Giant Cell Tumor of the Distal Radius treated with wide resection, ulnar translocation with wrist arthrodesis: A Case Series and Literature Review
Melissa Mae R. Sanchez, MD, Jose R. Reyes Memorial Medical Center, Sta. Cruz, Philippines
Background: Giant cell tumor of the distal radius is a rare, benign but locally aggressive tumor. Treatment options include curettage with bone grafting or application of bone cement, en bloc resection and reconstruction with fibular graft, ulnar translocation or endoprosthesis4. Surgical management should aim for complete resection of the tumor with reconstruction to better preserve forearm and hand function.
Case presentation: We present 2 cases, 19 yo female and 43 yo male, with giant cell tumor of the distal radius who were treated with wide resection, ulnar translocation and wrist arthrodesis. Both cases presented with swelling and pain of the wrist and on imaging, we noted of eccentric, expansile, osteolytic lesion at the epiphysis extending to metaphysis and diaphysis. Biopsy was done which confirmed the initial impression of giant cell tumor, distal radius. Radiographic and functional outcome were recorder preoperatively and monitored on follow up.
Result: Functional outcome with forearm range of motion were recorded until 1 year follow up and there was noted improvement with supination of 85 degree and pronation of 70 degree, comparable with contralateral forearm. Grip strength were also noted to improve post operatively. Bony union of the graft was noted at 3 months. Chest xrays were monitored to check for tumor metastasis. Musculoskeletal Tumor Society (MSTS) Scoring showed marked improvement at 1 year ff up.
Conclusion: Giant cell tumor of the distal radius treated with wide resection, ulnar translocation and wrist arthrodesis provides good functional outcomes with preservation of range of motion of hand and forearm. Ulnar translocation is a shorter duration procedure that utilizes a single incision and local availability of distal ulnar vascularized graft. With minimal dissection and preservation of the ulna soft tissue and muscle attachments resulted in maintaining good finger grip strength.
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