The reconstruction after en-bloc resection of giant cell tumors at the distal radius: A systematic review and meta-analysis of the ulnar transposition reconstruction technique |
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| Affiliation: | 1. Division of Hand and Microsurgery, Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Chinese University of Hong Kong, 5/F, Lui Che Woo Clinical Sciences Building, 30-32 Ngan Shing Street, Shatin, NT, Hong Kong SAR;2. Division of Hand and Microsurgery, Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Chinese University of Hong Kong, Room 09A31, Main Clinical Block and Trauma Centre, 30-32 Ngan Shing Street, Shatin, NT, Hong Kong SAR;3. Division of Hand and Microsurgery, Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Chinese University of Hong Kong, The Club Lusitano, 16/F, 16 Ice House Street, Central, Hong Kong SAR;1. Department of Pathology, All India Institute of Medical Sciences, New Delhi, India;2. Senior Research Associate, Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India;3. Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India;1. Department of Orthopaedics, AIIMS, New Delhi, India;2. Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, India;1. Maulana Azad Medical College, BSZ Marg, New Delhi, India;2. Robert Jones and Agnes Hunt Hospital, Oswestry SY10 7AG, UK;1. Service d’orthopédie, hôpital Roger-Salengro, CHRU de Lille, rue du Professeur-Emile-Laine, 59037 Lille cedex, France;2. Laboratoire d’anatomie, faculté de médecine Henri-Warembourg, Université de Lille 2, place de Verdun, 59045 Lille cedex, France |
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| Abstract: | BackgroundEn-bloc resection of giant cell tumors (GCTs) of the distal radius remains the mainstay treatment for those with high-graded lesions. Several techniques have been described for reconstruction of the resected segment, of which transposition of the ipsilateral ulna is scarcely reported.ObjectivesTo investigate the efficacy and safety of the different techniques of ulnar translocation following GCTs total resection.MethodsA systematic review and meta-analysis was conducted concerning the reported functional outcomes, including grip strength, range of forearm motion, functional scores, and new bone formation, as well as postoperative complications, such as delayed union, local recurrence and metastasis. The ranges of functional outcomes were reviewed and the pooled prevalence rates of complication and their respective 95% confidence intervals (95% CIs) were computed.ResultsIn a total of 12 studies, 90 patients (51.1% males, 84.8% had Campanacci grade III tumors) underwent five different reconstruction techniques. As compared to the normal side, the mean grip strength in the affected side ranged between 59 and 71%. The average union time was 1–8 months, while delayed union was reported in 50% (95% CI, 15.35 to 84.65) of patients whom their grafts were fixed with Steinmann pins. The shortest union time, the highest forearm supination and pronation degrees, new bone formation at the ulnar stump, and the highest functional scores were reported following a modified distal radius plate technique. Using a dynamic compression plate and a clover leaf plate provided lower, but considerable, functional outcomes.ConclusionUlnar translocation following GCT en-bloc resection warrants additional investigation in large cohorts and well-designed studies to corroborate the promising outcomes presented in this review. |
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| Keywords: | Giant cell tumors Distal radius Ulnar transposition |
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