Functional outcome following excision of tumours of the distal radius and reconstruction by autologous non-vascularized osteoarticular fibula grafting

The distal radius and its articulations clearly have a vital role in the functional abilities of the hand and wrist. The treatment of tumours of the radius, therefore, needs to achieve satisfactory clearance of the lesions while also preserving as much wrist function as possible. We have employed osteoarticular autologous fibula grafts to reconstitute the distal radius after tumour excision. Since 1992, 13 patients have been treated by this technique for tumours of the distal radius. The group comprised patients with primary and recurrent giant cell tumours of bone, osteosarcoma, chondrosarcoma and Ewing's tumour. This technique achieves a satisfactory functional result without compromise of the prognosis for the tumour.     

Functional outcome following bone transport reconstruction of distal tibial defects

BACKGROUND: Little has been written about the functional outcome of patients treated with bone transport to reconstruct a distal tibial defect. The aim of this study was to investigate the functional capabilities of patients who had undergone reconstruction with distraction osteogenesis for the treatment of a distal tibial defect in one lower limb. METHODS: At least eighteen months after completion of treatment, eight patients who had no pain and were able to walk and climb stairs without difficulty performed isometric ankle plantar flexion maximum voluntary contractions while the electromyographic activity of the tibialis anterior and triceps surae muscles was simultaneously recorded. Seven of the patients also underwent gait analysis. Data for the involved limb were compared with those collected for the contralateral limb. RESULTS: During gait, stance time (p = 0.01), the plantar flexion angular displacement and peak moment developed during the second half of stance (p < 0.046), and the amount of ankle power generated (p = 0.02) were significantly decreased in the involved limb compared with the contralateral limb. Similar decreases were observed in the plantar flexion (p = 0.01) and dorsiflexion (p = 0.01) maximum voluntary contractions and the corresponding electromyographic activity (p = 0.01). CONCLUSIONS: These results suggest that adaptive changes had occurred at the level of the transported muscles, which affected both routine and maximal effort capabilities. These findings contribute to our understanding of the functional limitations of patients who have undergone bone transport with its obligatory shortening of muscle length.     

Ulnar translocation after excision of giant cell tumour of distal radius

Translocation of the ipsilateral ulna has been carried out in six cases after radical resection of a giant cell tumour of the distal radius. The carpo-ulnar junction united readily in all cases. Union of the radio-ulnar junction is often delayed, but this can be overcome by the addition of cancellous grafts at the time of ulnar translocation. All the patients had very good forearm rotation and an acceptable appearance. There were no significant complications.     

Osteoarticular allograft reconstruction of the distal radius after bone tumour resection

Resection of the distal end of the radius is indicated in the treatment of locally aggressive primary benign and malignant bone tumours. The aim of this study was to evaluate the technique of osteoarticular allograft reconstruction of this bone defect. We analysed 12 patients retrospectively with a minimum follow-up of 2 years (range 26-145 months, median 52 months). Three patients had a malignant tumour and nine had a giant cell tumour. The patients ages ranged from 13 to 65 years. The mean resected length of the radius was 6.6 (range 4-14)cm. Non-union of the osteotomy line was diagnosed 6 months after surgery in one case and needed bone grafting. Distal radio-ulnar joint instability was observed in eight cases. Subchondral bone alterations and joint narrowing were present in all cases but were painful in only one patient. The mean range of motion was 51 degrees of flexion and 37 degrees of extension.     

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...     

Functional outcome following extensor synovectomy and excision of the distal ulna in patients with rheumatoid arthritis

We prospectively measured hand and wrist function in rheumatoid patients undergoing excision of the distal ulna. Range of motion, visual analogue pain scores and grip strength were measured in 22 wrists, and the Jebsen hand function test was administered to seven patients, preoperatively and at 3 and 12 months. At 1 year there were improvements in forearm pronation (P=0.04), supination (P=0.03) and wrist extension (P=0.02), but a reduction in flexion (P=0.009). Active radial deviation was reduced and ulnar deviation increased. There was a significant improvement in grip strength (P=0.05) and reduction in wrist pain (P=<0.0001). At 1 year the Jebsen hand function test showed improvements in simulated feeding, stacking checkers, and lifting large empty cans. Excision of the distal ulna in rheumatoid patients results in an improvement in some aspects of hand function.     

Functional outcome of arthroscopic assisted fixation of distal radius fractures

Background:

Many studies in literature have supported the role of wrist arthroscopy as an adjunct to the stable fixation of unstable intraarticular distal radial fractures. This article focuses on the surgical technique, indications, advantages, and results using wrist arthroscopy to assess articular reduction and evaluates the treatment of carpal ligament injuries and triangular fibrocartilage complex (TFCC) injuries in conjunction with the stable fixation of distal radial fractures.

Materials and Methods:

We retrospectively evaluated 27 patients (16 males and 11 females), who underwent stable fixation of intraarticular distal radial fractures with arthroscopic evaluation of the articular reduction and repair of associated carpal injuries. As per the AO classification, they were 9 C 1, 12 C2, 2 C3, 3 B 1, and 1 B2 fractures. The final results were evaluated by modified Mayo wrist scoring system. The average age was 41 years (range: 18-68 years). The average followup was of 26 months (range 24-52 months).

Results:

Five patients needed modification of the reduction and fixation after arthroscopic joint evaluation. Associated ligament lesions found during the wrist arthroscopy were TFCC tears (n=17), scapholunate ligament injury (n=8), and luno-triquetral ligament injury (n=1). Five patients had combined injuries i.e. included TFCC tear, scapholunate and/or lunotriquetral ligament tear. There were 20 excellent, 3 good, and 4 fair results using this score.

Conclusion:

The radiocarpal and mid carpal arthroscopy is a useful adjunct to stable fixation of distal radial fractures.     

Recurrent giant-cell tumour after en bloc excision of the distal radius and fibular autograft replacement

We report two patients, each with a giant-cell tumour of the distal radius treated by curettage and bone grafting. Local recurrence of the tumour occurred in the autograft and in the adjacent soft tissues in both patients, and was successfully treated by local excision; one patient also had radiation therapy. Both remain well 20 years and five years later.     

Reconstruction of distal radius by fibula following excision of grade III giant cell tumour: Follow-up of 18 cases

The purpose of this study was to evaluate the long-term results of vascularised fibular graft for reconstruction of the wrist after excision of grade III giant cell tumour in the distal radius. From January 1998 to September 2003, 18 patients with wrist defects due to distal radius grade III giant cell tumour resection were treated with vascularised fibular graft and were followed-up. The limb function was restored to an average 80% of normal function and bone union was achieved within six months in 18 patients with vascularised fibular graft. MSTS score averaged 25.6 and ranged between 21 and 29; Mayo wrist score averaged 56 with a range from 40 to 65. It is appropriate to use the head of the fibula as a substitute for the distal radius. The healing of vascularised fibular graft is very quick and without bone resorption. Thus, in the procedure for reconstruction and limb salvage after bone tumour resection of distal radius, the free vascularised fibular graft with fibular head is an ideal substitute.     

Reconstruction of the distal radius by fibula following excision of giant cell tumor

Thirty giant cell tumors of the distal radius were excised and reconstructed using a nonvascular fibular osteoarticular autograft. Four different surgical techniques for stabilization were used. There were ten recurrences, which could not be correlated with Campanacci's radiological or Jaffe's histological grading. Twenty cases without recurrence were followed up over 1.5-25.5 (average 8.5) years. Average time for incorporation of the graft was 5.2 months. The surgical technique using a radiofibular plate and K wire through the wrist had a low nonunion rate, no graft related complications, good range of movement, and good hand functions.     

Functional outcome and complications following two types of dorsal plating for unstable fractures of the distal part of the radius

BACKGROUND: There is a paucity of data in the literature documenting the functional outcomes for patients who have been managed with a dorsal plate because of a distal radial fracture. The purpose of the present study was to determine the functional outcome and complications following dorsal plating for dorsally displaced, unstable fractures of the distal part of the radius. METHODS: The records of all patients who had been managed at our institution with dorsal plating because of a comminuted, dorsally displaced fracture of the distal part of the radius were reviewed. Patients with less than twelve months of follow-up were excluded from the study. Outcomes were evaluated at the time of the latest follow-up with use of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the Gartland and Werley scoring system. RESULTS: Twenty-eight patients (nineteen women and nine men) with a mean age of forty-two years formed the basis of the study. The mean duration of follow-up was twenty-one months. Nineteen patients had been treated with a Synthes pi plate, and nine had been treated with a low-profile plate. There were no instances of loss of reduction, malunion, or nonunion. The mean score on the DASH questionnaire was 14.5 points. All patients had an excellent (nineteen patients) or good (nine patients) result according to the scoring system of Gartland and Werley. Nine patients had postoperative complications requiring repeat surgical treatment for hardware removal or extensor tendon reconstruction. All nine reoperations were performed in patients who had been treated with a Synthes pi plate, while none were performed in patients who had been treated with a low-profile plate (p < 0.025). Four complications occurred in patients who had been treated with a titanium plate, and five complications occurred in patients who had been treated with a stainless-steel plate (p = 0.71). CONCLUSIONS: Patients in whom a dorsally displaced distal radial fracture is treated with a titanium or stainless-steel Synthes pi plate have a significantly increased risk of complications compared with those in whom such a fracture is treated with a low-profile plate. Regardless of the type of plate used, all of the patients in the present study had a good or excellent long-term functional outcome.     

肩关节肿瘤切除和重建后的患肢功能观察

目的 肩关节肿瘤切除后,探讨不同重建方式的患肢长期功能。方法回顾性分析32例肩关节肿瘤保肢患者的临床资料。重建方式包括：8例一期肩关节融合,7例假体异体骨复合物,6例功能性间隔物,5例未行重建或悬吊术,3例假体,2例带血管蒂腓骨和1例异体骨。结果23例生存患者平均随访81个月。不同重建方式的功能评分分别为：一期肩关节融合为87％,主动运动优良,肩部有力;假体异体骨复合物为79％,间隔物为66％,未重建为85％,假体为60％和带血管蒂腓骨为73％。结论肩关节肿瘤的重建方式是根据切除范围和患者的实际需要来选择。如外展肌群无法重建,肩关节融合的功能良好,肩部有力;如果外展肌群可以重建,假体异体骨复合物功能较好。     

Hernia mesh prevent dislocation after wide excision and reconstruction of giant cell tumor distal radius

Giant cell tumor(GCT) remains as major health problem. GCT which located at the lower end of the radius tends to be more aggressive. Wide excision and reconstruction of the wrist in stage 3 of distal radius GCT lesion is an optimal modality to prevent tumor recurrence. However, dislocation often occurs as its complication. We are reporting patient with GCT of distal radius treated with wide excision and reconstruction using nonvascularized fibular graft and the addition of hernia mesh. Circumferential non-absorbable polypropylene hernia mesh was applied, covered radioulnar joint and volar aspect of radius, and served as additional support to prevent dislocation. During five years and two months of follow-up, we found no dislocation in our patient. Furthermore, good functional outcome was obtained. Our finding suggests that the addition of hernia mesh after wide excision and reconstruction with nonvascularized fibular graft may benefit to prevent dislocation and provides an excellent functional outcome.     

The use of osteo-articular allografts for reconstruction after resection of the distal radius for tumour

Several techniques have been described to reconstruct a mobile wrist joint after resection of the distal radius for tumour. We reviewed our experience of using an osteo-articular allograft to do this in 17 patients with a mean follow-up of 58.9 months (28 to 119). The mean range of movement at the wrist was 56° flexion, 58° extension, 84° supination and 80° pronation. The mean ISOLS-MSTS score was 86% (63% to 97%) and the mean patient-rated wrist evaluation score was 16.5 (3 to 34). There was no local recurrence or distant metastases. The procedure failed in one patient with a fracture of the graft and an arthrodesis was finally required. Union was achieved at the host-graft interface in all except two cases. No patient reported more than modest non-disabling pain and six reported no pain at all. Radiographs showed early degenerative changes at the radiocarpal joint in every patient. A functional pain-free wrist can be restored with an osteo-articular allograft after resection of the distal radius for bone tumour, thereby avoiding the donor site morbidity associated with an autograft. These results may deteriorate with time.     

Predicting the outcome of distal radius fractures

There are myriad factors that affect patient satisfaction following a distal radius fracture, including anatomic alignment, age, motion, pain,and hand dominance to name a few. The seeming contradictions in the literature serve to illustrate that individual outcomes are not entirely predict-able because of the different functional demands,expectations, and pain tolerance for each patient.Elderly populations may tolerate greater degrees of residual deformity because of a more sedentary lifestyle. Unrecognized intracarpal pathology may account for poor results despite acceptable radiographic alignment. Possessing a knowledge of the predictive factors that affect adversely the functional outcome, however, does allow the surgeon to manage complications proactively to maximize the potential for an acceptable end result.     

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.     

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.     

Functional outcome of en bloc resection and osteoarticular allograft reconstruction with locking compression plate for giant cell tumor of the distal radius

Background

Giant cell tumors of the distal radius at Campanacci grade III are particularly challenging to treat. We have treated 15 cases of giant cell tumor of the distal radius by en bloc excision and osteoarticular allograft reconstruction with locking compression plate (LCP). The purpose of this study was to assess the intermediate outcomes of all patients treated with this surgery.

Methods

From July 2002 to January 2009, we followed up 15 patients with giant cell tumors of the distal radius who were treated with en bloc excision and osteoarticular allograft reconstruction with LCPs that were long enough to approach the distal end of the allograft. All of the cases were evaluated based on clinical and radiologic examinations, the passive range of motion of the wrist joint, complications, Mayo wrist score, and short form (SF)-36.

Results

The clinical follow-up time after reconstruction averaged 5.2 years. The mean resected length of the radius was 8.1 cm. One patient had tumor recurrence in the soft tissues after 3 years (recurrence rate 6.67 %). No patient had allograft bone fracture, nonunion, or metastases. Subchondral bone alterations and joint narrowing were present in all cases, with 1 patient suffering from the pain, but the pain could be endured without the need for analgesics. The average range of motion of the wrist was 46.7° of dorsiflexion, 33.3° of volar flexion, 61.3° of supination, and 72.3° of pronation. The mean Mayo wrist score was 70 and the mean modified SF-36 score was 71.

Conclusions

En bloc excision and osteoarticular allograft reconstruction with an appropriate LCP for a Campanacci grade III giant cell tumor of the distal radius result in a reasonable functional outcome at intermediate follow-up evaluation. This method can excise the tumor integrally with a low rate of recurrence, good function, and a satisfactory range of motion.