Distal Radius Allograft Reconstruction Utilizing a Step-Cut Technique After En Bloc Tumor Resection

Hand (N Y). 2019 Jul;14(4):530-533. doi: 10.1177/1558944717751193. Epub 2018 Feb 1.

Abstract

Background: En bloc resection of the distal radius is a common treatment for advanced and recurrent giant cell tumors and less commonly for sarcoma. Various reconstructive options exist, including ulnar transposition, osteoarticular autograft and allograft, and allograft arthrodesis. We present a technique of reconstruction using a distal radius bulk allograft with a step-cut to allow for precise restoration of proper length and to promote bony union. Methods: Preoperative templating is performed with affected and contralateral radiographs to assess the size of the expected bony defect, location of the step-cut, and the optimal size of the distal radius allograft required. A standard dorsal approach to the distal radius is utilized, and the tumor is resected. A proximal row carpectomy is performed, and the plate/allograft construct is applied to the remaining host bone. Iliac crest bone graft is harvested and introduced at the graft-bone interface and radiocarpal arthrodesis sites. Results: We have previously reported outstanding union rates with the step-cut technique compared with a standard transverse cut. Conclusions: The technique described provides reproducible union and stabilization of the wrist and forearm with adequate function following en bloc resection of the distal radius for tumor.

Keywords: allograft; distal radius; giant cell tumor; step-cut; wrist arthrodesis.

Publication types

  • Comparative Study

MeSH terms

  • Allografts / transplantation*
  • Arthrodesis / methods
  • Bone Plates / standards
  • Carpal Bones / diagnostic imaging
  • Carpal Bones / surgery
  • Forearm / diagnostic imaging
  • Forearm / physiology
  • Forearm / surgery
  • Giant Cell Tumor of Bone / surgery*
  • Humans
  • Ilium / transplantation
  • Margins of Excision
  • Plastic Surgery Procedures / methods*
  • Preoperative Period
  • Radiography / methods
  • Radius / pathology
  • Radius / surgery*
  • Range of Motion, Articular
  • Recurrence
  • Sarcoma / surgery*
  • Transplantation, Autologous / methods
  • Ulna / diagnostic imaging
  • Ulna / surgery
  • Wrist / diagnostic imaging
  • Wrist / physiology
  • Wrist / surgery