Limb Salvage Surgery in Large and Fungating Giant Cell Tumors of Distal Radius: A Case Series

Abstract

Introduction: A Giant Cell Tumor (GCT) is a benign tumor, but often aggressive with recurrence or metastasis tendency. Often, distal radius GCT is presented in relatively small or medium sizes. Large and fungating distal radius GCT is characterized by its higher ability to infiltrate, destruct, and compromise its surrounding tissue. Therefore, it increases the risk of complications including amputation. The treatment requires more complex surgery and reconstruction than usual GCT. In this case series, we prefer to perform the limb salvage surgery with wide en bloc resection, followed by reconstruction of the bone and soft tissue, instead of amputation. Case Presentation: We report 4 patients with massive GCT at the distal radius. All complained about pain and a lump in the wrist. The tumors are large in dimension with the size of 12 x 8 x 6 cm, 10 x 10 x 8 cm, 11 x 9 x 9 cm, and 17 x 14 x 8 cm respectively, fungating and compromised surrounding soft tissue. Limb salvage procedures are performed with wide en-bloc resection, bone cement spacer insertion, K-wire fixation, dissection, and tendon reconstructions followed by soft tissue defect closure using distant flap and primary suture. Follow-up post-surgery was variable within 2 to 36 months. All patients had a reduced scale of VAS, increased functional outcome measured with quick DASH score, no major complications, and no sign of recurrence or metastasis during the follow-up period. Conclusion: Large and fungating GCT of distal radius managed by limb salvage surgery and complex reconstruction deliver a good result. Thus, it can give other options other than amputation.