Giant cell tumour of distal end radius:various treatment protocol and results
Introduction: Giant cell tumor are benign aggressive type of tumor which account 20% of benign bone tumors and 6% of all bone tumors. GCT usually occurs at metaphysis of long bones and distal end radius is 3rd most common site after distal end of femur and proximal end tibia. Various treatment modalities are mentioned in literature from simple curettage to reconstruction or prosthetic replacement of distal radius.
Material and method: A prospective study of 26 patients of GCT of distal end of radius treated by various procedures in our institute and followed upto 24 months to evaluate complications and functional outcome based on The Musculo Skeletal Tumour Society Score.
Results: All patients had been followed strictly so no loss of follow up of a single patient. After 24 months of follow up functional score evaluated as 80% in patients treated as curettage with PMMA augmentation or iliac bone grafting, 73% in treated as resection with fibular autografting or ulnar translocation with osteosynthesis and 60% in those who are undergone as resection and centralization of ulna with osteosynthesis.
Conclusion: A careful clinical and radiological assessment of distal radius GCT and judicious treatment plan is the key for successful outcome in these lesions.
Bahalaik V., Anand S, Anderton JM. Giant cell tumour of the cuboid. A case report. Foot 2001;11:94-96.
Unni K, Inwards CY, Dahlin's bone tumours: general aspects and data on 10165 cases. 6th ed Philadelphia, P A: Lippincott Williams and Wilkins: 2010.
Fletcher CD, Unni K K, Mertens F. Pathology and genetics of tumour of soft tissue and bone. I.A.R.C. Press: Lyon;2002,World Health Organization classification of tumours; 309-12
Dorfmann HB, Czerniak B. Bone tumours - Giant cell lesion. Mosby Inc:559-606.
Briggs TWR, Cobb J, Mc Auliffe T, Pringle J, Kemp H. Giant cell tumours of bone. J Bone Joint Surg 1990;72(B):937.
Harness N G, Mankin HJ, Giant cell tumour of the distal forearm. The Journal of Hand Surgery 2004;29A:188-193.
Khan MT, Gray JM, Carter SR, Grimer RJ, Tillman RM, Management of the giant cell tumours of the distal radius. Ann R Coll Surg Eng.2004;86:18-24.
Blackley H R, Wunder JS, Davis Am, White LM, Kandel R, Bell RS. Treatment of giant cell tumour of long bones with curretage and bone grafting.J Bone Joint Surg Am.1999;81:811-20.
Cheng CY, Shih HN, Hus KY, Hus RW . Treatment of giant cell tumour of distal radius . Clin Ortho Relat Res. 2001; 388: 221-8.
Sheth DS, Healey JH, Sobel M, Lane JM , Marcore RC. Giant cell tumour of distal radius. J Hand Surg Am.1995;20:432-40.
Minami A , Kato H ,Iwasaki N, Vascularised fibular graft after exicision of gint cell tumour of distal radius : wrist arthoplasyr versus partial wrist arthodesis. Plastic and Reconstructive Surgery 2002; 100 (1):112-7.
Bickert B, Heitmann Ch, Germann G. Fibulo-scapholunate arthodesis as a motion-preserving procedure offer tumour resection of the distal radius. J Hand Surg Br. 2002; 27: 573-6.
Mukherjee K, Chatterjee S, Bala SR, Giant cell tumours of the lower end of the radius-a new treatment modality. J Indian Med Assoc. 1996; 94: 170-1.
Seradge H. Distal Ulnar Translocation in the treatment of gaint cell tumours of the distal end of the radius. J. Bone Joint Surg Am. 1982; 64: 67-73.
Bhan S, Biyani A. Ulnar translocation offer excision of gaint cell tumours of distal radius. J Hand Surg Br. 1990; 15: 496-500
Muramatsu K, Ihara K, Azuma E, Orui R, Goto Y , Shigetomi M et at, Free Vascularized fibula grafting for reconstruction of the wrist following wide tumour exicision, Microsurgery 2005; 25: 101-6.
Ono H,Yajima H,Mizumoto S, Miyauchi Y, MiiY Tamai S.Vascularised fibula graft for reconstruction of the wrist after exicision of gaint cell tumour.Plast Reconstr Surg.1997;99:1086-93.
R.A. Vander Griend and C.H. Funderburk, "The treatment of giant-cell tumours of the distal part of the radius" J. Bone Joint Surg Am. 1993; 75: 899-908.
R. Pollock, P. Stalley, K. Lee, and D. Pennington, "Free Vascularized fibula grafts in limb-salvage surgery. Journal of Reconstructive Microsurgery,2005; 21(2) :79-84.
J.A. Murray and B. Schlafly, "Giant-cell tumours in the distal end of the radius, Treatment by resection and fibular auto graft inter positional arthrodesis."J Bone Joint Surg Am 1968 ; 68(5) : 687-694.
R.W.W. Hsu, M.B. Wood, F.H. Sim ad E.Y.S. Chao, "Free Vascularised fibular grafting for reconstruction after tumour resection," J Bone Joint Surg Br,1997; 79(1) : 36-42.
M. Campanacci, N. Baldini, S. Boriani and A. Sudaness, "Giant Cell Tumour of Bone." J Bone Joint Surg Am,1987; 69(1) : 106-114.
D.J. McDonald, F.H. Sim, R.A. Mc Leod, and D.C. Dahlin " Giant C ur of Bone" J Bone Joint Surg Am 1986; 68(2) :235-242.
R.R. Goldenberg, C. J. Campbell, and M. Bonfiglio, Giant Cell tumours of bone. An analysis of two hundred and eighteen cases." J Bone Joint Surg Am1970;52(4) : 619-664.
Enneking WF, Dunham W, Gebhardt MC, Malawai M, Pritchard DJ: A System for the functional evaluation of reconstructive procedures after surgical treatment of tumours of the musuloskeletal system. Clin Orthop Relat Res. 1993; 286: 241-6.
Szendroi M: Giant Cell Tumour of bone J Bone Joint Surg. Br. 2004; 86(1): 5-12.
Innocenti M, Delcroix L. Manfrini M, Ceruso M, Capanna R. Vascularized proximal fibular epiphyseal transfer for distal radial reconstruction. J Bone Joint Surg Am. 2004; 86-A; 1504- 11.
Lackmann RD, McDonald DJ, Beckenbaugh RD, Sim FH. Fibular reconstruction for giant cell tumour of the distal radius. Clin Orthop Relaf Res. 1987; 218: 2328.
Salenius P. Santavirla S, Kiviluoto O , Kaskinen EV; Application of free authogenous fibular graft in the treatment of aggressive bone tumours of the distal end of the radius. Arch Orthop Trauna Surg. 1981; 98 (4): 285-7.
Chadha M, Arora SS, Singh AP, Gulati D, Singh AP: Autogenous non-vascularized fibula for treatment of giant all tumour of distal end radius. Arch Orthop Trauma Surg. 2010; 130 (12) : 1467-73.
Aithal VK Bhaskaranand K Reconstruction of distal radius by fibula following exicision ofgint cell tumour, Int Orthop 2003;27:110-3.
Maruthainar N, Zambakidis C, Haiper G. Calder D, Cannon SR, Briggs TW. Functional outcome following exicision of tumours of the distal radius by reconstruction by autogenous non- vasculorised osteo articular fibula grafting. J Hand Surg. Br. 2002, 27 (2): 171-4.
Asavamongkolkul A, Walkakul S, Phimolsarniti R, Kiatisevi P:. Functinal outcome following exicision of a tumours and reconstruction of the distal radius. Int Orthop 2009; 33(1): 203-9.
Bassiony AA: Giant cell tumour of the distal radius: wide resection and reconstruction by non-vasularised proximal fibular auto graft. Ann Acad Med Singapore 2009; 38(10): 900-4.
Campanacci M. Giant cell tumour and Chandrosarcomas: grading, treatment and results (Studies of 209 and 131 cases) Recent Results Cancer Res 1976; 54; 257-61.
Lalla RN, Bhupathi SC, Treatment of giant cell tumours of the distal radius by ulnar translocation. A case report and review of the literature. Orthopedics. 1987; 10(5) : 735-739.
Turcotte RE, Wunder JS, Isler MH et al. Giant cell tumour of long bone: a Canadian Sarcoma Group Study. Clin Orthop Relat Res. 2002; (397): 248-258.
Puri A, Gulia A, Agarwal MG. Reddy K: Ulnar Translocation offer exicision of Campannacci grade 3 giant-cell tumour of the distal redius; an effective method of reconstruction .J Bone Joint Surg. Br. 2010; 92(6): 875-9.
Kocher MS, Gebhardt MC , Mankin HJ .Reconstruction of distal aspect with use of an osteoarticular allograft after exicion of a skeletal tractiontumour. J Bone Joint Surg Am. 1998;80:40719.
Szabo RM, Anderson KA, Chen JL: Functional outcome of en bloc exicision and osteoarticular allograft replacement with the Sauve-Kapandji procedures for campanacci grade 3 giant cell tumour of the distal radius. J Hand Surg. Am. 2006; 31 (8); 1340-8.
Bianchi G, Donati D, Staals EL. Mercure M; Osteoarticular allograft reconstruction of the distal radius offer bone tumours resection. J Hand Surg. Br. 2005 ; 30(4); 369-73.