Modified Ulnar Translocation Technique for the Reconstruction of Giant Cell Tumor of the Distal Radius

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Abstract

abstract

Surgical excision of juxtaarticular giant cell tumor of the distal radius and reconstruction of the remaining defect is a demanding and challenging procedure. We report a modification of the standard ulnar translocation technique for the treatment of Cam-panacci grade III giant cell tumor of the distal radius in a 66-year-old woman. After wide excision of tumor, the main applied alterations of the initial described method were constituted from: a) complete removal of lunate that allowed accurate estimation of the length of intercalary graft, b) fusion of the sliding ulnar graft with the capitate in a ball-and-socket fashion that provided increased adjustability of bone contact surfaces, c) total wrist arthrodesis via a dorsal plate from the radius to third metacarpal that offered immediate inherent stability, and d) introduction of massive iliac bone graft for enhancement of bone healing at both sides of the sliding ulnar fragment and reinforcement of the one-bone configuration of distal forearm. The above principles led to solid fusion, no mass recurrence and uneventful functional outcome 13 years postoperatively. Furthermore, they eliminated the potential of proximal radioulnar site nonunion that was reported in 5 out of 10 published cases in the literature. Ultimately, the modified ulnar translocation technique for the treatment of giant cell tumor of the distal radius may offer better results regarding the parameters of stability and bone union. Particularly, in cases with distal tumor expansion and destruction of the radio-carpal joint or lunate it could restore more precisely the overall wrist height, position, and alignment.

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