The Use of a Custom-made Prosthesis in the Treatment of Chondrosarcoma of Distal Radius.

Abstract

The most common neoplasms of the distal radius are primary tumors, of which aneurysmal bone cysts and giant cell tumors are seen almost exclusively. Chondrosarcomas are most commonly located in the pelvis, ribs and proximal segments of the extremities; they rarely occur in forearm bones. Bone defects after distal radial resection can be replaced with bone grafts, both autogenous and allogenic. There is always a risk of failure of the bones to mend or slower synostosis, which necessitates the search for new treatments. Recently, custom-made prostheses have been used with increasing frequency. In early 2015, a 25-year-old male patient was admitted to the Department of Orthopedic Oncology in Brzozów on account of a tumor involving the epiphysis and metaphysis of the right distal radius. Imaging studies confirmed that the lesion was a neoplasm and a biopsy revealed a chondrosarcoma. Radical resection of the tumor was attempted and a custom-made prosthesis was inserted in the place of the bone defect. The prosthesis was designed and manufactured over 4 weeks. No complications occurred during the surgery or in the postoperative period. After the surgery, the forearm and wrist were in a plaster splint for 6 weeks and then rehabilitation was started. The treatment outcome was good. Now, three months after the surgery, the patient has good wrist mobility and efficient grip. Surgical treatment of malignant tumors of the distal radius with extensive bone resection poses the challenge of bone replacement and recovery of fair hand function. Commonly known and practised, reconstructions with autogenous or allogenic bone grafts enable partial restoration of the radiocarpal joint surface and DRUJ. The use of large bone grafts is associated with a risk of non-union and limited hand function even if the grafts are vascularized. Arthrodesis of the radiocarpal joint is currently performed less and less frequently. Custom-made prostheses appear to be a good solution. This method makes it possible to restore the anatomy of bones and joint surfaces and to achieve good limb function and mobility and the incidence of complications, as described in the literature, is low. Large meta-analyses on the use of custom-made prostheses are still lacking.