Artikel
Radioscapholunate Fusion following Resection of Giant Cell Tumours of the Distal Radius
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Autoren
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Mark Puhaindran
- Department of Hand and Reconstructive Microsurgery, National Univeristy Hospital, Singapore, Singapore, Singapore
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Yuin Cheng Chin
- Department of Hand and Reconstructive Microsurgery, National Univeristy Hospital, Singapore, Singapore, Singapore
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Sophia Strike
- Johns Hopkins University School of Medicine, Baltimore, United States
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David Tan
- Department of Hand and Reconstructive Microsurgery, National Univeristy Hospital, Singapore, Singapore, Singapore
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: The objective of this study was to review the oncologic and functional outcomes of patients who underwent en bloc resection of distal radius giant cell tumours followed by radioscapholunate fusion with either a vascularised or non-vascularised bone graft.
Methods: A retrospective review of patients with tumours of the hand and upper extremity that were treated at our institution from 2010 to 2018 was conducted. Patients with giant cell tumours of the distal radius that had undergone en bloc resection of the distal radius, and had reconstruction with either vascularised fibular graft or non-vascularised iliac crest bone graft and radioscapholunate fusion were selected for this study. The oncologic outcomes that were assessed were the presence of local and distant recurrence. Functional outcomes were assessed after patient's function had stabilised (more than one year after surgery) using the Musculoskeletal Tumor Society (MSTS) rating score of limb salvage and Short Form (SF)-36 scores.
Results and Conclusions: 5 patients were identified (1 male, 4 female). 3 presented with primary tumours, while 2 presented with recurrent tumours. Median age at the time of presentation to our centre was 35 years (range, 23 to 47 years). The 3 patients with primary disease had Campanacci Grade 3 disease. None had distant metastases at the time of surgery.
After a median follow up of 4 years (range, 4 months to 5 years), none of the patients had developed local or distant recurrence. One patient developed a peri-implant fracture requiring repeat fixation, while another developed complex regional pain syndrome that resolved with medication and aggressive hand occupational therapy. MSTS and SF-36 scores were available for the 3 patients that were more than 1 year post-op - The mean MSTS score was found to be excellent at 91.3% (range 86.7% to 96.7%) and the mean SF-36 score was 70.3% (range 59.5% to 78.5%). Assessment of range of motion of the affected wrist at mid-carpal joint revealed an average of 34.3 degrees (range 0° to 60°) of palmar flexion, 41.7° (range 40° to 45°) of dorsiflexion, 81.7° (range 65° to 90°) of supination and 78.3° (range 60° to 90°) of pronation.
En bloc resection and radioscapholunate fusion is a viable treatment option for patients with large and / or recurrent giant cell tumours of the distal radius.
