Skip to main content
Log in

Functional outcome of en bloc resection and osteoarticular allograft reconstruction with locking compression plate for giant cell tumor of the distal radius

  • Original Article
  • Published:
Journal of Orthopaedic Science

Abstract

Background

Giant cell tumors of the distal radius at Campanacci grade III are particularly challenging to treat. We have treated 15 cases of giant cell tumor of the distal radius by en bloc excision and osteoarticular allograft reconstruction with locking compression plate (LCP). The purpose of this study was to assess the intermediate outcomes of all patients treated with this surgery.

Methods

From July 2002 to January 2009, we followed up 15 patients with giant cell tumors of the distal radius who were treated with en bloc excision and osteoarticular allograft reconstruction with LCPs that were long enough to approach the distal end of the allograft. All of the cases were evaluated based on clinical and radiologic examinations, the passive range of motion of the wrist joint, complications, Mayo wrist score, and short form (SF)-36.

Results

The clinical follow-up time after reconstruction averaged 5.2 years. The mean resected length of the radius was 8.1 cm. One patient had tumor recurrence in the soft tissues after 3 years (recurrence rate 6.67 %). No patient had allograft bone fracture, nonunion, or metastases. Subchondral bone alterations and joint narrowing were present in all cases, with 1 patient suffering from the pain, but the pain could be endured without the need for analgesics. The average range of motion of the wrist was 46.7° of dorsiflexion, 33.3° of volar flexion, 61.3° of supination, and 72.3° of pronation. The mean Mayo wrist score was 70 and the mean modified SF-36 score was 71.

Conclusions

En bloc excision and osteoarticular allograft reconstruction with an appropriate LCP for a Campanacci grade III giant cell tumor of the distal radius result in a reasonable functional outcome at intermediate follow-up evaluation. This method can excise the tumor integrally with a low rate of recurrence, good function, and a satisfactory range of motion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Szendröi M. Giant-cell tumour of bone. J Bone Jt Surg. 2004;86B:5–12.

    Google Scholar 

  2. Bertoni F, Present D, Sudanese A, Baldini N, Bacchini P, Campanacci M. Giant-cell tumor of bone with pulmonary metastases: six case reports and a review of the literature. Clin Orthop Relat Res. 1988;237:275–85.

    PubMed  Google Scholar 

  3. Sheth DS, Healey JH, Sobel M, Lane JM, Marcove RC. Giant cell tumor of the distal radius. J Hand Surg. 1995;20A:432–40.

    Google Scholar 

  4. Campanacci M, Giunti A, Olmi R. Giant cell tumors of bone: a study of 209 cases with long term follow-up in 130. Ital J Orthop Traumatol. 1975;1:249–77.

    Google Scholar 

  5. Blackley HR, Wunder JS, Davis AM, White LM, Kandel R, Bell RS. Treatment of giant-cell tumors of long bones with curettage and bone-grafting. J Bone Jt Surg. 1999;81A:811–20.

    Google Scholar 

  6. Prosser GH, Baloch KG, Tillman RM, Carter SR, Grimer RJ. Does curettage without adjuvant therapy provide low recurrence rates in giant-cell tumors of bone? Clin Orthop Relat Res. 2005;435:211–8.

    Article  PubMed  Google Scholar 

  7. Gold AM. Use of a prosthesis for the distal portion of the radius following resection of a recurrent giant-cell tumor. J Bone Jt Surg. 1965;47A:216–8.

    Google Scholar 

  8. Campanacci M, Laus M, Boriani S. Resection of the distal end of the radium. Ital J Orthop Traumatol. 1979;5:145–52.

    PubMed  CAS  Google Scholar 

  9. Aithal VK, Bhaskaranand K. Reconstruction of the distal radius by fibula following excision of giant cell tumor. Int Orthop. 2003;27:110–3.

    PubMed  CAS  Google Scholar 

  10. Muramatsu K, Ihara K, Azuma E, Orui R, Goto Y, Shigetomi M, Doi K. Free vascularized fibula grafting for reconstruction of the wrist following wide tumor excision. Microsurgery. 2005;25:101–6.

    Article  PubMed  Google Scholar 

  11. Seradge H. Distal ulnar translocation in the treatment of giant-cell tumors of the distal end of the radius. J Bone Jt Surg. 1982;64A:67–73.

    Google Scholar 

  12. Szabo RM, Anderson KA, Chen JL. Functional outcome of en bloc resection and osteoarticular allograft replacement with the Sauve–Kapandji procedure for Campanacci grade 3 giant-cell tumor of the distal radius. J Hand Surg. 2006;31B:1340–8.

    Google Scholar 

  13. Kocher MS, Gebhardt MC, Mankin HJ. Reconstruction of the distal aspect of the radius with use of an osteoarticular allograft after excision of a skeletal tumor. J Bone Jt Surg. 1998;80A:407–19.

    Google Scholar 

  14. Bianchi G, Donati D, Staals EL, Mercuri M. Osteoarticular allograft reconstruction of the distal radius after bone tumour resection. J Hand Surg. 2005;30B:369–73.

    Google Scholar 

  15. Khodamorad J, Hamid M. Osteoarticular allograft reconstruction of the distal radius after giant cell tumor resection. MJIRI. 2008;22:1–7.

    Google Scholar 

  16. Gautier E, Sommer C. Guidelines for the clinical application of the LCP. Injury. 2003;34(suppl 2):B63–76.

    Article  PubMed  Google Scholar 

  17. Sommer C, Gautier E, Müller M, Helfet DL, Wagner M. First clinical results of the locking compression plate (LCP). Injury. 2003;34(suppl 2):B43–54.

    Article  PubMed  Google Scholar 

  18. Wagner M. General principles for the clinical use of the LCP. Injury. 2003;34(suppl 2):B31–42.

    Article  PubMed  Google Scholar 

  19. Virkus WW, Miller BJ, Chye PC, Gitelis S. The use of locking plates in orthopedic oncology reconstructions. Orthopedics. 2008;31:438.

    Article  PubMed  Google Scholar 

  20. Buecker PJ, Berenstein M, Gebhardt MC, Hornicek FJ, Mankin HJ. Locking versus standard plates for allograft fixation after tumor resection in children and adolescents. J Pediatr Orthop. 2006;26:680–5.

    Article  PubMed  Google Scholar 

  21. Rastogi S, Kumar A, Khan SA. Do locking plates have a role in orthopaedic oncological reconstruction. Arch Orthop Trauma Surg. 2010;130:1493–7.

    Article  PubMed  Google Scholar 

  22. Cooney WP, Bussey R, Dobyns JH, Linscheid RL. Difficult wrist fractures. Perilunate fracture-dislocations of the wrist. Clin Orthop. 1987;214:136–47.

    PubMed  Google Scholar 

  23. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–83.

    Article  PubMed  Google Scholar 

  24. Oda Y, Miura H, Tsuneyoshi M, Iwamoto Y. Giant cell tumor of bone: oncological and functional results of long-term follow-up. Jpn J Clin Oncol. 1998;28:323–8.

    Article  PubMed  CAS  Google Scholar 

  25. Cheng CY, Shih HN, Hsu KY, Hsu RW. Treatment of giant cell tumor of the distal radius. Clin Orthop Relat Res. 2001;383:221–8.

    Article  PubMed  Google Scholar 

  26. Murray JA, Schlafly B. Giant-cell tumors in the distal end of the radius: treatment by resection and fibular autograft interpositional arthrodesis. J Bone Jt Surg. 1986;68A:687–94.

    Google Scholar 

  27. Ferracini R, Gino G, Battiston B, Linari A, Franz R, Bertolo S. Assessment of vascularized fibular graft 1 year after reconstruction of the wrist after resection of a giant-cell tumour. J Hand Surg. 1999;24B:497–500.

    Google Scholar 

  28. Harness NG, Mankin HJ. Giant-cell tumor of the distal forearm. J Hand Surg. 2004;29A:188–93.

    Google Scholar 

  29. Leung PC, Chan KT. Giant cell tumor of the distal end of the radius treated by the resection and free vascularized iliac crest graft. Clin Orthop Relat Res. 1986;202:232–6.

    PubMed  Google Scholar 

  30. Egol KA, Kubiak EN, Fulkerson E, Kummer FJ, Koval KJ. Biomechanics of locked plates and screws. J Orthop Trauma. 2004;18:488–93.

    Article  PubMed  Google Scholar 

  31. Stoffel K, Dieter U, Stachowiak G, Gachter A, Kuster MS. Biomechanical testing of the LCP—how can stability in locked internal fixators be controlled? Injury. 2003;34(suppl 2):B11–9.

    Article  PubMed  Google Scholar 

  32. Enneking WF, Mindell ER. Observations on massive retrieved human allografts. J Bone Jt Surg. 1991;73B:1123–42.

    Google Scholar 

  33. Tomford WW, Doppelt SH, Mankin HJ. Bone banking procedures. Clin Orthop. 1983;174:15–21.

    PubMed  Google Scholar 

  34. Vander Griend RA. The effect of internal fixation on the healing of large allografts. J Bone Jt Surg. 1994;76A:657–63.

    Google Scholar 

  35. Muscolo DL, Ayerza MA, Aponte-Tinao LA, Ranalletta M. Partial epiphyseal preservation and intercalary allograft reconstruction in high-grade metaphyseal osteosarcoma of the knee. J Bone Jt Surg. 2004;86A:2686–93.

    Google Scholar 

  36. Gitelis S, Heligman D, Quill G, Piasecki P. The use of large allografts for tumor reconstruction and salvage of the failed total hip arthroplasty. Clin Orthop Relat Res. 1988;231:62–70.

    PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to acknowledge Drs. Chen Ren and Yan Xiong for performing follow-up examinations of 4 patients and collecting their data.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Chong-qi Tu.

About this article

Cite this article

Duan, H., Zhang, B., Yang, Hs. et al. Functional outcome of en bloc resection and osteoarticular allograft reconstruction with locking compression plate for giant cell tumor of the distal radius. J Orthop Sci 18, 599–604 (2013). https://doi.org/10.1007/s00776-013-0394-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00776-013-0394-1

Keywords

Navigation