Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Belgium

IFSSH-PP 140: Treatment of giant cell tumours of the distal radius with an osteoarticular allograft. Report of two cases and review of the literature.

N Hollevoet, G Sys, W Vanhove

Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Belgium

Purpose

Reconstruction of the distal radius with a massive osteoarticular allograft is one of the treatment options for recurrent giant cell tumours of bone. Aim of the study was to evaluate the clinical and radiological outcome of two patients who had this treatment in our hospital and to compare their results with other cases published in the literature.

Methods

One woman of 39 and one of 25 years old had resection of the distal radius and reconstruction with an osteoarticular allograft. Range of motion of the wrist, grip strength, X-rays and MRI were available with a follow up of two years. Results published in papers with a follow-up of minimum two years were pooled.

Results

In both patients fusion was obtained between the allograft and the radius and there were no signs of recurrence of the tumour. In one patient ulnar translation of the carpus with destruction of the radiocarpal joint was present. The wrist was painful and swollen and the patient had to wear a brace. Range of motion of the wrist was 10° flexion, 20° extension, 70° pronation and 60° supination. Grip strength was 13 kg (other side 23 kg). In the other patient ulnar translation of the carpus anddegenerative signs of the distal radioulnar joint were seen. Wrist flexion measured 15°, extension25°, pronation40° and supination 70°. Grip strength was 16 kg (other side 26 kg).

A total of seventy-two cases were reported in the literature. Follow-up ranged between 2 and 28 years. Mean wrist extension ranged between 21° and 58°, mean flexion between 21° and 56°, mean pronation between 50° and 80° and mean supination between 58° and 85°. In 8 cases a total wrist joint fusion and inone a total joint replacement had to be done. Local recurrence of the tumour was reported in 6 cases, nonunion in 5, fracture of the allograft in 7 and problems with the distal radioulnar joint in 9. Radiocarpal instability in a volar direction occurred in 4 cases and ulnar translation of the carpus in 11.

Conclusion

An osteoarticular allograft can be used to reconstruct the distal radius. Advantages are that harvesting of the proximal fibula or a procedure with only one forearm bone can be avoided. Disadvantage is degeneration of the articularsurfaces with the allograft.