Clinical Outcome of En-Bloc Resection of Distal Radius Giant Cell Tumor And Reconstruction by Non Ascularized Fibular Graft &Transossious Augmentation of Wrist By PalmarishLongusTendon,An Improvise Technique

Abstract

Introduction: Giant cell tumor (GCT) of bone is a benign but locally aggressive tumor with tendency for local recurrence. Usually it can be treated by en-bloc resection and reconstruction arthroplasty using autogenous non-vascularizedipsilateral proximal fibular graft. Fibulo-carpal subluxation can be prevent by transossiouspamarishlongus tendon. This improvise technique found useful in preserving the movements and functions as well as stability of the wrist. Materials and Methods: Ten patients with a mean age of 33 years, witheither Campanacci grade II or III histologically proven giant cell tumours of lower end radiuswere treated with wide excision and reconstruction with ipsilateral non-vascularised proximalfibularautograft. Host graft junction was fixed with dynamic compression plate (DCP) in allcases. Wrist ligament reconstruction and fixation of the head of the fibula with carpal bonesand distal end of the ulna using K-wires along with pamarishlongus tendon reinforcement throw transeossiciousroot and primary cancellous iliac crest grafting at grafthost junction was done in all cases. Results: The follow-up ranged from 30 to 60 months (mean,46.8). At last follow-up, the average combined range of motion was 100° with range varyingfrom 60° to 125°. The average union time was 7 months (range, 4 to 12). Non-union occurredin 1 case. Graft resorption occurred in another case. Localised soft tissue recurrence occurredin another case after 3 years and was treated by excision. There was no case of graft fracture,metastasis, death, local recurrence or signifi cant donor site morbidity. A total of 3 secondaryprocedures were required. Conclusions: Enbloc resection of giant cell tumours of the lowerend radius is a widely accepted method. Reconstruction with non-vascularised fibular graft,internal fixation with DCP with primary corticocancellous bone grafting with transfixation of the fibular head and wrist ligament reconstruction minimises the problem and gives satisfactoryfunctional results.