesis or fibular arthroplasty (69%). Previous intervention did not appear to increase the recurrence rates. Even though complications occur, judicious decision-making and an appropriate treatment plan can ensure a satisfactory outcome in the majority of cases.     

Resection-reconstruction arthroplasty for giant cell tumor of distal radius

Background:

Giant cell tumor (GCT) of the distal radius poses problems for reconstruction after resection. Several reconstructive procedures like vascularized and non-vascularized fibular graft, osteo-articular allograft, ceramic prosthesis and megaprosthesis are in use for substitution of the defect in the distal radius following resection. Most authors advocate wrist arthrodesis following resection of distal radius and non vascularized fibular graft. Here we have analyzed the results of aggressive benign GCTs of the distal radius treated by resection and reconstruction arthroplasty using autogenous non-vascularized fibular graft.

Materials and Methods:

Twenty-four cases of giant cell tumor of the distal radius (mean age 32 years, mean follow-up 6.6 years) treated by en-bloc resection and reconstruction arthroplasty using autogenous non-vascularized ipsilateral fibular graft with a minimum followup of two years have been included in this retrospective study. Nineteen cases were of Campanacci grade III and five were of Grade II recurrence. The mean resected length of the radius was 9.5 (8-12) cm. Routine radiographs and clinical assessments regarding pain, instability, recurrence, hand grip strength and functional status were done at regular intervals and functional results were assessed using (musculoskeletal tumor society) MSTS-87 scoring.

Results:

Early radiological union at host-graft junction was achieved at mean 12.5 weeks, (range 12-14 weeks) and solid incorporation with callus formation was observed in mean 29 weeks (range 28-32 weeks) in all the cases. Satisfactory range of motion (mean 63%, range 52-78%) of the wrist was achieved in 18 cases. Grip strength compared to the contralateral hand was found to be 67% (range 58-74%). Functional results were excellent in six cases (25%), good in 14 cases (58.3%) and four (16.7%) cases had fair results. Soft tissue recurrence was seen in one patient. The most commonly encountered complication was fibulo-carpal subluxation (10 cases, 41.7%).

Conclusion:

Resection of the distal radius and reconstruction arthroplasty with non-vascularized proximal fibular graft is useful in preserving the functional movement and stability of the wrist as well as achieving satisfactory range of movement and grip strength.     

Single-incision chronic distal biceps tendon repair with tibialis anterior allograft

Purpose

Several techniques for chronic distal biceps tendon repair have been reported; however, the literature is sparse.

Methods

Seven male patients who underwent chronic distal biceps tendon reconstruction were retrospectively evaluated. All patients had significant retraction necessitating the use of an allograft for reconstruction. The procedure was done through a single incision using suture anchors and a tibialis anterior allograft. In each case, the graft was first fixed to the radial tuberosity with suture anchors, and then the allograft was sutured to the remnant of the native biceps tendon at 60° of elbow flexion. Patients were evaluated with the Mayo Elbow Performance Score (MEPS), Disabilities of Arm, Shoulder and Hand (DASH) scores and elbow range of motion (ROM).

Results

The average time from injury to surgery was 25 (12–56) weeks, and the average follow-up was 16 (minimum 12) months. Average postoperative elbow ROM was as follows: extension 4° (0–12°), flexion 134° (130–140°), pronation 82° (75–85°) and supination 80° (70–85°); average MEPS was 94 (80–100); average DASH score was 6.67 (0–19.8). One patient developed a lateral antebrachial cutaneous neuritis postoperatively that resolved by three months.

Conclusion

Though many reported techniques for chronic distal biceps tendon repair achieve satisfactory outcomes with limited complications, we present a technique with theoretical advantages of a single incision, use of suture anchors, use of a tibialis anterior allograft and tensioning after attachment of the graft to the radial tuberosity. In a series of complicated patients, early results were good to excellent.     

Distal radioulnar allograft reconstruction after giant cell tumor resection

Giant cell tumor of bone is considered to be a benign, locally aggressive lesion. When diagnosed early, it can be successfully treated with wide en bloc excision. No reports of complete distal radioulnar allograft reconstruction after en bloc excision of a distal ulnar lesion were found in the literature. We report a case of a distal ulnar giant cell tumor treated with wide en bloc excision and 2-stage allograft reconstruction and followed up for 40 months.     

Severe posttraumatic radiocarpal cartilage damage: first report of autologous chondrocyte implantation

Study design

Case report.

Clinical question

Traumatic articular cartilage defects predispose to secondary osteoarthritis accompanied by impairment or complete loss of function in the corresponding joint. On this account, the timely and correct diagnosis as well as the selection of an appropriate therapy for reconstruction of articular cartilage defects is important.

Methods

A 22-year-old healthy male patient with history of traumatic intra-articular distal radius fracture is presented with in the course detectable 4° cartilage damage in the fovea scaphoidea and into the fovea lunata. For the first time, autologous chondrocyte implantation by the use of an in situ polymerizable albumin–hyaluronic acid gel was performed to restore the articular cartilage.

Results

The assessment 6 months after autologous chondrocyte implantation using the standard DASH questionnaire for upper extremity pointed out an improvement in the patient outcome (DASH score pre-operative: 10.8 and 6 months post-operative: 7.5). The clinical examination also showed an improvement in the range of movement of the wrist without pain. The radiological control investigation (MRI- examination) of the wrist 6 months after implantation also revealed a good integration of the implant.

Conclusion

The case presented here demonstrates the first use of autologous chondrocyte implantation for cartilage reconstruction using an in situ polymerizable albumin–hyaluronic acid gel after traumatic cartilage lesion with 4° cartilage damage of the wrist in a 22-year-old non-smoking, active and healthy man. Initial results are promising in terms of mobility, pain and patient outcome. However, further clinical studies have to be performed with larger number of cases.     

Palmar multidirectional fixed-angle plate fixation in distal radius fractures: do intraarticular fractures have a worse outcome than extraarticular fractures?

Introduction

The results and complications using a palmar plate system with the possibility of multidirectional fixed-angle screw fixation (Aptus^® Radius 2.5 mm by Medartis^®) for the treatment of unstable distal radius fractures were evaluated in a single cohort study including 62 patients.

Patients

Patients with extra- and intraarticular fractures were evaluated separately. The mean follow-up was 14.7 months. Active wrist motion averaged 60.1° extension, 52.0° flexion, 86.3° pronation, and 84.6° supination. Grip strength averaged 89% of the contralateral wrist.

Results

There was no loss of the initial reduction with bony union in all cases. The mean DASH-score was 12.6 points. Postoperative complications included two extensor pollicis longus tendon ruptures, two median nerve compression syndromes, one complex regional pain syndrome, and one postoperative haematoma. In our series the results of the intraarticular fracture group were similar to the extraarticular fracture group. The complication rate, however, was substantially higher in the intraarticular fracture group.

Conclusion

We conclude that palmar plating with multidirectional fixed-angle screw insertion is an effective and useful treatment option, especially for complex intraarticular distal radius fractures.     

Distal radius fractures and the volar lunate facet fragment: Kirschner wire fixation in addition to volar-locked plating

Background

The volar lunate facet fragment of a distal radius fracture may not be stabilized with volar-locked plating alone due to the small size and distal location of the fragment. Identification and stabilization of this small fragment is critical as unstable fixation may result in radiocarpal and radioulnar joint subluxation. The addition of spring wire fixation with volar plating can provide stable internal fixation of this critical fracture fragment.

Methods

A retrospective review (2006–2011) identified nine patients with distal radius fractures with an associated volar lunate facet fragment that were treated with volar-locked plating and spring wire fixation of the volar lunate facet fragment. Radiographic indices, range of motion, grip strength, and postoperative Patient-related wrist evaluation (PRWE) scores were obtained to assess pain and function.

Results

All distal radius fractures healed, and the volar lunate facet fragment reduction was maintained. The mean follow-up was 54 weeks. Mean active range of motion was 46° wrist flexion, 51° wrist extension, 80° pronation, and 68° supination. The mean grip strength was 21 Kg, achieving 66 % of the uninjured limb. The average PRWE score was 17. No patient required removal of hardware or had evidence of tendon irritation.

Conclusions

The addition of spring wire fixation to volar-locked plating provided stable fixation of the volar lunate facet fragment of distal radius fractures without complication. This technique addresses a limitation of volar-locked plating to control the small volar lunate facet fragment in distal radius fractures otherwise amenable to volar plating.

Level of Evidence

A retrospective case series, Level IV.     

复杂性骨巨细胞瘤的外科治疗初步随访分析

目的提出复杂性骨巨细胞瘤的定义并回顾分析其治疗方法和结果，为减少其术后复发提供临床依据。方法2001年4月～2005年4月共治疗22例复杂性骨巨细胞瘤患者。男11例，女11例。年龄15～60岁。肿瘤位于股骨下段10例，胫骨上段5例，股骨近端2例，肱骨近端2例，髋骨2例和桡骨远端l例。所有患者按Campanicci’s分级，Ⅱ级4例，余均为Ⅲ级。行肿瘤边缘性切除或扩大性切除加大段同种异体骨与关节移植14例，肿瘤型人工关节置换8例。结果将骨巨细胞瘤已穿破骨皮质和／或侵犯至关节软骨下，已发生病理性骨折，瘤组织活检显示肿瘤细胞具有较强的侵袭性和肿瘤已有一次或多次复发定义为复杂性骨巨细胞瘤。所有患者获随访6～48个月，平均23个月。2例患者分别于术后8个月和11个月复发，分别经截肢和放射治疗后好转，复发率为9％。人工关节置换的关节功能优于同种异体骨移植；不带关节的同种异体骨移植的关节功能优于带关节的同种异体骨移植。所有移植的同种异体骨均获得不同程度的骨愈合。结论对定义为复杂性骨巨细胞瘤患者采用上述方法进行治疗，可获得较低的肿瘤复发率和一定范围的关节功能，是临床上治疗复杂性骨巨细胞瘤可采用的一种方法。     

Ulnar shortening osteotomy for malunited distal radius fractures: results of a 7-year follow-up with special regard to the grade of radial displacement and post-operative ulnar variance

Introduction

The treatment of ulnar-sided wrist pain after malunited distal radius fractures remains controversial. Radial corrective osteotomy can restore congruity in the distal radioulnar joint (DRUJ) as well as adequate length of the radius. Ulnar shortening osteotomies leave the radius’ angular deformities unchanged, risking secondary DRUJ osteoarthritis. We supposed that, even within the widely accepted limit of 20°, a greater angulation of the radius in the sagittal plane correlates with a higher rate of DRUJ osteoarthritis. Furthermore, we suspected worse results from an ulna shortened to a negative rather than a neutral or positive ulnar variance.

Materials and methods

For this retrospective study, we reviewed 23 patients a mean 7.2 (range 5.6–8.5) years after ulnar shortening osteotomy for malunion of distal radius fractures. We compared 14 patients with up to 10° dorsal or palmar displacement from the normal palmar tilt of 10° to 9 patients with more than 10° displacement, and 15 patients whose post-operative ulnar variance was neutral or positive to 8 who had a negative one.

Results

Ulnar-sided wrist pain decreased enough to satisfy 21 of the 23 patients. Clinical results tended to be better when radial displacement was minor and when post-operative ulnar variance was positive or neutral. A shorter ulna significantly increased the rate of DRUJ osteoarthritis, whereas a greater degree of radial displacement only increased the rate slightly.

Conclusions

Radial corrective osteotomy should be discussed as alternative when displacement of the radius in the sagittal plane exceeds 10°. The ulna should be shortened moderately to reduce the risk of osteoarthritis in the distal radioulnar joint.     

Treatment of giant cell tumor of distal radius with limited soft tissue invasion: Curettage and cementing versus wide excision

Background

Intralesional curettage and adjuvant versus wide en bloc excision (WEE) as the best treatment method of giant cell tumor (GCT) of distal radius with limited soft tissue extension is a controversial topic.

En bloc excision and autogenous fibular reconstruction for aggressive giant cell tumor of distal radius: a report of 12 cases and review of literature

Introduction  

Giant cell tumor (GCT) of distal radius follows a comparatively aggressive behaviour. Wide excision is the management of choice, but this creates a defect at the distal end of radius. The preffered modalities for reconstruction of such a defect include vascularized/non-vascularized bone graft, osteoarticular allografts and custom-made prosthesis. We here present our experience with wide resection and non-vascularised autogenous fibula grafting for GCT of distal radius.