Giant Cell Tumour of the Distal Radius: Wide Resection and Reconstruction by Non-vascularised Proximal Fibular Autograft

Abstract

Giant cell tumours of the bone are aggressive and potentially malignant lesions. Juxtaarticular giant cell tumours of the lower end radius are common and present a special problem of reconstruction after tumour excision. Out of the various reconstructive procedures described, non-vascularised fibular autograft has been widely used with satisfactory functional results. Ten patients with a mean age of 33.4 years, with either Campanacci grade II or III histologically proven giant cell tumours of lower end radius were treated with wide excision and reconstruction with ipsilateral non-vascularised proximal fibular autograft. Host graft junction was fixed with dynamic compression plate (DCP) in all cases. Wrist ligament reconstruction and fixation of the head of the fibula with carpal bones and distal end of the ulna using K-wires and primary cancellous iliac crest grafting at graft host junction was done in all cases. The follow-up ranged from 30 to 60 months (mean, 46.8). At last follow-up, the average combined range of motion was 100.5 degrees with range varying from 60 degrees to 125 degrees. The average union time was 7 months (range, 4 to 12). Non-union occurred in 1 case. Graft resorption occurred in another case. Localised soft tissue recurrence occurred in another case after 3 years and was treated by excision. There was no case of graft fracture, metastasis, death, local recurrence or significant donor site morbidity. A total of 3 secondary procedures were required. Enbloc resection of giant cell tumours of the lower end 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 satisfactory functional results.