A Newer Technique of Distal Ulna Reconstruction Using Proximal Fibula and TFCC Reconstruction Using Palmaris Longus Tendon following Wide Resection of Giant Cell Tumour of Distal Ulna

Elango Mariappan,Justin Moses,Pragash Mohanen

doi:10.1155/2013/953149

Abstract

Giant cell tumour of the bone (GCT) is a rare locally aggressive primary bone tumour with an incidence of 3% to 5% of all primary bone tumours. The most common location for this tumour is the long bone metaepiphysis especially of the distal femur, proximal tibia, distal radius, and the proximal humerus. Involvement of distal ulna is rare accounting for 0.45% to 3.2%. Considering local aggressive nature and high recurrence, wide resection is the treatment recommended. Instability of ulnar stump and ulnar translation of the carpals are known complications following resection of distal ulna. To overcome these problems, we attempted a newer technique of distal ulna reconstruction using proximal fibula and TFCC reconstruction using palmaris longus tendon following wide resection of giant cell tumour of distal ulna in a 44-year-old male. This technique of distal radioulnar joint reconstruction has excellent functional results with no evidence of recurrence after one-year followup.

Highlights

As most of these tumours are locally aggressive in nature, wide resection of the distal ulna is the recommended treatment for Giant cell tumour of the bone (GCT) in such locations [3]
We report a case of giant cell tumour of the distal ulna in a 44-yearold male treated by wide resection and reconstruction of the distal radioulnar joint (DRUJ) with proximal fibula and triangular fibrocartilage complex (TFCC) reconstruction using palmaris longus graft with augmentation by extensor carpi ulnaris tenodesis and stabilisation of the graft with dynamic compression plating
Giant cell tumour of distal ulna is a rare entity with no clearcut guidelines for treatment

Summary

Introduction

Giant cell tumour of the bone (GCT) is a rare locally aggressive primary bone tumour with an incidence of 3% to 5% of all primary bone tumours [1]. Involvement of distal ulna is rare accounting for 0.45% to 3.2% [2] As most of these tumours are locally aggressive in nature, wide resection of the distal ulna is the recommended treatment for GCTs in such locations [3]. The loss of ulnar support results in wrist instability leading to pain, weakness, and loss of grip strength as the ulnar stump may impinge upon the distal radius [4,5,6]. We report a case of giant cell tumour of the distal ulna in a 44-yearold male treated by wide resection and reconstruction of the distal radioulnar joint (DRUJ) with proximal fibula and triangular fibrocartilage complex (TFCC) reconstruction using palmaris longus graft with augmentation by extensor carpi ulnaris tenodesis and stabilisation of the graft with dynamic compression plating

Case Report

Findings

Discussion

Conclusion