Bloc resection of a giant cell tumor of the distal ulna and stabilization the ulnar stump with palmaris longus autograft: A case report
DOI:
https://doi.org/10.1016/j.rccot.2022.05.008Keywords:
giant cell tumor, ulna, resection, stabilizationAbstract
Introduction: Giant cell tumor is a benign but locally invasive neoplasia; presentation at the distal end of the ulna is very rare. In Campanacci grade 3 lesions of the distal ulna, en bloc resection of the tumor is recommended, with or without reconstruction or stabilization of the ulnar stump.Case report: A 29-year-old woman with a Campanacci grade 3 giant cell tumor of the distal ulna; she was treated with en bloc resection of the tumor, including the extensor carpi ulnaris (ECU) due to being well adhered to the tumor; tendon defect was replaced with a palmaris longus (PL) autograft, to later stabilize the ulnar stump with the reconstructed tendon. Follow- up after 2 years 5 months showed no evidence of tumor recurrence with an excellent functional result and stable ulnar stump.
Discussion: Currently there is insufficient evidence to support the use of a stabilization technique or not, however, it is expected that the treatment carried out will be interesting and avoid possible stability problems of the ulnar stump in the face of wide resections that compromise the extensor carpi ulnaris (ECU).
Level of evidence: IV.
Downloads
References
Klenke FM, Wenger DE, Inwards CY, Rose PS, Sim FH. Giant cell tumor of bone: risk factors for recurrence. Clin Orthop Relat Res. 2011;469:591-9, https://doi.org/10.1007/s11999-010-1501-7
McGrath PJ. Giant-cell tumour of bone: an analysis of fifty-two cases. J Bone Joint Surg Br. 1972;54:216-29. https://doi.org/10.1302/0301-620X.54B2.216
Goldenberg RR, Campbell CJ, Bonfiglio M. Giant-cell tumor of bone An analysis of two hundred and eighteen cases. J Bone Joint Surg Am. 1970;52:619-64. https://doi.org/10.2106/00004623-197052040-00001
Dahlin DC. Caldwell Lecture. Giant cell tumor of bone: highlights of 407 cases. AJR Am J Roentgenol. 1985;144:955-60, https://doi.org/10.2214/ajr.144.5.955
Kayias EH, Drosos GI, Anagnostopoulou GA. Resection of the distal ulna for tumours and stabilisation of the stump. A case report and literature review. Acta Orthop Belg. 2006;72:484-91.
Campanacci M, Baldini N, Boriani S, Sudanese A. Giant-cell tumor of bone. J Bone Joint Surg Am. 1987;69:106-14. https://doi.org/10.2106/00004623-198769010-00018
Sobti A, Agrawal P, Agarwala S, Agarwal M. Giant Cell Tumor of Bone - An Overview. Arch Bone Jt Surg. 2016;4:2-9.
Palmer AK, Werner FW. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res. 1984:26-35. https://doi.org/10.1097/00003086-198407000-00005
Bieber EJ, Linscheid RL, Dobyns JH, Beckenbaugh RD. Failed distal ulna resections. J Hand Surg Am. 1988;13:193-200, https://doi.org/10.1016/S0363-5023(88)80047-9
Cooney WP, Damron TA, Sim FH, Linscheid RL. En bloc resection of tumors of the distal end of the ulna. J Bone Joint Surg Am. 1997;79:406-12, https://doi.org/10.2106/00004623-199703000-00014
Wolfe SW, Mih AD, Hotchkiss RN, Culp RW, Keifhaber TR, Nagle DJ. Wide excision of the distal ulna: a multicenter case study. J Hand Surg Am. 1998;23:222-8, https://doi.org/10.1016/S0363-5023(98)80117-2
Gainor BJ, Columbia MO. Lasso stabilization of the distal ulna after tumor resection: a report of two cases. J Hand Surg Am. 1995;20:324-6, https://doi.org/10.1016/S0363-5023(05)80034-6
Ferracini R, Masterson EL, Bell RS, Wunder JS. Distal ulnar tumours Results of management by en bloc resection in nine patients and review of the literature. J Hand Surg Br. 1998;23:517-21, https://doi.org/10.1016/S0266-7681(98)80136-8
Goldner JL, Hayes MG. Stabilization of the remaining ulna using one-half of the extensor carpi ulnaris tendon after resection of the distal ulna. Orthop Trans. 1979;3:330-1.
Gracia I, Proubasta IR, Trullols L, Peiró A, Moya E, Cortés S, et al. Distal radioulnar joint prosthesis for the treatment of giant cell tumor of the distal ulna: a case report and literature review. Strategies Trauma Limb Reconstr. 2011;6:103-6, https://doi.org/10.1007/s11751-011-0113-4