Primary bone tumors and tumor-like lesions of the wrist: a single-center experience

Abstract

Aim: The incidence of primary bone tumors of the wrist is increasing. The aim of this study was to examine the characteristics, treatment protocols, complication rates, and functional outcomes of bone tumors of the wrist treated in a tertiary orthopedic oncology center.
 Material and Method: We retrospectively analyzed 93 patients with bone tumors located in the wrist (63 distal radius, 23 distal ulna, 7 carpal bone) who were operated on between 2005 and 2020. Demographic information was recorded. Functional outcomes were evaluated with the Musculoskeletal Tumor Society System (MSTS) scoring system.
 Results: There were 57 male and 36 female patients. The average follow-up period was 32 months (range 16-163). There were 82 benign and 11 malignant lesions. Distal radius was the most common site of involvement. The most common type of benign tumor in the distal radius and distal ulna was the giant cell tumor (GCT; 26 and 10 patients, respectively). Among the malignant tumors in the distal radius, 5 were Ewing sarcoma, and 2 were osteosarcoma. All patients with malignant lesions underwent wide surgical resection and free vascularized fibular graft (FVFG) reconstruction. Of the malignant tumors in the distal ulna, 3 were Ewing sarcoma, and 1 was osteosarcoma. These were treated with wide resection and FVFG reconstruction (n=3) and wide resection and fibular strut graft (n=1). The rarest site for tumors in the wrist was the carpal bones. Carpal bone lesions included scaphoid (n=5) and lunate (n=2) tumors. In all of these patients, pathological examination indicated intraosseous ganglion cysts. The average MSTS score of all patients was 27 (range 24-30). Of the 36 patients with GCT, 4 (11%) developed local recurrence. One patient with Ewing sarcoma developed local recurrence and underwent secondary amputation. Distant lung metastasis was observed in 5 of 8 patients with Ewing sarcoma. 
 Conclusion: Our study confirmed that bone tumors in the wrist are rare. Most benign tumors can be treated with curettage and cement augmentation. For malignant tumors, it is possible to restore function with FVFG.