Phalangeal transfer for recurrent giant-cell tumor of the phalanx of a finger in a nine-year-old child. A case report with forty-one-year follow-up

Reconstruction with fibular autograft and silicone implant arthroplasty after resection of giant-cell tumour of the proximal phalanx: a case report with 18-month follow-up

Primary giant-cell tumour of phalanx is a rare entity. Only few cases are described in the literature. Giant-cell tumour of hand is reported to have high local recurrence rate. Curettage and bone grafting have been performed by few authors with limited success. Most of the cases have been treated with ray amputation. We report this case as the first reported case in the literature that has been treated with fibular autograft and silicone implant arthroplasty for giant-cell tumour of the proximal phalanx.

Giant cell tumour of bone: reconstruction of the index metacarpophalangeal joint with an osteochondral graft from the lateral femoral condyle

We describe the successful reconstruction of the index finger metacarpophalangeal joint with an osteochondral autograft from the lateral femoral condyle following failed curettage and cementation of a giant cell tumour of the proximal phalanx base. At the 2-year follow-up, a good functional outcome was noted with 0-80° range of motion of the metacarpophalangeal joint and no clinical or radiographic evidence of tumour recurrence.

[Giant cell tumor of the thumb proximal phalanx: resection-iliac graft and double arthrodesis]

Giant cell tumours (GCT) of bone are frequent, with variable behaviour, high risk of recurrence and an often benign histological appearance. Their location in the hand is uncommon, and there are few publications on the subject. Surgical treatment as described in the literature is very variable. We report a case of recurrent grade II GCT, arising in the proximal phalanx of the thumb, aggressive and causing a pathological fracture. After a surgical biopsy, we performed an "en bloc" resection of the first phalanx, with an iliac crest graft reconstruction and a double arthrodesis of the metacarpophalangeal and interphalangeal joint. No recurrence or lung metastasis was seen at 18 months follow-up.

Primary giant cell tumours of the digital bones of the hand

Primary giant cell tumours involving digital bones of the hand are rare lesions which are generally diagnosed at an advanced stage. Accurate diagnosis requires clinical evaluation, imaging studies and histopathological assessment. Conservative treatment by digit-sparing surgery is associated with high recurrence rates. In a ten year retrospective review, this study identified only four cases. Three cases involved a phalanx and were treated by distal amputation of the involved digit. None recurred. One involved the metacarpal and recurred twice following repeated curettage and bone grafting. No further recurrence has been detected after resection and replacement with a non-vascularised fibular graft and Silastic implant replacement of the metacarpophalangeal joint. Our small series of cases supports a policy of aggressive primary surgery, including amputation or en bloc resection and reconstruction.

Reconstruction d'une phalange totale par greffe chondrale libre non vascularisée après échec de sclérothérapie d'un kyste anévrysmal

We treated an eleven year-old boy for an aneurysmal bone cyst of the middle phalanx of the long finger. Diagnosis was established after total curettage. The tumor involved the whole phalanx and grew steadily after two attempts at sclerotherapy (with absolute alcohol and Ethibloc). After two years, en-bloc resection had to be performed, and raised the problem of reconstructing a complete finger phalanx with its proximal and distal epiphyses. A free cartilaginous graft from the non-ossified iliac crest was shaped to the exact dimensions of the phalanx and set in its place, with minimal damage to the surrounding tissues during dissection and fixation. By six months an almost normal range of motion was achieved in the PIP (10 to 90 degrees ) and DIP (5 to 30 degrees) joints and radiographs showed complete metaplasia of the chondral graft into an ossified phalanx at 20 months follow-up. The joint spaces also remodelled, and this was confirmed with MRI scanning. Reports on partial replacement of diaphysis or epiphyses in the digits are discussed, but the only valid comparison of total phalanx replacement is free toe phalanx grafting. We did not choose this solution in a normal hand because of the length discrepancy between finger and toe phalanges. This case shows that, in this particular paediatric situation, the free non-vascularised transfer of a chondral graft restored excellent function, with remodelling of the phalanx and joint spaces of the finger.

Aneurysmal bone cyst and giant cell tumor of bone of the hand and distal radius

Aneurysmal bone cyst and giant cell tumor of bone have historically been considered benign lesions that can behave in locally aggressive fashion. The clinical and pathologic findings share some common characteristics. When considering a radiographic differential diagnosis, these entities are usually considered together. There are some very distinct differences in potential aggressiveness and in response to treatment. This report summarizes current knowledge regarding these lesions when they occur in the hand and outlines current treatment methods.

Allograft replacement in giant cell tumour of the hand

Allografts were used to replace excised bone segments affected by giant cell tumour of the hand in three patients. The tumour involved the second, third and fourth metacarpals and the capitate in one case; the first metacarpal and the trapezium in one, and the proximal phalanx of the index in one. All had histological confirmation of diagnosis. One patient had recurrence one year after marginal resection of his third metacarpal and required resection of the two adjacent metacarpals and the capitate. He had no recurrence two years after the secondary treatment. The other two had no recurrence at two and three years after their primary procedures. Their affected hands were functioning well.

Structural and functional reconstruction after resection of aneurysmal bone cyst of the fifth metatarsal: a case study

We report a case of a primary benign bone tumor (aneurysmal bone cyst [ABC]) involving the distal portion of the fifth metatarsal, identified in an adolescent. The tumor, histologically identified as an ABC with reparative giant cell reaction, became symptomatic. Treatment included resection, followed by reconstruction of the fifth metatarsal using grafts of autologous bone with preservation of function in the metatarsophalangeal joint. The basis for selecting this form of treatment is discussed, as well as the natural history of ABC and giant cell reparative granuloma. Restoration of form and function is illustrated by this case study with a 23-month follow-up.

Recurrent metacarpal giant cell tumour treated by en bloc resection and metatarsal transfer

Recurrent giant-cell tumours of bone have a higher risk of malignancy than primary giant-cell tumours of bone, and giant-cell tumours of bone in the hand are more likely to recur than those that arise elsewhere. Therefore, en bloc resection and reconstruction, or amputation, have been the accepted treatments for recurrent giant-cell tumours of bone in the hand. We describe two cases of successful transplantation of a metatarsal to a metacarpal, which was the site of a recurrent giant-cell tumour. The patients had satisfactory results 3 years later without problems in the foot. En bloc resection of the tumour and reconstruction with an autograft should be considered in the treatment of recurrent giant cell tumour of the hand.

Nonunion rates of limited carpal arthrodesis: a meta-analysis of the literature

Numerous types of limited intercarpal arthrodeses have been reported in dozens of articles in the English-language medical literature. The nonunion rate varies considerably within and between the different types of arthrodeses. This may be due in part to the small number of cases in most studies. The data on the number of good results and nonunion rates for 27 different types of limited carpal arthrodeses reported in the English-language medical literature from 1946 to 1993 were collected, and for each study, the 95% confidence intervals (95% CI) were calculated. The studies were then combined for specific types of arthrodeses and the overall nonunion rates and confidence intervals were calculated to more accurately determine the actual nonunion rate expected for limited intercarpal arthrodeses. Nonunion rates (95% CI) for the most popular types of limited arthrodeses were as follows: of 385 scaphotrapezium-trapezoid arthrodeses reported, there was a 14% nonunion rate (95% CI, 11%-18%); of 104 lunotriquetral arthrodeses, the nonunion rate was 27% (95% CI, 19%-36%); and of 17 scapholunate arthrodeses, the nonunion rate was 47% (95% CI, 26%-69%).