Abstract
Objectives
A defect following resection of Giant Cell Tumour of the distal radius (GCT-DR) is reconstructed by either vascularised free fibular transfer (VFF) or non-vascularised structural iliac crest transfer (NIC). The purpose of this study was to compare these procedures.
Methods
Twenty-seven patients at two centres were identified, 14 underwent VFF and 13 NIC. The two groups were comparable for age, sex, and tumour grade. Functional outcomes were assessed with TESS, MSTS, and DASH. In the VFF group, ankle joint morbidity was assessed with the Ankle Osteoarthritis Scale. In the NIC group, iliac crest morbidity was assessed with a short questionnaire.
Results
Two local recurrences occurred in the VFF group and one in the NIC group. Following the index surgery, three patients in the VFF group underwent surgery for cosmesis, hardware removal or tendon release, and one is scheduled for tendon release. In the NIC group two infections required debridement, one of which went on to free fibular transfer, but there were no re-operations for union or donor site morbidity. The surgical time was significantly shorter for NIC. Functional scores showed no differences between the groups on any of the parameters studied for the upper limb (Mann-Whitney test). The Anke OA scale and the iliac crest morbidity questionnaire revealed only a few mild problems with donor site morbidity in either group.
Conclusion
Both VFF and NIC are effective surgical techniques that result in a well-functioning wrist arthrodesis. VFF should be considered when there is a significant skin defect, as it allows the inclusion of a vascularised skin paddle, or when the osseous defect is too long for NIC. We were unable to demonstrate any difference in functional scores between VFF and NIC. As the re-operation rate is less for NIC and surgical time is shorter, we recommend NIC whenever possible.
