Limited Arthrodesis of the Wrist for Treatment of Giant Cell Tumor of the Distal Radius

• Published in: The Journal of hand surgery (American ed.) Vol. 38; no. 8; pp. 1505 - 1512
• Main Authors: Flouzat-Lachaniette, Charles-Henri, MD, Babinet, Antoine, MD, Kahwaji, Antoine, MD, Anract, Philippe, MD, Biau, David-Jean, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2013
• Subjects: Adult; Arthrodesis - methods; Bone Neoplasms - diagnostic imaging; Bone Neoplasms - pathology; Bone Neoplasms - surgery; Bone Transplantation - methods; Cohort Studies; Combined Modality Therapy; en bloc resection; Female; Follow-Up Studies; fracture; Giant Cell Tumor of Bone - diagnostic imaging; Giant Cell Tumor of Bone - pathology; Giant Cell Tumor of Bone - surgery; Humans; Male; Middle Aged; nonunion; Orthopedics; Prospective Studies; Radiography; Radius; Range of Motion, Articular - physiology; Reconstructive Surgical Procedures - methods; Recovery of Function; recurrence; Risk Assessment; Structural nonvascularized bone graft; Time Factors; Transplantation, Autologous; Treatment Outcome; Wrist Joint - diagnostic imaging; Wrist Joint - pathology; Wrist Joint - surgery; recurrence; Structural nonvascularized bone graft; nonunion; en bloc resection; fracture
• ISSN: 0363-5023; 1531-6564
• DOI: 10.1016/j.jhsa.2013.04.026

Purpose To present the functional results of a technique of radiocarpal arthrodesis and reconstruction with a structural nonvascularized autologous bone graft after en bloc resection of giant cell tumors of the distal radius. Methods A total of 13 patients with a mean age of 37 years with aggressive giant cell tumor (Campanacci grade III) of distal radius were managed with en bloc resection and reconstruction with a structural nonvascularized bone graft. The primary outcome measure was the disability evaluated by the Musculoskeletal Tumor Society rating score of limb salvage. Secondary outcomes included survival of the reconstruction measured from the date of the operation to revision procedure for any reason (mechanical, infectious, or oncologic). Other outcomes included active wrist motion and ability to resume work. Results Mean follow-up period was 6 years (range, 2–14 y). The median arc of motion at the midcarpal joint was 40°, median wrist flexion was 20°, and median extension was 10°. The median Musculoskeletal Tumor Society score based on the analysis of factors pertinent to the patient as a whole (pain, functional activities, and emotional acceptance) and specific to the upper limb (positioning of the hand, manual dexterity, and lifting ability) was 86%. Five patients underwent a second surgical procedure. The cumulative probability of reoperation for mechanical reason was 31% at similar follow-up times at 2, 5, and 10 years. Conclusions This technique provided a stable wrist and partially restored wrist motion with limited pain. However, further surgical procedures may be necessary to reach this goal. Type of study/level of evidence Therapeutic IV.