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Category: Volume 07 Issue 05 May 2019
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Title: Functional Outcomes of Aggressive Giant Cell Tumours of Distal End Radius Managed with Wide Resection & Proximal Fibular Reconstruction

Authors: Dr Jujhar Singh, Dr Shailendra Khare, Dr Vivek Kumar

 DOI: https://dx.doi.org/10.18535/jmscr/v7i5.136

Abstract

Introduction: Giant cell tumour (GCT) of distal end radius is a locally aggressive tumour with high tendency for recurrence. As compared to intralesional procedures, wide resection has been uniformally reported to have better results. The defect created by resection can be reconstructed using various modalities, such as vascularized/non-vascularized bone grafts, osteoarticular allografts, custom made prosthesis etc. We studied the outcomes of wide resection and reconstruction with non-vascularized fibular autograft as management of biopsy proven giant cell tumours of distal end radius.

Material & Methods: 13 patients with giant cell tumour distal end radius (Campanacci Grade 3) were treated during a period from 2010 to 2017 at our institution by wide excision and bone grafting using non-vascularised fibula followed by iliac crest bone grafting at the radio-fibular junction.

Results: Mean follow-up duration was 74.31 months (60-84 months). At last follow-up, the average combined range of motion was 154.6° (supination, pronation, dorsifl exion, palmar flexion, ulnar deviation and radial deviation) with range varying from 120° to 180°. Mean functional score was 92.61 (83-96) as per modified system of the Musculoskeletal Tumour Society. The average union time was 6.25 months (range 4 to 9 months). Delayed union was encountered in 1 case & graft resorption in 1 case.

Conclusion: Non- vascularised proximal fibular reconstruction after wide excision of the tumour appears to be the most reliable technique for GCT of distal end radius as it preserves movements, stabilizes the wrist and provides good functional outcomes.

Keywords: Giant cell tumour; Distal end radius; Fibula reconstruction; wide resection; Locally aggressive

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Corresponding Author

Dr Shailendra Khare

Central Institute of Orthopaedics (CIO), VMMC & Safdarjung Hospital, New Delhi- 110029