Functional Outcomes of Centralization of the Ulna as a Method of Reconstruction Following Resection of Campanacci Grade 3 Giant Cell Tumor of the Distal Radius

J Hand Surg Am. 2024 Jan;49(1):63.e1-63.e9. doi: 10.1016/j.jhsa.2022.05.011. Epub 2022 Jul 14.

Abstract

Purpose: Wrist reconstruction after distal radial tumor resection poses a challenge to the orthopedic oncologist. We evaluated the functional outcomes of centralization of the ulna with ulnocarpal arthrodesis as a method of reconstruction following resection of distal radius tumors, using impairment measures and patient-reported outcomes.

Methods: Evaluation of functional outcome was performed using the Musculoskeletal Tumor Society 93 scoring system and Disabilities of the Arm, Shoulder, and Hand questionnaire. We also determined hand grip strength on the affected side, time to radiologic union at the ulnocarpal junction and reduction in wrist circumference. Local complications and oncologic outcomes were recorded.

Results: The study included 26 patients with Campanacci grade 3 giant cell tumor of the distal radius. Mean follow-up period in the study was 32.8 ± 12 months. Mean resection length was 10.3 ± 2.5 cm. Radiologic union at the ulnocarpal junction was achieved in 38.5%, 77% and 96% of the patients by 4, 5, and 6 months respectively. Mean hand grip strength was 74 ± 3.9% of the contralateral side whereas mean reduction in wrist circumference was 16.9 ± 6.4%. A good functional outcome with a mean the Musculoskeletal Tumor Society 93 score of 26 ± 1.4 and mean Disabilities of the Arm, Shoulder, and Hand score of 10.5 ± 6.3 was observed. Fracture of the ulna, hardware loosening, and reflex sympathetic dystrophy were each noted in 1 patient, with an overall complication rate of 10.7% (3/28). No patient had nonunion, infection, or local recurrence.

Conclusions: This is a simple and effective modality of reconstruction after resection of distal radial tumors. It provides good functional outcome and preservation of good hand grip strength, with low complication rates.

Type of study/level of evidence: Therapeutic IV.

Keywords: Centralization of ulna; distal radius tumors; wrist reconstruction.

MeSH terms

  • Bone Neoplasms* / diagnostic imaging
  • Bone Neoplasms* / pathology
  • Bone Neoplasms* / surgery
  • Giant Cell Tumor of Bone* / diagnostic imaging
  • Giant Cell Tumor of Bone* / surgery
  • Hand Strength
  • Humans
  • Radius / pathology
  • Radius / surgery
  • Range of Motion, Articular
  • Retrospective Studies
  • Treatment Outcome
  • Ulna
  • Wrist Joint / diagnostic imaging
  • Wrist Joint / pathology
  • Wrist Joint / surgery