Giant cell tumors of lower end of the radius : Problems and solutions

Background: Giant cell tumors of bone are aggressive, potentially malignant lesions. Juxtaarticular giant cell tumours of lower end radius are common and present a special problem of reconstruction after tumor excision. Out of the various reconstructive procedures described, use of nonvascularised fibular autograft has been widely used with satisfactory functional results. Methods: Sixteen patients with a mean age of 20.2 years, with either Campanacci grade II or III histologically proven giant cell tumours of lower end radius were treated with wide excision and reconstruction with ipsilateral nonvascularised proximal fibular autograft. Host graft junction was fixed with intramedullary nail in 12 cases and DCP in last 4 cases. Wrist ligament reconstruction and fixation of the head of fibula with carpal bones using K-wires and primary cancellous iliac crest grafting at graft host junction with DCP was done in last 2 cases. Results: The follow up ranges from 2 - 5 years (mean 3.5 years). At last follow up, the average combined range of motion was 110° with range varying from 60-125°. The average grip strength was 39% in comparison to the contralateral side (range 21-88%). The average union time was 8 months (range 4-12 months). Sound union occurred in 5 months, where DCPs were used. There were 5 nonunions, one resorption of graft, 10 wrist subluxations (2 painful), one recurrence, 3 superficial infections, one wound dehiscence and one amputation. There was no case of graft fracture, metastasis, death or significant donor site morbidity. A total of 10 secondary procedures were required. Conclusions: Enbloc resection of giant cell tumours of lower end radius is a widely accepted method. Reconstruction with nonvascularised fibular graft, internal fixation with DCP with primary corticocancellous bone grafting with transfixation of the fibular head and wrist ligament reconstruction minimizes the problem and gives satisfactory functional results.