gms | German Medical Science

Objectives: Is partial wrist fusion through centralization of the ulna into the scapholunate joint after resection ofaggressivetumors of the distal radius can achieve favorable long term results than other existing methods of wrist reconstruction.

Methods: Records of 7 women and 3 men aged 22 to 54 years who underwent wide resection and partial wrist fusion through centralization of the ulna into the scapho-lunate joint for two osteosarcoma patients( one primary and one secondary radiation induced osteosarcoma 15 years after treatment of giant cell tumor of distal radius), one chondrosarcoma of distal radius,and seven patients of Campanacci stage III giant-cell tumor (GCT) (n=6) and stage II (n=1 after collapse of the primary reconstruction with autogenous iliac bone graft) of the distal radius were reviewed. Functional outcome was evaluated using the modified Musculoskeletal Tumor Society scoring system. The principle of the reconstruction is after wide resection of the distal radius we aim at ulno-scapho-lunate partial wrist arthrodesis. Grip strength and range of motion of the remaining wrist, metacarpophalangeal joint were also assessed.

Results: The mean follow-up period was 40 (range, 30–84) months. At the end of follow up there was a single soft tissue GCT recurrence that developed 18 months after surgery that was successfully resected without further recurrence. There was no metastasis. The mean grip strength was 50% (range, 35–80%) of the contralateral side. All patients achieved normal range of motion of the metacarpophalangeal and interphalangeal joints, all patients had average of 20 degrees wrist flexion, 20 degrees wrist extension, 20 degrees wrist adduction and 15 degrees wrist abduction. The Wrist fusion through centralization of the ulna mean time to wrist fusion was 6 (range, 4–10) months, all patients received localbone grafting and internal fixation was done by two Kirshner wires aiming at centralization of the distal ulna to be aligned with third metacarpal bone.

Conclusion: Partial wrist fusion through centralization of the ulna for aggressive tumors of the distal radius is a viable option, its advantages include shorter operative time, easier surgery, limited internal fixation, easily removable hardware, short union time and retaining some wrist motion.