Abstract
Introduction: Giant cell tumour (GCT) of the distal humerus is very rare and the treatment depends on the grade of the tumour. Case Report: We present a 32yearold lady with Grade III GCT of the left distal humerus treated with en bloc excision and custom made total elbow replacement. Her preoperative Mayo Elbow Performance Score was 30. At 56 months follow up, she is pain free with a Mayo Elbow Performance Score of 90 and no evidence of recurrence. Conclusion: Enneking’s staging and Campanacci’s radiographic grading helps in planning the treatment. When the lesion has violated a joint, en bloc excision followed by reconstruction or joint sacrifice is the treatment of choice. The options of reconstruction are auto or allografts, custom made endoprosthesis or allograft endoprosthetic composite. Reconstruction using autograft is seldom feasible in elbow. Allografts are met with high complication rates. Custom made total elbow arthroplasty is a good option especially for primary tumours of the elbow and can be done with good oncologic safety. Custom made total elbow arthroplasty is a good option for Campanacci Grade III GCT of the elbow. It provides excellent pain relief and good functional improvement with low complication rate.
Highlights
Giant cell tumour (GCT) of the distal humerus is very rare and the treatment depends on the grade of the tumour
We present a case of distal humerus GCT which had breached the cortex and was successfully treated with custom made total elbow arthroplasty and was prospectively followed up
Biopsy from the lesion revealed uniform ovoid mononuclear cells with numerous osteoclast type multinucleate giant cells which was consistent with GCT. She was treated with en bloc resection of the distal humerus and custom made total elbow arthroplasty using 316 L SS, constrained, hinged cemented prosthesis
Summary
Giant Cell Tumour (GCT) of bone is a distinct clinicopathologic entity with distinguishing radiologic features. We present a case of distal humerus GCT which had breached the cortex and was successfully treated with custom made total elbow arthroplasty and was prospectively followed up. She was treated with en bloc resection of the distal humerus and custom made total elbow arthroplasty using 316 L SS, constrained, hinged cemented prosthesis. Histopathologic examination of the three excised specimen showed one cm tumor free margin proximally while distally the tumor had breached the cortex and involved the soft tissues She was prospectively followed up and on final follow up at 56 months she was pain free with flexion of 20110° and was able to carry out her personal and house hold works independently with a Mayo Elbow Performance Score of 90.
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