GCT of Distal Radius Treatment and Reconstruction Options

Giant cell tumor of Distal Radius Sumroeng Neti, M.D. (1st class honors) Orthopedic Center Bumrungrad International Hospital

Epidemiology ,[object Object],[object Object],[object Object]

LocaIization ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Clinical presentation ,[object Object],[object Object],[object Object],[object Object]

Plain radiograph Tumor effect to bone - Purely lytic : geographic pattern - Eccentrically located in the epiphyses and abut the subchondral bone Bone response to tumor - Expansile - Margin : Distinct or poorly outlined : Classically nonsclerotic : Erosion through the cortex

Classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

MRI ,[object Object],[object Object]

Pathology ,[object Object],[object Object],[object Object]

Goal of Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Conventional Surgical Treatment GCT of bone Grade En Bloc excision & R econstruction Grade 3 Extended curettage C ement or Bone graft Grade 1 & 2

Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],Extended curettage = curettage + high-speed burr + adjuvant agents (phenol, liquid nitrogen , etc.)

Treatment ,[object Object],[object Object]

Filling materials ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bone graft Advantage - biologic healing - preserve bone stock Disadvantage - delayed rehabilitation - difficult tumor recurrence detection

Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Treatment ,[object Object],[object Object],[object Object],En Bloc resection  reduce the risk of recurrence

Treatment ,[object Object],[object Object],[object Object],Radiation A. Chakravarti MD et al JBJS 1999 : 20 patients underwent a single course of megavoltage radiation (40- 70 gray )  tumor had not progress 17/20 : no radiation-induced malignancy (Mean F/U 9.3 yrs)

Lung metastasis ,[object Object],[object Object],[object Object],[object Object]

F/U plan ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Dx : GCT of Distal Radius stage III : Aggressive Rx : En Bloc resection + osteochondral allograft with good result

Reconstruction of the distal radius with use of an osteoarticular allograft Mankin HJ et al – JBJS(A) 1998 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Reconstruction of the distal radius with use of an osteoarticular allograft Mankin HJ et al – JBJS(A) 1998 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Case # 2 35 year – old Thai male

Dx : GCT of Distal Radius stage III : Aggressive Rx : En Bloc resection + osteochondral allograft with allograft collapse

Case # 3 21 year – old female S/P wide resection + allograft arthrodesis

Dx : GCT of Distal Radius stage III : Aggressive 1 st Rx : En Bloc resection + osteochondral allograft with allograft fracture, nonunion 2 nd Rx : Free vascularized fibular bone graft

Vascularized fibular graft for reconstruction of the wrist after excision of GCT Ono H et al – Plast Reconstr Surg. 1997 ,[object Object],[object Object],[object Object],[object Object]

Case # 4 52 year – old female

Dx : GCT of Distal Radius stage III : Aggressive Rx : Extended curettage (+ phenol) & bone cement [ No recurrence within 2 years]

Treatment of GCT of bone : a comparison of curettage and wide resection Liu HS et al – Changgeng Yi Xue Za Zhi. 1998 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Treatment of GCT of bone : a comparison of curettage and wide resection Liu HS et al – Changgeng Yi Xue Za Zhi. 1998 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Currently recommended Surgical Treatment GCT of bone Grade En Bloc excision & R econstruction Grade 3 c marked destruction Extended curettage C ement or Bone graft - Grade 1, 2, 3 s marked destruction -

Reconstruction for Distal Radius

Reconstruction for Distal Radius ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Thank you for your attention

GCT of Distal Radius Treatment and Reconstruction Options

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GCT of Distal Radius Treatment and Reconstruction Options