Introduction

Giant cell tumour is a solitary benign locally aggressive lesion characterized by osteoclast like multinucleated giant cell mainly involving epiphysis. They are 4-5% of primary bone tumours and 20% of benign bone tumours [1]. Aggressiveness of this lesions is between purely benign and frankly malignant. It occurs in patients 20 to 40 years old. The most common location for this tumour is the distal femur followed closely by the proximal tibia and the distal radius [2].

Patient usually presents late with pain, local swelling and limited range of motion at wrist and associated pathological fracture locally, pulmonary metastases occur in approximately 3% of patients [2]. Treatment of Giant cell tumour in distal radius is difficult, mainly because of their close proximity to multiple tendons, nerve, radial artery and carpal bone. Radiographic findings often are diagnostic. The lesions are eccentrically located in the epiphyses of long bones and usually about the subchondral bone. Management of giant cell tumour of distal end

radius mentioned in literature are, curettage with polymethylmethacrylate cement, en bloc excision and reconstruction with fibular autografts, allografts or ulnar centralization however the aims of treatment are complete removal of the tumour while preserving maximum function of the limb [3,4].

Case Report

35year Normotensive Euglycemic male presented to us with complains of swelling and restricted range of motion at Right wrist since last 6 months for which curettage and cementing was done 4 month back somewhere else. Patient was asymptomatic for next 2 months’ post procedure but gradually swelling reappeared with restricted movement at wrist, since last one month patient complains of pain which increases on performing any day to day activity and relives with rest. Patient had no history of trauma, fever, weight loss or loss of appetite. On examination old healed scar present on dorso- lateral aspect of right wrist, a gross, firm and tender swelling of size 8 x 6 cm was seen on dorso- lateral aspect of distal radius with feeling of egg shell cracking, all wrist movement were restricted and painfulwith no Distal neurovascular involvement.

Figure 1: Clinical Picture

Figure 4: Postoperative X-ray

Discussion

GCT of the distal radius can be managed by excision of the tumour while preserving good function of the wrist and hand. It has been suggested that intra-lesion curettage may be preferred to reduce the incidence of local recurrence [6]. However O Donnell R. J. et al. reported high rate of recurrence [7]. Factors that needed to be considered when evaluating a technique of reconstruction includes the ease of the procedure, its morbidity, the complications and functional outcome and the durability of the reconstructed segment.

En bloc excision and reconstruction with fibular autograft, allograft or ulnar centralization is preferred choice of treatment for giant cell tumour of distal end radius. However, the disadvantage, of en bloc excision and reconstruction with fibular autograft or allograft includes donor site morbidity, delayed union or non-union [8]. Also, allografts may not be available in all orthopaedic setups and there is at least a theoretical risk of transmission of viral diseases [9].Centralization of ulna is relatively shorter surgical procedure and use of local vascular graft possibly help to reduce infection and improves the chances of union.

The complications cited with this procedure includes ankylosis of the wrist, damage to neural structures, vascular insufficiency of the hand, wound infection, necrosis of wound margins, fracture of the ulna, and hardware failure. However, we did not note any of these complications in our case over the period of 18 months. Local recurrence of tumours is not a reflection of the technique of reconstruction which has been used.