Giant cell tumour of the distal ulna: is reconstruction required after excision of the distal third of the ulna?

Recurrent giant cell tumour of the distal ulna after en bloc resection with preoperative denosumab use

In recent years, denosumab has been used to treat giant cell tumour of bone (GCTB) not only in cases where surgery is complicated but also preoperatively to decrease the preoperative grade or to facilitate surgery for Campanacci grade II and III cases. However, there are no clear protocols regarding the preoperative use of denosumab before en bloc resection. There are a few reports of recurrent cases after en bloc resection; however, the association with the use of denosumab is unknown. We present the clinical, radiological and histopathological findings of a case of Campanacci grade III GCTB at the distal end of the ulna, which resulted in soft tissue recurrence after en bloc resection with the preoperative use of denosumab.

How to optimize the therapeutic effect of free autogenous fibula graft and wrist arthroplasty for giant cell tumors of distal radius?

Objective

The purpose of this study is to retrospectively analyze the clinical efficacy of free fibula autograft and wrist arthroplasty in the treatment of giant cell tumors (GCT) of distal radius.

Methods

We retrospectively reviewed 26 patients with GCT of distal radius who underwent free autogenous fibula graft and wrist arthroplasty for repairing residual defect after en-block resection. The length of the fibula graft was 8.2 cm (6–10 cm). Postoperative follow-up regularly for an mean of 66.9 months. Bone healing was assessed by radiographs, pain was assessed by Visual Analog Scale (VAS) score and limb function was evaluated by Musculoskeletal Tumor Society (MSTS) score and disabilites of the arm, shoulder and hand (DASH) score. The range of motion (ROM) of wrist and grip strength were also evaluated.

Result

There were four males and 22 females with an mean age of 36.7 years (19–60 years); the mean length of lesions was 4.8 cm (2.3–6.6 cm); 21 primary cases and five recurrent cases; eight cases of Campanacci Grade II, 18 cases of Grade III. We had no postoperative lung metastasis and only one case had a local recurrence, three cases (11%) with subluxation of lower ulnoradial joints and five cases (19%) showed narrowing of wrist joint space. The mean postoperative VAS pain score was 0.7 ± 0.7 and grip strength retained 71% of the normal hand, MSTS score was 27.7 ± 1.1 and DASH score was 9.0 ± 3.7. The ROM of the involved wrist only slightly restricted and no donor complications. Postoperative wrist joint function was significantly improved.

Conclusion

Strict surgical resection boundary and solid reconstruction of wrist joint capsule are the key to achieving excellent oncological prognosis and function of distal radius GCT.

Extensor Carpi Ulnaris Tenodesis Versus No Stabilization After Wide Resection of Distal Ulna Giant Cell Tumors

BACKGROUND

The necessity of stabilizing the residual ulnar stump after distal ulna tumor resection remains controversial. The authors retrospectively compared the outcome of patients who underwent wide resection of distal ulna giant cell tumors (GCTs) and reconstruction with tenodesis of the extensor carpi ulnaris (ECU) or without reconstruction.

METHODS

Between 2007 and 2015, 9 patients (6 females, 3 males; mean age, 36.8 years; range, 24-65 years) who underwent distal ulna resection for GCT of bone were retrospectively reviewed. The mean resection length was 8.1 cm. Five patients had no reconstruction, whereas 4 patients had stabilization of the ulnar stump using ECU tenodesis. With a mean follow-up of 3.6 years (2-9 years), the functional outcome using the quick Disability of Arm, Shoulder and Hand (DASH) score; Musculoskeletal Tumor Society score and grip strength; as well as the oncological outcome were evaluated.

RESULTS

Musculoskeletal Tumor Society functional scores were more than 24 in 7 patients and 20 to 24 in 2 patients (mean, 27.6 or 92%). Quick DASH scores ranged from 0 to 27.3 (mean, 11.1). In both groups, similar scores were observed ( P > .5). No patient had instability or pain related to the stump. There was no ulnar translation or subluxation of the radiocarpal joint. Grip strength in the operated hand, controlled for handedness, was 11% less than in the contralateral hand, although there was no difference between groups ( P > .4). All patients were disease-free at the latest follow-up.

CONCLUSIONS

The distal ulna may be widely resected with or without stabilization of the residual ulnar stump, yielding satisfactory local disease control and functional outcome.

Surgical treatment outcome of giant cell tumor of distal ulna: En bloc resection vs. curettage and bone graft

Background: Giant cell tumor (GCT) of the bone is a benign neoplasm with local aggressive behavior. Distal ulna is a very rare place for GCT. Published studies have mainly focused on case reports, and thus there is no consistent treatment strategy for this tumor at this location. This retrospective study was conducted to evaluate the oncological and functional results of 2 different surgical treatment methods for GCT in distal ulna.

Methods: In this study, 9 patients with GCT of distal ulna were followed after surgical treatment of GCT of distal ulna. Of the patients, 2 had local recurrence after surgery in other hospitals and 7 had primarily been admitted to our hospital. Four patients, all with grade 2 Enneking and Campanacci’s classification, were treated by extended curettage and bone grafting, while 5 patients with grade 3 were managed by distal ulnar resection. Minimum follow-up time was 24 months.

Results: Patients with grade 3 GCT of distal ulna, who had extended curettage, had a local recurrence up to one year after surgery. Local recurrence was never seen in those with grade 3 disease with resection or in those with grade 2 disease with extended curettage as the treatment of GCT in this location.

Conclusion: Based on our study, which is the largest cohort of GCT of distal ulna, extended curettage, and en bloc resection can be suggested as valuable methods of treatment for grades 2 and 3 tumors, respectively.