gms | German Medical Science

130. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

30.04. - 03.05.2013, München

A rare case of massive carpal osteoblastoma requiring complex reconstructive surgery

Meeting Abstract

  • Sebastian E. Dunda - Universitätsklinikum Aachen, Plastische Chirurgie, Hand- und Verbrennungschirurgie, Aachen
  • Jens Kauczok - Universitätsklinikum Aachen, Plastische Chirurgie, Hand- und Verbrennungschirurgie, Aachen
  • Erhan Demir - Universitätsklinikum Aachen, Plastische Chirurgie, Hand- und Verbrennungschirurgie, Aachen
  • Till Braunschweig - Universitätsklinikum Aachen, Plastische Chirurgie, Hand- und Verbrennungschirurgie, Aachen
  • Norbert Pallua - Universitätsklinikum Aachen, Plastische Chirurgie, Hand- und Verbrennungschirurgie, Aachen

Deutsche Gesellschaft für Chirurgie. 130. Kongress der Deutschen Gesellschaft für Chirurgie. München, 30.04.-03.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. Doc13dgch382

doi: 10.3205/13dgch382, urn:nbn:de:0183-13dgch3824

Veröffentlicht: 26. April 2013

© 2013 Dunda et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction: Osteoblastoma is a rare, commonly benign, osteoid producing neoplasm of the bone with an incidence of 2% of primary bone tumors. The male-to-female ratio is reported as 2:1 with usually about 80 percent of the patients being younger than 30 years. The common symptoms are local pain and discomfort. The average duration from symptoms onset until diagnosis varies from a few days to several years with an average of 17 months.

Material and methods: A 54 years old right-handed male presented himself in our department with the complaints of increasing swelling of his left wrist, accompanied with persistent pain even without exercise for more than 4 years without any trauma. CT-scan revealed suspicious subcutaneous tissue formations along of a massive carpal destruction, also affecting the radiocarpal and radioulnar joints. Therefore we decided to perform biopsies in different layers including the carpal bones.

Results: The histopathology resulted in the diagnosis of an osteoblastoma based on the hamatum bone. In agreement with the patient we decided to perform a complete eradication of this massive carpal tumor with subsequent reconstruction of both, bones and soft tissue, by transplanting an osteocutaneous iliac crest flap. Intraoperatively we decided to resect not only the carpal and, in parts, the metacarpal bones, but also the affected distal parts of the radius and ulna bone.

Conclusion: Six-months follow-up showed improvement of the hand function in terms of flexion, extension and strength without discomfort or further pain. However, full range of motion of the affected hand could not be realized in consequence of the necessary complex surgical intervention and in particular because of the destructive tumor growth with long time immobilization for almost 4 years. For this reason, additional diagnostic measures like CT- or MRI-scan should be performed in a reasonable short period of time in a patient with persistent, unexplainable carpal complaints. In addition, also invasive diagnostic steps with multi-layer biopsies might be necessary as shown in this case.