GIANT CELL TUMOR OF DISTAL RADIUS- EXCISION AND RECONSTRUCTION WITH NONVASCULARISED PROXIMAL FIBULAR AUTOGRAFT A CASE SERIES

Abstract

Giant cell tumor is a benign aggressive bone         tumor of obscure origin presenting in between second and fourth decade of life, accounts for 4-5percent of primary bone tumors and about 20 percent of benign bone tumors.              Worldwide significantly higher incidence rates are observed in

Asia, where it constitutes about 20percent of all primary bone tumors in China. It is slightly more common in females, has predilection for the epiphyseal metaphyseal region of long bones. After distal femur and proximal tibia, distal radius is the most common site of occurrence for GCT. This site has further distinction of having more aggressive behaviour of GCT with higher chances of recurrences and malignant   transformation. Treatment options for GCT at this site include intraleisonal curettage with bone grafting or cementing,            sandwich technique, adjuvant treatment with Bisphosphonate Irrigation therapy, en bloc excision and reconstruction with non vascular or vascularised fibular autograft, osteoarticular allograft, ulnar translocation,endo prosthesis, custom mega prosthesis. Although amputation would seem likely to be  curative, it is seldom warranted in a tumour that rarely             metastasizes.4 patients with mean age of 21years, with either Campanacci grade I, II or III histopathologically proven giant cell tumors of distal end radius were treated with wide             excision with 2-3cm margin clearance and transverse              osteotomy of proximal radius and reconstruction with                        ipsilateral nonvascularised proximal fibular autograft. Host graft junction was stabilised with Asian DCP in all cases. Wrist ligament reconstruction and fixation of the head of the fibula with carpal bones and distal ulna using K-wires and primary cancellous iliac crest grafting at graft host junction was done in all cases.The follow-up ranged from 14 to 20months. At last follow-up, the average combined range of motion was 100.5degrees with range varying from 60 to 125degrees. The average union time was 7.5months (range 4 to 12months). There was no case of graft fracture,                  metastasis, death or significant donor site morbidity.                Conclusion, Enbloc resection of giant cell tumor of the distal end radius is widely accepted method. Reconstruction with nonvascularised fibular graft, internal fixation with Asian DCP

with primary corticocancellous bone grafting with transfixation of fibular head minimises the problem and gives satisfactory            functional outcome.