Midfoot Reconstruction for a Large, Aggressive Giant-Cell Tumor

Abstract

The occurrence of a giant-cell tumor (GCT) in the small bones of the foot is rare. Two studies have shown incidences of 1% and 2%1,2. The younger age of patients with a GCT in the foot, compared with those with tumor in the long bones, as well as a multifocal trend and a higher recurrence rate have been stressed in the literature3. In one study, eighteen of twenty-one GCTs that involved the foot were distributed in the tarsal bones, with a noteworthy number of cases in the talus4. Although metatarsal lesions were rare in that series, several cases of single or double metatarsal reconstruction in patients with GCT have been reported in the literature5-7. The proposed treatments for GCT of the foot are curettage and bone-grafting as well as marginal or wide excision; however, wide excision is usually impossible to achieve without performing an amputation8. Some authors have recommended that en bloc resection and bone-grafting be used as the first line of treatment for GCT in suitable sites5. The reconstruction techniques include the use of allografts or large autogenous grafts with fusion6,7,9. We present a case of a large, aggressive GCT that originated in the medial cuneiform. It destroyed the adjacent cuneiforms as well as the first, second, and third metatarsal bases. We treated the patient with a marginal en bloc resection of the medial two cuneiforms and the proximal two-thirds of the first and second metatarsals combined with a partial excision of the medial halves of the lateral cuneiform and the third metatarsal base. The resultant osseous defect was reconstructed with a large iliac strut graft and fixation with multiple plates and screws. The midterm clinical results …