Management of distal ulna giant cell tumor by en bloc resection and reconstructed by a novel technique

Abstract

Giant cell tumor (GCT) is a locally aggressive benign primary bone tumor accounting for 20% of all the benign primary bone tumors. Peak incidence is between 20 and 45 years with slight female predominance. Distal end of ulna is a rare site for any primary bone tumor, especially 2-4 for giant cell tumors with reported incidence of 0.45 to 3.2% in literature. Considering local aggressive nature and high recurrence, resection is the treatment recommended. In such cases, instability of the ulnar stump and ulnar translation of the carpals are known 3-6 complications causing reduced grip strength. Literature review states, reconstruction with iliac bone graft and stabilization of the ulnar stump with tenodesis using extensor carpi ulnaris. We report a 34 year old female with giant cell tumor of the distal ulna treated by en bloc resection and reconstruction of the distal radio-ulnar joint (DRUJ) and triangular fibrocartilage (TFCC) complex with proximal fibula, palmaris longus graft with augmentation by extensor carpi ulnaris tenodesis and stabilization of the proximal stump with dynamic compression plate. This newer technique of DRUJ and TFCC reconstruction with proximal fibula and palmaris longus graft following en bloc resection of the distal ulna had excellent functional results with no evidence of recurrence after seven months follow-up. This case is presented for its rarity and novelty of the technique used for the anatomical reconstruction.