Free Osteoarticular Metatarsal Transfer for Giant Cell Tumor of Metacarpal—a Surgical Technique

Abstract

BackgroundGiant cell tumor is a relatively uncommon tumor of bonesaccountingfor5%ofalltheprimarybonetumors.Inthesmallbones of hands it occurs even more rarely. Only 2–5% of allthegiantcelltumorshavebeenreportedtoaffectthehandandmetacarpal involvement is much less common than aphalangeal one [1–4]. The tumor occurring at this sitecommonly presents at an advanced stage and is associatedwith more bony destruction thereby complicating treatment[5–8]. Also these are associated with higher rate ofrecurrence [2]. The various treatment modalities describedare curettage with or without bone grafting, en bloc resectionand reconstruction and ray amputations [2] . We heredescribe a case of successful transplantation of 4th metatarsalalong with its osteo-articular ligamentous complex to replacethe 5th metacarpal bone which was the site of tumor. Thisenabled us to preserve the full function of the metacarpo-phalangeal joint by a relatively simple technique.Case PresentationA 25 year old female patient presented to us with a 8-monthhistory of pain and progressive swelling of the right littlefinger metacarpal. She did not sustain any kind of trauma orsuffer any febrile illness during this period. The patient wasin good general condition with normal systemic examina-tion. Local examination revealed a fusiform, non tenderswelling in the area of 5th metacarpal (Fig. 1).Theoverlying skin was free without any sign of inflammation.Movements of the adjoining joint were full in range andwere painless. A radiograph of the hand showed anexpansile, lytic lesion in the diaphyseal region with paperthin cortex of right 5th metacarpal extending up to thesubchondral bone. There was breach in the ulnar side ofcortex. (Figure 2). A radiograph survey of the skeletonshowed no other lesions. Provisional diagnosis of giant celltumour was made and diagnosis confirmed with corebiopsy.Surgical TechniqueEnbloc resection of tumor was done by dorsal approach(Fig. 3a). Whole of the capsule and collateral ligaments ofmetacarpo-phalangeal joint were preserved while excisingthe tumor (Fig. 3b). Disarticulation was done at the level ofcarpo-metacarpal joint. 4th metatarsal was harvested fromthe foot along with capsule and collateral ligaments of itsmetatarso-phalangeal joint. Metatarsal was osteotomisedproximally at a level, according to the pre-operativeplanned length, desired at the recipient site. The capsuleand ligaments of the transferred metatarsal were sutured tothe corresponding capsule and ligaments at the recipientsite, to reconstruct metacrpo-phalangeal joint (Fig. 3c, d).