Non-vascularized Fibular Graft Research Articles

Use of Fibular Strut Graft for Reconstruction of Bone Defects

Introduction • Bone recalcitrant nonunion and bone defects usually follow trauma, resection of a malignant tumor of the musculoskeletal system and osteomyelitis. • Instead of amputation, which was used in the past, limb salvage surgeries, including non-vascularized or vascularized autografts and allografts, bone transport and replacement with prostheses are performed. • Among the above methods, nonvascularized autogenous bone graft use is an important treatment strategy that has been performed for over a hundred years. • The fibula is a tubular bone that has a suitable length, geometrical shape and mechanical strength and is considered to be the best donor bone for large bone defects. • Free vascularized fibular grafts achieve higher union rate than non-vascularized fibular grafts in the reconstruction of long bone defects. • In this study, 6 patients with bone defects treated by non-vascularized fibular grafts .We intended to assess the clinical outcomes of graft union, functional outcome.

Limb Salvage and Pelvic Reconstruction With Endoprosthesis After Pelvic Tumor Resection: A Narrative Review.

Periacetabular defects following tumor resection present formidable challenges in reconstruction and continue to pose clinical difficulties. Historically, treatment approaches leaned towards hindquarter amputation; however, due to associated morbidities and functional limitations, limb-sparing procedures gained prominence in the 1980s. Nevertheless, the intricacies of pelvic anatomy and the imperative of achieving wide surgical margins while preserving essential structures make pelvic tumor resection and subsequent reconstruction inherently complex. Various reconstruction modalities have been explored, including non-vascularized fibular grafts and prosthetic implants. Among these options, the LUMiC® endoprosthesis stands out as a promising solution for pelvic reconstruction post-tumor resection. Characterized by a modular design featuring a hydroxyapatite-coated stem and acetabular cup, this device has shown favorable implant survival rates in studies, despite encountering complications primarily associated with soft tissue failure, dislocation, and infection. Notably, the incidence of complications varies across studies. The Henderson classification system delineates these complications, encompassing soft tissue issues, aseptic loosening, periprosthetic fractures, infections, and tumor recurrence. Despite the encouraging functional outcomes associated with the LUMiC® endoprosthesis, it is not immune to limitations. Concerns persist regarding complications such as dislocation and infection, underscoring the imperative for further research to evaluate the long-term durability and reliability of this reconstructive approach. Moreover, advancements in surgical techniques, perioperative management, and the advent of navigation-assisted procedures hold promise for enhancing outcomes and mitigating complication rates in pelvic reconstruction surgeries.

A Deep-Learning Model for Predicting the Efficacy of Non-vascularized Fibular Grafting Using Digital Radiography

To develop a fully automated deep-learning (DL) model using digital radiography (DR) with relatively high accuracy for predicting the efficacy of non-vascularized fibular grafting (NVFG) and identifying suitable patients for this procedure. A retrospective analysis was conducted on osteonecrosis of femoral head patients who underwent NVFG between June 2009 and June 2021. All patients underwent standard preoperative anteroposterior (AP) and frog-lateral (FL) DR. Subsequently, the radiographs were pre-processed and labeled based on the follow-up results. The dataset was randomly divided into training and testing datasets. The DL-based prediction model was developed in the training dataset and its diagnostic performance was evaluated using the testing dataset. A total of 339 patients with 432 hips were included in this study, with a hip preservation success rate of 71.52% as of June 2023. The hips were randomly divided into a training dataset (n=324) and a testing dataset (n=108). The ensemble model in predicting the efficacy of NVFG, reaching an accuracy of 78.9%, a precision of 78.7%, a recall of 96.0%, a F1-score of 86.5%, and an area under the curve (AUC) of 0.780. FL views (AUC, 0.71) exhibited better performance compared to AP views (AUC, 0.66). The proposed DL model using DR enables automatic and efficient prediction of NVFG efficacy without additional clinical and financial burden. It can be seamlessly integrated into various clinical scenarios, serving as a practical tool to identify suitable patients for NVFG.

Non-Vascularized Fibular Bone Graft for Giant Cell Tumor of the Distal Ulna: A Case Report

Abstract: Cases of bone giant cell tumors (GCT) are rarely found, generally benign and locally aggressive tumors. Surgical resection is the universal standard for treatment of bone GCT. Non vascularized fibular graft (NVFG) is useful in the reconstruction of skeletal defects, especially in cases of scarred and avascular recipient sites and patient with tumor surrounded by poor tissue condition. We report a 53-year-old woman, with a lump in her left hand for three years. X-ray examination revealed a mass with firm border and regular edge that reached the epiphysis expansively with thinning of the cortex in the distal region of the left ulna. Tumor excision was performed with open reduction internal fixation (ORIF) and fibular bone graft. To date, GCT is one of the most obscure and intensively examined bone tumors, and its histological images do not predict the clinical outcome. Moreover, many unanswered questions regard to the treatment and prognosis without any consensus regarding the ideal treatment selection. NVFG osteosynthesis shows encouraging results, and adequate therapy, wound care and patient compliance affect the patient’s outcome. In conclusion, NVFG and internal fixation are effective options for post tumor excision, and osteosynthesis has encouraging result. Keywords: non vascularized fibular graft (NVFG); giant cell tumor; bone graft; ulna

Nonvascularized fibular graft with locking screw fixation for metaphyseal bone loss of distal femur: biomechanical assessment validated by a clinical case series.

The optimal modality to surgically treat significant bone loss of distal femur remains inconclusive. The objectives of the present study were to assess the mechanical performance of nonvascularized fibular graft (NVFG) with locking screw fixation in distal femur fixation construct by finite element analysis and to retrospectively describe the outcomes of the present technique in clinical cases. Four constructs which the fractured femur was stabilized by LCP-DF alone, dual plating, LCP-DF combined with NVFG, and LCP-DF combined with NVFG (LCP-DF-NVFG-S)with locking screw were assessed the biomechanical performance under physiological loads. For the clinical case series, 12 patients with open intercondylar fracture with metaphyseal bone loss of distal femur were operated by LCP-DF-NVFG-S. The collected data included fracture consolidation, length of NVFG, perioperative complications and objective clinical results. LCP-DF-NVFG-S demonstrated lower implant equivalent von Mises stress (EQV) stress and better fracture stability than other constructs. A locking screw presented its essence in maintaining the NVFG in the required position and subsequently enhancing the fracture stability. In regard to the clinical series, all fractures were consolidated with an average duration of 27.8weeks (range 20-32). An average NVFG length was 7.8cm (range 6-12). No perioperative complication was demonstrated. By the Knee Society score, 1 was considered to be excellent, 9 to be good and 2 to be poor. Based on the results of mechanical assessment and case series, LCP-DF-NVFG-S can be an effective technique in the management of metaphyseal bone loss of distal femur.

Sclerosis rim volume ratio and Japanese Investigation Committee classification as predictive factors for femoral head collapse progression after non-vascularized fibular grafting in osteonecrosis patients

ObjectiveThe purpose of this retrospective cohort study was to determine the relationship between sclerosis rim volume ratio (SVR) and the progression of femoral head collapse after non-vascularized fibular grafting (NVFG) surgery in patients with osteonecrosis of the femoral head (ONFH), investigating risk factors associated with femoral head collapse progression and establishing a predictive model to enhance clinical decision-making. MethodsONFH patients who underwent NVFG between January 2008 and December 2021 were analyzed retrospectively to assess the risk of post-operative collapse progression (collapse >2 mm). A logistic regression model was used to evaluate the independent risk factors associated with collapse progression, including age, sex, etiology, affected side, Japanese Investigation Committee classification (JIC), and the sclerosis rim volume ratio (SVR). SVR values was collected from three weight-bearing columns, namely SVR1, SVR2, and SVR3, respectively. Results57 patients with 64 hips who had undergone NVFG and were followed up for at least one year were included. During the follow-up, collapse＞2 mm occurred in 30 hips (46.88%). Multivariable analysis revealed that JIC (p =0.037) and SVR1 (p = 0.04) were independent risk factors for collapse progression after NVFG. The results of the receiver operating characteristic (ROC) analysis indicated that the aforementioned indices provided a satisfactory prediction of early femoral head collapse progression in ONFH patients after NVFG. The regression model using the above two indicators as a composite index showed satisfactory performance in predicting early postoperative femoral head collapse progression, with an area under the curve (AUC) of 84.6%. ConclusionsSVR is significant predictor of post-operative collapse progression following NVFG, and the composite index provides an optimal predictive value for femoral head collapse progression after surgery.

Treatment of Non-Union with Bone Loss in Femur Fracture Using Non-vascularized Fibular Graft: A Case Report

Abstract: Fibula is a very versatile source of autogenous graft and has been used for decades in the field of limb reconstruction. Bony defects of the lower extremity are usually the result of high-energy trauma, tumor resection, or severe sepsis. Non-vascularized fibular graft (NVFG) is useful in the reconstruction of skeletal defects, especially in cases of scarred and avascular recipient sites, or in patients with combined bone and soft tissue defects. This study aimed to assess the effectiveness of NVFG in the management of non-union bone fracture. We reported a 16-years-old male with non-union femur fracture. Debridements were applied at the first time of admission to the hospital. Open reduction of fracture with internal femur fixation. Fibula bone was extracted as the donor of vascularized graft for the bone loss. After two years of follow-up, the patient acquired his motor functions back well, and was able to carry out daily activities as expected. In conclusion, taking together the repair and reconstruction of non-union bone in the lower extremity with NVFG and internal fixation is an effective and important option for treating non-union femoral fracture. NVFG osteosynthesis has encouraging results in such instances. It is technically less demanding, simple, and can be performed in almost all centers where image intensifier is available. Keywords: bone fracture; non-vascularized fibular graft; reconstructive microsurgery; femoral non-union

"A New Clinical and Radiological Classification of Grading GCT and Its Impact on the Management".

The management of the GCT continues to be controversial. The most accepted treatment reported is extended curettage with various adjuvants. However, the rate of recurrence has been very high (10-66%). For better understanding of the lesion and its management, it has become necessary to revise the existing grading system. The recommendation of the proposed grading is based on 480 cases of GCT along with the analysis of other major reports published. Out of these, 279 were grade-II and 109 grade-III which were subjected to en bloc excision and reconstruction with non-vascularized fibular graft. Depending on the site, the grafts were stabilized with a suitable plate or extra long Kirschner wires. The observations made in 480 cases over a period of 5 decades revealed that for Campanacci grade-II and grade-III lesions, en bloc excision and suitable reconstruction resulted in minimum recurrence rate of 1.2%. The fibular reconstruction after excision has proved advantageous to our patients as it provides a stable joint in the form of an arthrodesis of the neighboring joint. GCT of bone has been a challenging lesion. Extended curettage has been recommended as the choice of treatment but the reported rate of recurrence has been high. En bloc excision and suitable reconstruction with fibular strut graft have resulted in 1.2% recurrence. It is, therefore, suggested the existing grading system should be revised mainly for grade-II and grade-III lesions which can bring down the high rate of recurrence in this unpredictable tumor. Level-IV.

Surgical techniques for medial clavicular tumors: A report of 3 cases

Introduction and importanceClavicular tumors are rare, consisting of <1 % of all skeletal tumors. In this series, we described our experience of treating medial clavicular tumors. Case presentationWe treated three patients with medial clavicle tumors at a national tertiary referral hospital in Jakarta, Indonesia. The patients were treated with wide excision following bony reconstruction from fibular bone and one patient was treated by marginal excision. Each patient was treated by surgery and one patient underwent reconstruction using non-vascularized fibular graft and composite using bone cement. Clinical discussionAll patients resulted in restoration of symmetry of the lower neck and upper chest and no post-surgical complication. Based on these cases above and the extension of tumor, we recommend medial clavicle tumor resection classification divided into three type to decide which type of surgical procedure that should be performed. In our report, all patients resulted in restoration of symmetry of the lower neck and upper chest and no post-surgical complication. ConclusionClavicle resection in management of medial third clavicle tumor is technically demanding. We proposed three types of clavicular resection based on tumor extension. The surgical technique of medial end clavicle in this patient resulted in tumor free margin of medial clavicular, medial scapula, and lateral scapular incision. Reconstruction surgery following clavicle resection can be done in order to restore symmetry of the lower neck and upper chest, protect nearby neurovascular bundle, and rarely associated with significant shoulder function loss.

Monostotic Fibrous Dysplasia of the Hip Treated with Autologus Non-Vascularized Fibular GraftMonostotic Fibrous Dysplasia of the Hip Treated with Autologus Non-Vascularized Fibular Graft

Fibrous dysplasia represents a dysplastic disorder of bone characterized by solitary or multifocal polyostotic intramedullary lesions composed of proliferations of fibroblast-like spindle cells with a characteristic whorled pattern in which trabeculae of immature woven bone. A 20 years old female with pain and limping on his left hip has been suffered for about 1 month. The pain was localized on the left hip with dull characteristics, and worsen when she moves and walks. The pain intensity also decreased with rest. Then she came to hospital and performed X-ray with shepherd crook deformity on her left hip and performed ipsilateral non-vascularized fibular strut graft on her left hip. Right after post-operative wound has been healed the chief complain was marked decrease. For about 2 years after the surgery follow up by X-ray and also MRI examination with contrast the condition of the fibular strut graft was viable, the complaint was gone and the progression of the disease has been stopped.

Treatment of pediatric tibial shaft nonunion using ipsilateral free non-vascularized fibular graft.

Although tibial shaft fractures are the third most common long bone fractures in children after the forearm and femur, nonunion of these fractures are rare in the pediatric population. Despite seldom seen, tibial nonunion is very complex and it is also a devastating complication of tibial fracture especially when infected. Numerous methods have been employed to treat pediatric tibial nonunion, but there is no consensus. Here, we present a case of a child with right tibial shaft fracture nonunion. We treated this patient with ipsilateral free non-vascularized fibular graft. Both the nonunion site and fibular donor site united well with good function in the injured extremity and no adverse events. We recommend the use of ipsilateral free non-vascularized fibular graft for the treatment of pediatric tibial shaft nonunion.

Delayed Reconstruction of Open Multiple Metatarsal Fractures Using Rib Bone Graft after Soft Tissue Coverage with Gracilis Free Flap: Case Report and Literature Commentary

Foot restoration after massive bone and soft tissue loss is a daunting task for surgeons. Existing literature has highlighted various methods of reconstruction. Masquelet technique, use of vascularised and non-vascularized fibular grafts, use of latissimus dorsi, serratus anterior in combination with rib grafts, iliac crest grafts have been described.

Management of Forearm Nonunion

Forearm nonunion is rare but a possible complication after standard treatment of the fracture of radius and ulna. The importance of precise restoration of length and anatomical relationship of both bones are among usual concerns. The situation is more complex when the infection is present in the union site. The several techniques have been applied to manage forearm nonunion consisting of osteosynthesis and using cancellous autograft, allograft, nonvascularized fibular graft, fibular flap, bone transport, induced membrane (Masquelet technique), and pedicled flap such as posterior interosseous and radial forearm bone flap (RFBF). Reviewing the recent studies focusing on treating forearm nonunion is the purpose of this review.

Fibular regeneration following fibulectomy in children- evaluation minimum two years after fibular harvest

Background the literature on fibular regeneration once procuring non-vascularized fibular grafts in child continuous to be scanty. The non-vascularized fibular graft has distinction of fibular regeneration occurring at the donor area.Material and methods retrospectively analyzed the fibular regeneration at the donor leg following harvest of non-vascularized fibular graft. These patients had minimum 2 years follow up. The radiological regeneration was made in percentage by calculating the area of both operated and normal limb.Results A total of 30 patients were evaluated. The average patient age was 9.56 years. No pain or neuromuscular deficit in the operated limb. The mean follows up of 39.4 months. The continuity of the fibula in the longitudinal was restored in 27 cases.

Union, complication, reintervention and failure rates of surgical techniques for large diaphyseal defects: a systematic review and meta-analysis

To understand the potential and limitations of the different available surgical techniques used to treat large, long-bone diaphyseal defects by focusing on union, complication, re-intervention, and failure rates, summarizing the pros and cons of each technique. A literature search was performed on PubMed, Web of Science, and Cochrane databases up to March 16th, 2022; Inclusion criteria were clinical studies written in English, of any level of evidence, with more than five patients, describing the treatment of diaphyseal bone defects. The primary outcome was the analysis of results in terms of primary union, complication, reintervention, and failure rate of the four major groups of techniques: bone allograft and autograft, bone transport, vascularized and non-vascularized fibular graft, and endoprosthesis. The statistical analysis was carried out according to Neyeloff et al., and the Mantel–Haenszel method was used to provide pooled rates across the studies. The influence of the various techniques on union rates, complication rates, and reintervention rates was assessed by a z test on the pooled rates with their corresponding 95% CIs. Assessment of risk of bias and quality of evidence was based on Downs and Black’s “Checklist for Measuring Quality” and Rob 2.0 tool. Certainty of yielded evidence was evaluated with the GRADE system. Seventy-four articles were included on 1781 patients treated for the reconstruction of diaphyseal bone defects, 1496 cases in the inferior limb, and 285 in the upper limb, with trauma being the main cause of bone defect. The meta-analysis identified different outcomes in terms of results and risks. Primary union, complications, and reinterventions were 75%, 26% and 23% for bone allografts and autografts, 91%, 62% and 19% for the bone transport group, and 78%, 38% and 23% for fibular grafts; mean time to union was between 7.8 and 8.9 months in all these groups. Results varied according to the different aetiologies, endoprosthesis was the best solution for tumour, although with a 22% failure rate, while trauma presented a more composite outcome, with fibular grafts providing a faster time to union (6.9 months), while cancellous and cortical-cancellous grafts caused less complications, reinterventions, and failures. The literature about this topic has overall limited quality. However, important conclusions can be made: Many options are available to treat critical-size defects of the diaphysis, but no one appears to be an optimal solution in terms of a safe, satisfactory, and long-lasting outcome. Regardless of the bone defect cause, bone transport techniques showed a better primary union rate, but bone allograft and autograft had fewer complication, reintervention, and failure rates than the other techniques. The specific lesion aetiology represents a critical aspect influencing potential and limitations and therefore the choice of the most suitable technique to address the challenging large diaphyseal defects.

Évaluation de la régénération de la fibula après prélèvement chez les patients atteints de tumeurs osseuses bénignes : étude rétrospective comparant différents groupes d’âge

IntroductionUsing non-vascularized fibula as autogenous graft has gained much success in reconstruction after tumor resection owing to its simplicity. Donor-site morbidity related to fibula deficiency include valgus ankle, chronic pain and stress fractures of the ipsilateral tibia. HypothesisGrowth potential before skeletal maturity is the most important factor promoting fibular regeneration after non-vascularized harvesting, and its decline with skeletal maturity causes failure of fibular regeneration. Patients and methodsThis is a retrospective study of the patients with benign bone tumors who required bone defect reconstruction by non-vascularized fibular graft utilizing a periosteal preserving technique. The study entailed 118 patients below the age of 12, 100 age 12–18, and 80 above the age of 18 years. ResultsIn children below 12 years, regeneration was complete in 95%, incomplete in 4.2% and partial in 0.8% of the cases. In adolescents, regeneration was complete in 72%, incomplete in 15% and partial in 13% of the cases. After skeletal maturity, no regeneration occurred in 92.5%of the patients, while partial regeneration occurred in 7.5% of the cases. Valgus ankle occurred in 2.8% of the cases before skeletal maturity, and none in older patients. DiscussionComplete regeneration after non-vascularized fibula graft harvesting is the rule in pediatric patients and to a lesser extent in adolescent group. This is usually associated by near normal regaining of the regenerate strength and function. Non-regeneration dominates in older age group. The length of the harvested segment has no impact on the regeneration or the remodeling process. Level of evidenceIV; case series, retrospective comparative study.

Autologous Nonvascularized Fibula Graft and Locking Compression Plating for Failed Fixation of Humeral Shaft With Atrophic Gap Nonunion.

IntroductionThe surgical treatment of humeral shaft atrophic, gap nonunion following failed surgical fixation is challenging. We intended to evaluate the surgical outcome of failed fixation of humeral shaft atrophic, gap nonunions using locking compression plate (LCP) and autologous nonvascularized fibular graft (ANVFG) and autologous iliac crest bone graft (AICBG). MethodsThrough our database search between 2015 and 2018, we identified 12 patients with humeral shaft atrophic, gap nonunions with failed surgical fixation underwent open reduction and internal fixation using LCP with autologous fibula graft and iliac crest cancellous bone graft. ResultsWe have followed all twelve patients for a minimum period of 24 months. All patients had radiological and clinical union with a mean time to union of 17 weeks. In one case superficial surgical site infection was noted and successfully treated with intravenous antibiotics, and in another, transient peroneal nerve palsy was identified and resolved in six months. ConclusionLCP with ANVFG and AICBG is a reliable option for “complex” diaphyseal humerus atrophic and gap non unions, especially with significant bone loss. This construct provides mechanical stability and supports biological healing in these complex fractures.

Nonvascularized fibular harvest in children: impact on donor limbs.

Nonvascularized fibular graft is commonly used in children. We investigated periosteal intactness, proportion of harvested fibula and the distal remnant for their association to regeneration and development of ankle valgus in 25 donor limbs (n = 18 patients). The fibulae were harvested from healthy legs with all possible care to preserve periosteum. Intraoperatively, periosteal breach and length of graft obtained were recorded. Follow-up radiographs at 6 months documented lateral distal tibial angle, fibular station, and longitudinal continuous regeneration of fibula in the donor limb. Limbs with and without regeneration/ankle valgus were matched for proportion of harvested length and distal remnant, respectively. Odds ratios for periosteum breach versus nonregeneration and nonregeneration versus ankle valgus were additionally calculated. The average harvest length and distal remnant were 15.1 and 4.5 cm, respectively. The periosteum intactness was maintained in 18 (72%) limbs. At 6 months follow-up, regeneration of fibula was present in 15 (60%) limbs. The postharvest-acquired ankle valgus was present in five limbs (24%). There was almost 2.5 times increased likelihood of nonregeneration, if periosteum was breached. The odds ratio for nonregeneration versus regeneration to the development of ankle valgus stood at 12 ( P = 0.0483). Periosteal breach increased the odds of nonregeneration of harvested fibula. The length of harvested segment did not appear to have significant influence on regeneration nor did distal segment on ankle valgus. The nonregeneration of fibula, however, made the limb prone to ankle valgus.

Function after Wrist Arthrodesis with Non-Vascularized Fibular Graft in Distal Radius Giant Cell Tumor: Case Series

Giant cell tumor (GCT) of bone, the most common benign locally aggressive bone tumor, accounts for 4% to 5% of all primary bone neoplasms and 20% of benign bone tumors. The distal radius is the third commonest site of involvement in about 10% of GCT cases. Due to the high recurrence rate after curettage of the more progressed lesions, most surgeons prefer en bloc resection followed by reconstruction. Cases: Three distal radius GCT Campanacci III cases underwent en bloc resection and wrist arthrodesis with non-vascularized fibular graft. The mean follow-up period was nine months (6-12 months). Patients were evaluated with the Disabilities of the Arm, Shoulder, and Hand (DASH) Score. Results: Union had been achieved in 2 patients, and implant removal was done. One patient needs cancellous bone grafting after implant removal—no sign of recurrence after one year. DASH score showed moderate disability. Conclusion: Autogenous non-vascularized fibular graft reconstruction can be considered a reasonable option after en bloc resection of distal radius GCT.&#x0D; Giant Cell Tumor (GCT) adalah tumor tulang jinak yang paling sering dijumpai, bersifat agresif secara lokal, merupakan 4-5% dari seluruh neoplasma tulang primer dan 20% dari seluruh tumor tulang jinak. Radius distal merupakan lokasi GCT terbanyak ketiga, mencakup 10% kasus GCT. Mengingat tingginya rekurensi setelah prosedur kuretase, lebih disukai reseksi en bloc diikuti rekonstruksi. Kasus: Tiga pasien GCT pada radius distal (Campanacci III) menjalani reseksi en bloc disertai arthrodesis pergelangan tangan. Follow-up rata-rata selama 9 bulan (range 6-12 bulan). Pasien dinilai menggunakan skor Disabilities of the Arm, Shoulder, and Hand (DASH). Hasil: Union tulang tercapai pada 2 pasien, dan implan telah dicabut. Satu pasien membutuhkan graft dari tulanag cancellous setelah pencabutan implan. Tidak didapatkan rekurensi pada periode follow-up satu tahun. Skor DASH menunjukkan disabilitas sedang pada ketiga pasien. Simpulan: Prosedur rekonstruksi menggunakan nonvascularized fibular graft baik dilakukan setelah reseksi en bloc pada pasien GCT radius distal.

Giant Cell Tumor of the Middle Phalanx of Ring Finger Treated with Wide Excision and Reconstruction using Non-vascularized Fibular Graft: A Rare Case Report and Review of Literature

Giant cell tumor (GCT) involving the hand, specifically the phalangeal bones, is very rare, accounting for only 2% of cases of the bone. This type of GCT is associated with more aggressive behaviour and higher recurrence and metastasis rate. We present a rare case of large GCT of the middle phalanx of ring finger in a 33 year old female. The patient was treated with wide excision and reconstruction using non-vascularized fibular graft. At her most recent follow-up time, 1 year post-surgery, the patient showed no symptoms with neither complication nor recurrence reported.