engleski

Allograft reconstruction and wrist fusion for a giant cell tumor of the distal radius. Case report.

Goal: Present a case of distal radius resection due to giant cell tumor (GCT) followed by reconstruction with structural bone allograft and wrist fusion. Material and methods: We report the case of a 66-year old man in whom, in other institution, intralesional curettage and grafting due to GCT of the distal radius was done twice (1999 and 2001). After second recurrence of the tumor, in 2011, diagnostic evaluation followed with biopsy, were preformed in our Department. After pathohistological confirmation, we did en- bloc resection of the distal radius including proximal row carpectomy and temporary reconstruction with cement spacer and K-wire fixation. Five months later we removed cement spacer and preformed reconstruction with a structural bone allograft and wrist fusion. Allograft was fixed with two 3.5 mm DC plates and screws. One DC plate was used proximally for allograft fixation to remnant radius. Second was used for distally allograft fixation to second metacarpal bone and remnant carpal bones, which in combination with autologous corticospongioplasty result with wrist fusion. Results: Eight months postoperatively, patient is feeling well, has no pain, and has a normal hand grip and fingers function. Control X-rays show adequate bone remodeling at the site of osteosynthesis and wrist fusion, with no signs of tumor recurrence. DASH score during eight month follow up improves to 32.5, compared to 66.5 preoperatively. Conclusion: Although classified as benign aggressive, GCT of the distal radius carry a relatively higher rate of recurrence, and more frequently metastasize than GCT at other locations. Anatomically sensitive area of the wrist joint is difficult to manage with a wide resection without morbidity. En-bloc resection with allograft reconstruction including wrist fusion seems like a viable option. In such cases function of the hand can be expected as good, with no major difficulties in everyday activities.

giant cell tumor, distal radius, reconstruction

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