Wide excision and reconstruction with free vascularized fibula for aggressive giant cell tumor of distal 3rd tibia

Abstract

Giant cell tumor (GCT) at distal end of tibia is relatively a rare site of occurrence. We presented our experience with extensive excision and reconstruction for GCT of distal tibia using a free vascular double strut/single strut fibula graft. The present case series was conducted on six patients of GCT at lower end of tibia who were treated with extensive excision and reconstruction either in index (n=4) or recurrence (n=2) settings. Four patients were male and 2 were female. The mean age was 26.5 years. The average length of bone defect after tumor excision was 7.4 cm. The range of movement at ankle joint up to 70% of normal opposite side achieved in 2 cases and arthrodesis of ankle joint done in rest 4 cases (2 recurrent and 2 index cases). In GCT treatment, in spite of reconstruction difficulty for bony defect of lower end tibia due to its weight bearing property, vascularized free fibula graft has advantages like allows wide excision of tumor, single stage procedure, early weight bearing capacity in young patients and no bone resorption but bone thickening.