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. 2021 Feb 2;19(1):37.
doi: 10.1186/s12957-021-02143-3.

The use of denosumab in the setting of acute pathological fracture through giant cell tumour of bone

Wolfram Weschenfelder  1   2 , John M Abrahams  3 , Luke J Johnson  3
Affiliations

The use of denosumab in the setting of acute pathological fracture through giant cell tumour of bone

Wolfram Weschenfelder et al. World J Surg Oncol. .

Abstract

Background: Denosumab (XgevaTM) is a fully human antibody to RANK-Ligand, an important signal mediator in the pathogenesis of giant cell tumour of bone (GCTB). The use of denosumab in the treatment of GCTB has changed the way in which these tumours are managed over the past years.

Case presentation: Described is the case of an acute fracture through a GCTB of the distal radius of a fit and well 32-year-old, non-smoking, female patient following a simple fall onto her outstretched, dominant hand. The aim was to enable joint sparing management for the patient, as opposed to an acute fusion procedure of the carpus. The patient underwent percutaneous k-wire fixation with application of plaster and immediate commencement with denosumab to halt the activity of the GCTB. Bone healing was rapid; plaster and k-wires were removed after 6 weeks. At 6 months denosumab, was ceased and an open curettage and grafting procedure of the tumour bed was undertaken (using MIIG X3, Wright Medical, aqueous calcium sulphate as graft material).

Conclusions: The use of denosumab in the acute setting of pathological fracture through giant cell tumour of bone allowing joint salvage has not been previously described. The treatment was well tolerated and functional outcomes are excellent, with very promising 4-year follow-up. This novel approach may allow for more joint sparing strategies in the future for other patients in this difficult situation. Further cases will need to be gathered to establish this technique as a suitable treatment pathway.

Keywords: Curettage and grafting; Denosumab; Distal radius fracture; Giant cell tumour of bone (GCTB).

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
ap and lateral plain radiographs and coronal CT of initial imaging of right wrist
Fig. 2
Fig. 2
ap and lateral plain radiographs of right wrist 6 weeks after fixation and start of denosumab
Fig. 3
Fig. 3
Histologic images. a Pre-denosumab—note the large amounts of giant cells on a background of stromal cells. b 6 months post-denosumab—no giant cells, bland fibrous infiltrate
Fig. 4
Fig. 4
ap and lateral plain radiographs of right wrist 4 years after treatment
See this image and copyright information in PMC

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