Nonvascularized fibular autograft to treat recurrent giant cell tumor of the distal radius

We report a 22-year-follow-up of a giant cell tumor treated by en bloc excision of the distal radius and replacement with an autogenous fibular bone graft. There has been no recurrence of the tumor. The patient has a good functional result and is free of pain except with extremes of wrist motion.     

Resection arthrodesis for the management of aggressive giant cell tumor of the distal femur

Background:

Giant cell tumors (GCTs) of bone are aggressive benign tumors. Wide resection is reserved for a small subset of patients with biologically more aggressive, recurrent, and extensive tumors. Wide resection and mobile joint reconstruction are preferable for treating tumors around the knee. In certain situations, resection arthrodesis or an amputation is suggested. In this prospective study we report the outcome of 8 patients of aggressive GCT of lower end of femur treated with resection arthrodesis.

Materials and Methods:

Eight patients with mean age of 37.25 years (range 30–45 years) with Campanacci Grade III (Enneking stage III) giant cell tumors at the distal femur were treated with wide resection and arthrodesis using dual free fibular graft and locked intramedullary nail from January 2003 to January 2008. There were four males and four females patients. The mean follow-up was 48.75 months (range 30–60 months). The functional evaluation was done using the standard system of musculoskeletal tumor society with its modification developed by Enneking et al.

Results:

At the final follow up the functional score ranged from 20 to 27 out of total score of 30. Graft union was achieved in all cases in a duration mean of 14.5 months (range 12-20 months).One case required secondary bone graft due to delayed union, and one case had superficial wound infection which healed on systemic antibiotics. At final followup, all the patients were disease free.

Conclusion:

Wide resection and arthrodesis in aggressive GCTs of the distal femur with involvement of all muscle compartments is a good treatment option. Resection arthrodesis offers a biological reconstruction alternative to amputation in a special group of patients when extensive resection precludes mobile joint reconstruction.     

右踝关节内弥漫性腱鞘巨细胞瘤1例

患者,女,42岁,因右踝关节外伤3年,右踝肿块2年入院.患者3年前行走时不慎伤及右踝部,疼痛、肿胀.X线片:右踝骨与关节正常.给予对症处理后痊愈.患者1年后发现右踝关节外侧局部隆起无疼痛,行走时稍感不适,在当地医院诊断为"右踝关节囊肿",未治疗.右踝外侧肿块逐渐增大,并在右踝前侧及内侧发现肿块,内踝皮肤血管增粗.     

腓骨近端移植治疗桡骨远端骨巨细胞瘤:关节融合与成形的比较

[目的]回顾性比较研究桡骨远端骨巨细胞瘤切除后采用腓骨近端移植行腕关节成形术和腕关节部分融合术的临床疗效。[方法]2006年2月~2012年5月,采用桡骨远端瘤段切除自体腓骨移植重建腕关节方法治疗16例桡骨远端Ⅱ、Ⅲ级(Campanacci分级)骨巨细胞瘤患者。男8例,女8例,年龄19~55岁,平均35.40岁。病程1个月~2年,主要症状为关节疼痛、肿胀及活动受限。9例行部分腕关节融合术,7例行腕关节成形术。[结果]术后切口均一期愈合。所有患者均获随访,随访时间4.00~10.20年,平均6.40年。1例融合病例出现腓骨-舟月骨界面不愈合,排除出该研究。随访期间所有病例肿瘤无复发。融合术病例:腕关节屈伸(55.63±6.78)°,前臂旋转(126.25±14.58)°,平均握力为对侧的(75.14±5.74)%,MSTS评分平均为(25.5±0.76)分。成形术病例:屈伸(72.86±15.24)°;前臂旋转(140±14.72)°,平均握力为对侧的(60.62±11.83)%,MSTS评分平均为(25.86±1.46)分。前臂旋转功能方面两组差异无统计学意义;腕关节屈伸活动成形组优于融合组,而手腕握力融合组优于成形组,差异有统计学意义;但两组MSTS评分差异无统计学意义。[结论]瘤段切除自体腓骨近段移植重建腕关节是治疗桡骨远端骨巨细胞瘤的良好方法,腕关节成形术和腕关节部分融合术都能保留一定的腕关节功能,都是安全、有效的重建方式。应根据患者的实际情况作出个性化选择。     

Immediate tibiocalcaneal arthrodesis with interposition fibular autograft for salvage after talus fracture: a case report

Treatment goals in the operative management of talus fractures include prompt, anatomic, open reduction with rigid internal fixation; functional outcome is measured by degree of arthrosis, pain, range of motion, limb length, cosmesis, and return to premorbid activities. If restoration of the articular surfaces is precluded secondary to comminution, immediate and/or staged reconstructive salvage procedures must be considered. This report describes an immediate reconstructive procedure for salvage after a comminuted talus fracture with an ipsilateral tibia fracture. A standard antegrade tibial nail extending into the calcaneus was selected to stabilize both fracture sites. The technique of tibiocalcaneal arthrodesis using interposition fibular autograft and intramedullary fixation is presented as a unique treatment option.     

Vascularized fibular graft after excision of giant cell tumor of the distal radius. A case report

Although hemiarthroplasty of the wrist using vascularized proximal fibula has been described often, long term results with documentation of results are insufficient. A case of giant cell tumor of the distal radius with remarkable extraskeletal extension is reported. Vascularized fibula including its proximal head was used to replace the defect created after en bloc resection of the tumor. There was no deterioration in radiographic findings or function of the new joint at the time of the 10-year followup. Satisfactory range of motion of the wrist and the forearm was maintained. There was no instability in the joint, and grip strength measured 65% of the opposite side. Postoperative magnetic resonance imaging showed survival of the whole graft, including the subchondral portion. In addition to thorough revascularization of the graft, appropriate soft tissue reconstruction using dynamic tendon transfer contributed to the success. When these requirements are fulfilled, the graft can provide a functional and durable result. Although this is a single experience, the authors recommend wrist arthroplasty, rather than arthrodesis, in carefully selected patients.     

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.     

Functional outcome in giant cell tumor of distal radius treated with excision and fibular arthroplasty: a case series

European Journal of Orthopaedic Surgery & Traumatology - Giant cell tumor (GCT) of bone is a locally aggressive benign neoplasm that is associated with a wide spectrum of biological activity...     

Endoprosthetic replacement of the distal tibia and ankle joint for aggressive bone tumours

Below knee amputation remains the treatment of choice for most patients with aggressive tumours of the distal tibia. We report the clinical and functional outcome of limb preserving surgery and endoprosthetic reconstruction of the distal tibia and ankle joint in five patients who declined amputation. The mean age was 32 years. Two had osteosarcoma, one Ewing’s sarcoma, leiomyosarcoma and Giant cell tumour. Three patients developed significant complications including local recurrence, wound dehiscence and infection, and fibula impingement. Despite these complications the patients declined amputation even in the presence of significant discomfort. Early function was excellent in all patients but deteriorated with time. The patients still maintained an Enneking Score of more than 50%. Some patients are unwilling to undergo amputation for aggressive tumours of the distal tibia. For these, excision and reconstruction with endoprosthesis allow early functional recovery but there is significant medium term morbidity and functional deterioration.

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Résumé  L’amputation au dessous du genou reste le traitement de choix pour la plupart des patients présentant des tumeurs agressives au niveau de l’extrémité distale du tibia. Nous rapportons ici les résultats cliniques et fonctionnels de 5 patients qui, ayant refusé toute amputation à ce niveau, ont bénéficié d’une chirurgie conservatrice et d’une reconstruction prothétique de l’extrémité inférieure du tibia et de la cheville. L’age moyen était de 32 ans. Deux patients présentaient un ostéosarcome; les autres présentaient un sarcome d’Ewing, un leiomyo-sarcome et une tumeur à cellules géantes. Trois patients ont présenté des complications sérieuses: récidive locale, désunion et infection, conflit au niveau de la fibula. Malgré ces complications aux conséquences fonctionnelles lourdes, tous les patients ont refusé l’amputation. Le résultat fonctionnel précoce a été excellent pour tous les patients mais s’est détérioré avec le temps. Certains patients refusent de subir une amputation pour une tumeur agressive de l’extrémité inférieure du tibia. Pour ces patients, l’excision et la reconstruction à l’aide d’endo-prothèses permettent d’obtenir un bon résultat fonctionnel précoce cependant la morbidité ainsi que la détérioration fonctionnelle avec le temps reste importante.

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Accepted: 16 August 1999     

Supercharged free fibula for complex ankle arthrodesis: a case report

We report the successful use of a supercharged free fibula for tibial reconstruction and ankle arthrodesis. A 28-year-old woman underwent resection of a giant cell tumor of the distal tibia and reconstruction using a methyl methacrylate cement spacer 12 years prior. The spacer eroded into her ankle joint causing significant pain with ambulation. Therefore, she required ankle arthrodesis but lacked distal tibia bone stock. The ipsilateral fibula was harvested for reconstruction and transferred on its distal blood supply into the bony tibial defect. The proximal blood supply of the fibula flap was then anastomosed to the posterior tibial vessels to supercharge the blood supply. An Ilizarov was placed for external fixation. The combination of a supercharged free fibula and stable external fixation for tibial reconstruction led to timely bony union and ambulation, as well as avoiding the potential complications that can occur with other reconstructive options.     

Bilateral giant cell tumour of the distal radius: a case report

A case of bilateral distal radius giant cell tumour of bone is reported. Each lesion appears to have arisen de novo rather than as a metastasis.     

Simple bone cyst of the distal tibia: a case for ankle arthroscopy.

Intraarticular ankle anatomy may be better visualized arthroscopically than with an arthrotomy. Ankle arthroscopy was crucial in locating a simple bone cyst and directing therapeutic curettage of the lesion.     

A giant cell tumor of the thumb: a case report

Giant cell tumors of the flexor sheath are the second most common tumors of the hand. We present a case that is unusual in the extent of the tumor and the pronounced bony invasion, which is rare. Preoperative diagnosis was complicated by a history of gout in our patient.     

Giant-cell tumors in the distal end of the radius. Treatment by resection and fibular autograft interpositional arthrodesis

Eighteen giant-cell tumors in the distal end of the radius were treated by block resection and arthrodesis of the wrist utilizing a fibular autograft. The mean length of follow-up was 7.1 years. Local recurrence occurred in five patients, and one patient died of pulmonary metastases. In five patients, non-union developed between the graft and the radius. Three patients sustained a fracture of the graft. No patient had a pseudarthrosis. The average grip strength was 40 per cent of that of the unaffected hand. Pain was absent or slight. No patient required an amputation.     

Distal radioulnar joint prosthesis for the treatment of giant cell tumor of the distal ulna: a case report and literature review

Giant cell tumor (GCT) of the distal end of the ulna is an uncommon site for primary bone tumors. When it occurs, en-bloc resection of the distal part of the ulna with or without reconstruction stabilization of the ulnar stump is the recommended treatment. We present a case of a 56-year-old man with a GCT of the distal ulna treated successfully with an en-bloc resection of the distal ulna with reconstruction using radioulnar joint prosthesis. Although the experience with this type of treatment is limited, implantation of a metallic prosthesis to replace the distal part of the ulna can also be considered as a salvage procedure for the treatment of this difficult pathology.