Abstract
Twenty-five patients underwent wide resection of the distal radial giant cell tumours (GCTs) followed by ulno-carpal arthrodesis. There were 15 male and ten female patients, with an average age of 21.5 years. Tumours included ten primary aggressive and 15 recurrent GCTs. Mean follow up was 2.4 years. Pain, swelling and reduced range of movement (ROM) were noted. Average time to fusion was 7.6 months. Five patients had persistent pain in the proximal forearm. Grip strength was 65% compared to the uninvolved side. Two patients had superficial wound infection, two underwent additional bone grafting and three implant removals due to hardware prominence were carried out. There was no evidence of carpal instability or arthritis on clinical or radiological examination at the time of final follow up. Fusion of the carpus to the ulna is a simple method of producing a painless stable wrist, though at the expense of mobility. The procedure allows wide resection with a lower rate of recurrence. Pain in the proximal forearm seems to persist for 3 to 4 months only to improve at subsequent follow up. The procedure provides a valid option for the management of primary aggressive and recurrent GCTs of distal radius.
Résumé
25 patients ont bénéficié d’une large résection pour tumeurs à cellules géantes agressives de l’extrémité distale du radius. A ce traitement a été associé une arthrodèse cubito carpienne. Il s’agissait de 15 sujets de sexe masculin et de 10 sujets de sexe féminin. 10 tumeurs étaient primitives et 15 étaient des récidives. L’âge moyen des patients était de 21.5 ans, le suivi moyen de 2.4 ans. Les douleurs et la mobilité du poignet ont été évaluées. Le temps moyen pour la fusion osseuse a été de 7.6 mois. 5 patients présentaient des douleurs résiduelles au niveau de l’extrémité distale de l’avant bras, la force de serrage était de 65% en comparaison au côté sain. Deux patients ont présenté une infection superficielle, deux ont nécessité une greffe secondaire et trois une ablation de matériel nécessaire du fait de la gêne qu’il entraînait. Le suivi n’a pas mis en évidence d’instabilité du carpe ou d’arthrose. Seuls 4 patients ont dû changer de travail. L’arthrodèse du cubitus au carpe est une technique simple, peu douloureuse et permettant d’obtenir un poignet stable. Cette technique permet de larges résections avec un taux faible de récidive de la tumeur. La douleur semble persister au niveau de l’avant bras pendant 3 ou 4 mois puis paraît s’améliorer par la suite. Cette technique nous semble tout à fait valable pour le traitement des tumeurs primitives à cellules géantes agressives ainsi que pour les récidives de tumeurs à cellules géantes de l’extrémité distale du radius.
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Bhagat, S., Bansal, M., Jandhyala, R. et al. Wide excision and ulno-carpal arthrodesis for primary aggressive and recurrent giant cell tumours. International Orthopaedics (SICO 32, 741–745 (2008). https://doi.org/10.1007/s00264-007-0416-8
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DOI: https://doi.org/10.1007/s00264-007-0416-8