Abstract
Purpose: The purpose of this retrospective study was to assess the carcinological and functional results of resection-arthrodesis procedures for giant-cell tumours of the lower extreminty of the radius.
Material and methods: This series included 16 patients, nine men and seven women, mean ate 39 years (19–63). The initial symptom was pain in all patients. Nine of the 16 patients were referred for recurrence after primary curettage-filling: the seven others presented voluminous tumours encompasing nearly all of the epiphyseome-taphyseal region rendering curettage-filling impossible. En bloc resection of the tumour with reconstruction using two tibial splints applied proximally on the radius and distally on the first ray (eight cases) or the second ray (eight cases) of the carpus was performed in all cases. A plaster cast or external fixation protected the construct. All tumours were benign. Nine patients were reviewed for function (pain, motion, force) and radiographic assessment (lateral view of wrist in maximal flexion and extension). We collected data recorded at the last visit for the other patients.
Results: Mean follow-up was 70 months (12–205). The functional outcome was good with 15 patients totally pain free. For the eight patients whose mediocarpus could be preserved, dorsal flexion was 30° and palmar flexion was 15°. Pronosupination varied from 10° to 170°. Bone fusion was obtained in 15 patients. One developed nonunion which was revised with a bone graft and plate fixation and finally healed. Two graft fractures secondary to trauma consolidated normally after plate-screw fixation associated with a new graft. Three of the patients developed local recurrence in the form of subcutaneous nodules which were resected. One of these three patients had a bony recurrence at the graft-radius junction which was treated by a new bone resection and achieved cure.
Discussion: Resection-arthrodeis is indicated for recurrence after curettage-filling and for voluminous giant-cell tumours with extraosseous extension and failure of curetae-filling. Curettage is rarely possible in this location due to invasion of soft tissues and destruction of the joint surface which occurs early. It appears preferable to perform an arthrodesis between the radius and the first ray of the carpal bones to preserve partial motion of the wrist and good function.
The abstracts were prepared by Docteur Jean Barthas. Correspondence should be addressed to him at Secrétariat de la Société S.O.F.C.O.T., 56 rue Boissonade, 75014 Paris.
